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  5. EYE CLINIC OF SANDPOINT, P.A.

EYE CLINIC OF SANDPOINT, P.A.

Company Details

Name: EYE CLINIC OF SANDPOINT, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 19 Nov 1992 (32 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 309888
Place of Formation: IDAHO
File Number: 309888
ZIP code: 83864
County: Bonner County
Mailing Address: 307 S 1ST AVE SANDPOINT, ID 83864-1201

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
OPHTHALMOLOGY 401(K) PROFIT SHARING PLAN 2017 820456655 2018-05-30 EYE CLINIC OF SANDPOINT, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 2082638501
Plan sponsor’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864
OPHTHALMOLOGY 401(K) PROFIT SHARING PLAN 2016 820456655 2017-05-18 EYE CLINIC OF SANDPOINT, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 2082638501
Plan sponsor’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864
OPHTHALMOLOGY 401(K) PROFIT SHARING PLAN 2015 820456655 2016-04-22 EYE CLINIC OF SANDPOINT, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 2082638501
Plan sponsor’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864
OPHTHALMOLOGY 401(K) PROFIT SHARING PLAN 2014 820456655 2015-04-30 EYE CLINIC OF SANDPOINT, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 2082638501
Plan sponsor’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864
OPHTHALMOLOGY 401(K) PROFIT SHARING PLAN 2013 820456655 2014-06-12 EYE CLINIC OF SANDPOINT, P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 2082638501
Plan sponsor’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864
OPHTHALMOLOGY 401(K) PROFIT SHARING PLAN 2012 820456655 2013-09-19 EYE CLINIC OF SANDPOINT, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 2082638501
Plan sponsor’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864

Signature of
Role Plan administrator
Date 2013-09-19
Name of individual signing KATHRYN GEORGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-19
Name of individual signing KATHRYN GEORGE
Valid signature Filed with authorized/valid electronic signature
OPHTHALMOLOGY 401(K) PROFIT SHARING PLAN 2011 820456655 2013-09-13 EYE CLINIC OF SANDPOINT, P.A. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 2082638501
Plan sponsor’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864

Plan administrator’s name and address
Administrator’s EIN 820456655
Plan administrator’s name EYE CLINIC OF SANDPOINT, P.A.
Plan administrator’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864
Administrator’s telephone number 2082638501

Signature of
Role Plan administrator
Date 2013-09-13
Name of individual signing KATHRYN GEORGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-13
Name of individual signing KATHRYN GEORGE
Valid signature Filed with authorized/valid electronic signature
OPHTHALMOLOGY 401(K) PROFIT SHARING PLAN 2011 820456655 2012-10-11 EYE CLINIC OF SANDPOINT, P.A. 15
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 2082638501
Plan sponsor’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864

Plan administrator’s name and address
Administrator’s EIN 820456655
Plan administrator’s name EYE CLINIC OF SANDPOINT, P.A.
Plan administrator’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864
Administrator’s telephone number 2082638501

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing KATHRYN GEORGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-11
Name of individual signing KATHRYN GEORGE
Valid signature Filed with authorized/valid electronic signature
OPHTHALMOLOGY 401(K) PROFIT SHARING PLAN 2010 820456655 2011-10-17 EYE CLINIC OF SANDPOINT, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 2082638501
Plan sponsor’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864

Plan administrator’s name and address
Administrator’s EIN 820456655
Plan administrator’s name EYE CLINIC OF SANDPOINT, P.A.
Plan administrator’s address 307 SOUTH FIRST AVENUE, SANDPOINT, ID, 83864
Administrator’s telephone number 2082638501

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing KATHRYN GEORGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-17
Name of individual signing KATHRYN GEORGE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JASON M PETERSEN Agent 307 S FIRST AVE, SANDPOINT, ID 83864

Vice President

Name Role Address Appointed On
Brayden Petersen Vice President 307 S 1ST AVE, SANDPOINT, ID 83864-1201 2020-10-05

President

Name Role Address Appointed On Resigned On
Jason M Petersen President 307 S 1ST AVE, SANDPOINT, ID 83864 2023-10-09 2023-10-09

Filing

Filing Name Filing Number Filing date
Annual Report 0005921531 2024-10-03
Annual Report 0005435842 2023-10-09
Annual Report 0004933929 2022-10-03
Annual Report 0004446590 2021-10-14
Annual Report 0004024083 2020-10-05
Annual Report 0003636002 2019-10-02
Annual Report 0003324361 2018-10-15
Annual Report 0002283695 2017-12-18
Change of Registered Office/Agent/Both (by Entity) 0002283694 2017-11-02
Annual Report 0002283692 2016-12-28

Related by officers

Brayden Petersen

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Related by address

307 S 1ST AVE SANDPOINT, ID 83864-1201

307 SOUTH FIRST, LLC

Date of last update: 10 Dec 2024

Sources: Idaho Secretary of State

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