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  5. BLUESKY DENTAL, LLC

BLUESKY DENTAL, LLC

Company Details

Name: BLUESKY DENTAL, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 21 Jan 2009 (16 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 252404
Place of Formation: IDAHO
File Number: 252404
ZIP code: 83843
County: Latah County
Principal Address: 2500 W. A STREET SUITE 204 MOSCOW, ID 83843
Mailing Address: STE 204 2500 W A ST MOSCOW, ID 83843-6000

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLUESKY DENTAL 401(K) PLAN 2023 263983850 2024-02-07 BLUESKY DENTAL, LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W. A STREET #204, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2024-02-07
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
BLUESKY DENTAL 401(K) PLAN 2022 263983850 2023-04-03 BLUESKY DENTAL, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W. A STREET #204, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2023-04-03
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
BLUESKY DENTAL 401(K) PLAN 2021 263983850 2022-02-02 BLUESKY DENTAL, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W. A STREET #204, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2022-02-02
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
BLUESKY DENTAL 401(K) PLAN 2020 263983850 2021-06-02 BLUESKY DENTAL, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W. A STREET #204, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2021-06-02
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
BLUESKY DENTAL 401(K) PLAN 2019 263983850 2020-03-26 BLUESKY DENTAL, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W. A STREET #204, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2020-03-26
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
BLUESKY DENTAL 401(K) PLAN 2018 263983850 2019-08-01 BLUESKY DENTAL, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W. A STREET #204, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2019-08-01
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
BLUESKY DENTAL 401(K) PLAN 2017 263983850 2018-05-30 BLUESKY DENTAL, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W. A STREET #204, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2018-05-30
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
BLUESKY DENTAL 401(K) PLAN 2016 263983850 2017-02-23 BLUESKY DENTAL, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W. A STREET #204, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2017-02-23
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-02-23
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
BLUESKY DENTAL 401(K) PLAN 2015 263983850 2016-05-09 BLUESKY DENTAL, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W A ST STE 204, MOSCOW, ID, 838436000

Plan administrator’s name and address
Administrator’s EIN 263983850
Plan administrator’s name BLUESKY DENTAL, LLC
Plan administrator’s address 2500 W A ST STE 204, MOSCOW, ID, 838436000
Administrator’s telephone number 2088829911

Signature of
Role Plan administrator
Date 2016-05-09
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
BLUESKY DENTAL 401(K) PLAN 2014 263983850 2015-07-02 BLUESKY DENTAL, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621210
Sponsor’s telephone number 2088829911
Plan sponsor’s address 2500 W. A STREET #204, MOSCOW, ID, 83843

Plan administrator’s name and address
Administrator’s EIN 263983850
Plan administrator’s name BLUESKY DENTAL, LLC
Plan administrator’s address 2500 W. A STREET #204, MOSCOW, ID, 83843
Administrator’s telephone number 2088829911

Signature of
Role Plan administrator
Date 2015-07-02
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-02
Name of individual signing KEVIN HENRY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KEVIN C HENRY DDS Agent 2500 W. A STREET SUITE 204, MOSCOW, ID 83843

Manager

Name Role Address Appointed On
kevin henry Manager 2500 W. A ST. SUITE 204, MOSCOW, ID 83843 2023-12-04

Filing

Filing Name Filing Number Filing date
Annual Report 0006049557 2025-01-06
Annual Report 0005499388 2023-12-04
Application for Reinstatement 0005332078 2023-07-26
Dissolution/Revocation - Administrative 0004239732 2021-04-08
Application for Reinstatement 0003846856 2020-04-16
Dissolution/Revocation - Administrative 0003838021 2020-04-08
Annual Report 0003408109 2019-01-23
Annual Report 0001956730 2018-01-09
Annual Report 0001956729 2017-01-17
Annual Report 0001956728 2016-01-12

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2457437200 2020-04-16 1094 PPP 2500 West A St. Suite 204, MOSCOW, ID, 83843
Loan Status Date 2021-04-22
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 83300
Loan Approval Amount (current) 83300
Undisbursed Amount 0
Franchise Name -
Lender Location ID 72601
Servicing Lender Name Zions Bank, A Division of
Servicing Lender Address 1 S Main St, SALT LAKE CITY, UT, 84133-1109
Rural or Urban Indicator R
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address MOSCOW, LATAH, ID, 83843-0001
Project Congressional District ID-01
Number of Employees 6
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 72601
Originating Lender Name Zions Bank, A Division of
Originating Lender Address SALT LAKE CITY, UT
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 84018.89
Forgiveness Paid Date 2021-03-01
1891348409 2021-02-02 1094 PPS 2500 W A St Ste 204, Moscow, ID, 83843-6000
Loan Status Date 2021-08-17
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 82290
Loan Approval Amount (current) 82290
Undisbursed Amount 0
Franchise Name -
Lender Location ID 72601
Servicing Lender Name Zions Bank, A Division of
Servicing Lender Address 1 S Main St, SALT LAKE CITY, UT, 84133-1109
Rural or Urban Indicator R
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address Moscow, LATAH, ID, 83843-6000
Project Congressional District ID-01
Number of Employees 6
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 72601
Originating Lender Name Zions Bank, A Division of
Originating Lender Address SALT LAKE CITY, UT
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 82686.8
Forgiveness Paid Date 2021-07-30

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Date of last update: 03 Apr 2025

Sources: Idaho Secretary of State

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