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  5. TETON RETINAL INSTITUTE, P.A.

TETON RETINAL INSTITUTE, P.A.

Company Details

Name: TETON RETINAL INSTITUTE, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 04 Nov 1993 (31 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 320985
Place of Formation: IDAHO
File Number: 320985
ZIP code: 83406
County: Bonneville County
Mailing Address: STE 105 3544 E 17TH ST AMMON, ID 83406-6913

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TETON RETINAL INSTITUTE, P.A. DEFINED BENEFIT PLAN 2015 820463316 2016-10-14 TETON RETINAL INSTITUTE, P.A. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Business code 621320
Sponsor’s telephone number 2085354900
Plan sponsor’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406

Plan administrator’s name and address
Administrator’s EIN 820463316
Plan administrator’s name TETON RETINAL INSTITUTE, P.A.
Plan administrator’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406
Administrator’s telephone number 2085354900

Signature of
Role Plan administrator
Date 2016-10-14
Name of individual signing DARRYL G. MOFFETT, JR
Valid signature Filed with authorized/valid electronic signature
TETON RETINAL INSTITUTE, P.A. DEFINED BENEFIT PLAN 2014 820463316 2015-10-08 TETON RETINAL INSTITUTE, P.A. 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Business code 621320
Sponsor’s telephone number 2085354900
Plan sponsor’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406

Plan administrator’s name and address
Administrator’s EIN 820463316
Plan administrator’s name TETON RETINAL INSTITUTE, P.A.
Plan administrator’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406
Administrator’s telephone number 2085354900

Signature of
Role Plan administrator
Date 2015-10-08
Name of individual signing DARRYL G. MOFFETT, JR
Valid signature Filed with authorized/valid electronic signature
TETON RETINAL INSTITUTE, P.A. DEFINED BENEFIT PLAN 2013 820463316 2014-10-15 TETON RETINAL INSTITUTE, P.A. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Business code 621320
Sponsor’s telephone number 2085354900
Plan sponsor’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406

Plan administrator’s name and address
Administrator’s EIN 820463316
Plan administrator’s name TETON RETINAL INSTITUTE, P.A.
Plan administrator’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406
Administrator’s telephone number 2085354900

Signature of
Role Plan administrator
Date 2014-10-15
Name of individual signing DARRYL G. MOFFETT, JR
Valid signature Filed with authorized/valid electronic signature
TETON RETINAL INSTITUTE, P.A. DEFINED BENEFIT PLAN 2012 820463316 2013-10-07 TETON RETINAL INSTITUTE, P.A. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Business code 621320
Sponsor’s telephone number 2085354900
Plan sponsor’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406

Plan administrator’s name and address
Administrator’s EIN 820463316
Plan administrator’s name TETON RETINAL INSTITUTE, P.A.
Plan administrator’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406
Administrator’s telephone number 2085354900

Signature of
Role Plan administrator
Date 2013-10-07
Name of individual signing DARRYL G. MOFFETT, JR
Valid signature Filed with authorized/valid electronic signature
TETON RETINAL INSTITUTE, P.A. DEFINED BENEFIT PLAN 2011 820463316 2012-10-06 TETON RETINAL INSTITUTE, P.A. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Business code 621320
Sponsor’s telephone number 2085354900
Plan sponsor’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406

Plan administrator’s name and address
Administrator’s EIN 820463316
Plan administrator’s name TETON RETINAL INSTITUTE, P.A.
Plan administrator’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406
Administrator’s telephone number 2085354900

Signature of
Role Plan administrator
Date 2012-10-06
Name of individual signing DARRYL G. MOFFETT, JR
Valid signature Filed with authorized/valid electronic signature
TETON RETINAL INSTITUTE, P.A. DEFINED BENEFIT PLAN 2010 820463316 2011-10-10 TETON RETINAL INSTITUTE, P.A. 0
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-01-01
Business code 621320
Sponsor’s telephone number 2085354900
Plan sponsor’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406

Plan administrator’s name and address
Administrator’s EIN 820463316
Plan administrator’s name TETON RETINAL INSTITUTE, P.A.
Plan administrator’s address 3544 EAST 17TH STREET, SUITE 105, IDAHO FALLS, ID, 83406
Administrator’s telephone number 2085354900

Signature of
Role Plan administrator
Date 2011-10-10
Name of individual signing DR. DARRYL MOFFETT JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-10
Name of individual signing DR. DARRYL MOFFETT JR.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DARRYL G MOFFETT JR Agent 3544 EAST 17TH STREET, SUITE 105, AMMON, ID 83406

President

Name Role Address Appointed On
Darryl Moffett President 3544 E. 17TH ST, AMMON, ID 83406 2020-11-03

Filing

Filing Name Filing Number Filing date
Annual Report 0005919592 2024-10-03
Annual Report 0005465332 2023-11-06
Annual Report 0004970727 2022-11-03
Annual Report 0004485359 2021-11-04
Annual Report 0004048228 2020-11-03
Annual Report 0003633924 2019-10-01
Annual Report 0003349027 2018-11-15
Application for Reinstatement 0002343913 2017-03-23
Application for Reinstatement 0000854350 2017-03-13
Annual Report 0002343911 2015-10-07

Related by officers

DARRYL G MOFFETT JR

RESEARCH FOUNDATION, L.L.C.

Related by address

STE 105 3544 E 17TH ST AMMON, ID 83406-6913

RESEARCH FOUNDATION, L.L.C.

Date of last update: 11 Dec 2024

Sources: Idaho Secretary of State

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