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  5. INTERMOUNTAIN PEDIATRIC CLINIC, P.A.

INTERMOUNTAIN PEDIATRIC CLINIC, P.A.

Company Details

Name: INTERMOUNTAIN PEDIATRIC CLINIC, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 27 Dec 1990 (34 years ago)
Financial Date End: 31 Dec 2024
Entity Number: 291684
Place of Formation: IDAHO
File Number: 291684
ZIP code: 83704
County: Ada County
Mailing Address: 5211 N SORRENTO DR BOISE, ID 83704-2354

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2023 820441015 2024-10-14 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 4
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2024-10-14
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2022 820441015 2023-10-13 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 4
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2023-10-13
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2021 820441015 2022-10-17 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 4
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2020 820441015 2021-10-05 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 4
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2021-10-05
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2019 820441015 2020-10-12 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 4
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2020-10-12
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2018 820441015 2019-10-01 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 6
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2019-10-01
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2017 820441015 2018-10-08 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 6
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2018-10-08
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2016 820441015 2017-09-29 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 6
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2017-09-29
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2015 820441015 2016-10-16 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 6
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2016-10-16
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature
INTERMOUNTAIN PEDIATRIC CLINIC, P.A. PSP 2014 820441015 2015-09-28 INTERMOUNTAIN PEDIATRIC CLINIC, P.A 6
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1991-01-01
Business code 621111
Sponsor’s telephone number 2083221325
Plan sponsor’s address 7722 WEST USTICK, BOISE, ID, 83704

Signature of
Role Plan administrator
Date 2015-09-28
Name of individual signing JOHN P. JAMBURA, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GRAVIS LAW, PLLC Agent 1661 W SHORELINE DR, STE 200, BOISE, ID 83702

President

Name Role Address Appointed On
John P Jambura President 5211 N SORRENTO DR, BOISE, ID 83704-2354 2021-12-30
John P Jambura MD President 5211 N SORRENTO DR, BOISE, ID 83704 2020-12-06

Secretary

Name Role Address Appointed On
Karen Jambura Secretary 5211 N SORRENTO DR, BOISE, ID 83704-2354 2024-01-16

Filing

Filing Name Filing Number Filing date
Annual Report 0005563054 2024-01-16
Application for Reinstatement 0005222790 2023-05-04
Dissolution/Revocation - Administrative 0005162838 2023-03-21
Annual Report 0004545652 2021-12-30
Annual Report 0004090336 2020-12-06
Annual Report 0003763759 2020-02-03
Annual Report 0003370199 2018-12-12
Annual Report 0002180935 2017-11-12
Annual Report 0002180933 2016-11-01
Annual Report 0002180931 2015-10-17

Related by officers

GRAVIS LAW, PLLC

SCANDIA VILLAGE ASSOCIATES, LIMITED PARTNERSHIP VERDE PLAZA ASSOCIATES, LIMITED PARTNERSHIP TRIPLE M LAND & CATTLE, L.L.C. WACAT, L.L.C. BLASER FAMILY, L.L.C. GREAT WESTERN PROPERTIES, L.L.C. INDUSTRIAL HARDWARE IDAHO, INC. EASTMAN DRUG COMPANY ROTARY CLUB OF BOISE METRO, INC. R.A.I.N., INC.

Karen Jambura

WACAT, L.L.C.

Related by address

No related companies by address

Date of last update: 19 Jan 2025

Sources: Idaho Secretary of State

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