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  5. SKYLINE SURGERY CENTER, LLC

SKYLINE SURGERY CENTER, LLC

Company Details

Name: SKYLINE SURGERY CENTER, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 16 Jul 2012 (12 years ago)
Financial Date End: 31 Jul 2025
Entity Number: 355370
Place of Formation: IDAHO
File Number: 355370
ZIP code: 83201
County: Bannock County
Principal Address: 285 VISTA DR POCATELLO, ID 83201-4987

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2023 262792159 2024-09-03 SKYLINE SURGERY CENTER, LLC 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Signature of
Role Plan administrator
Date 2024-09-03
Name of individual signing JAKE ERICKSON
Valid signature Filed with authorized/valid electronic signature
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2022 262792159 2023-07-17 SKYLINE SURGERY CENTER, LLC 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Signature of
Role Plan administrator
Date 2023-07-17
Name of individual signing JAKE ERICKSON
Valid signature Filed with authorized/valid electronic signature
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2021 262792159 2022-03-24 SKYLINE SURGERY CENTER, LLC 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Signature of
Role Plan administrator
Date 2022-03-24
Name of individual signing RYAN HOPE
Valid signature Filed with authorized/valid electronic signature
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2020 262792159 2021-03-17 SKYLINE SURGERY CENTER, LLC 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Signature of
Role Plan administrator
Date 2021-03-17
Name of individual signing RYAN HOPE
Valid signature Filed with authorized/valid electronic signature
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2019 262792159 2020-06-24 SKYLINE SURGERY CENTER, LLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Plan administrator’s name and address
Administrator’s EIN 262792159
Plan administrator’s name SKYLINE SURGERY CENTER,
Plan administrator’s address 285 VISTA, POCATELLO, ID, 83201
Administrator’s telephone number 2084781704

Signature of
Role Plan administrator
Date 2020-06-24
Name of individual signing JANELLE LARSEN
Valid signature Filed with authorized/valid electronic signature
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2018 262792159 2019-07-31 SKYLINE SURGERY CENTER, LLC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Plan administrator’s name and address
Administrator’s EIN 262792159
Plan administrator’s name SKYLINE SURGERY CENTER,
Plan administrator’s address 285 VISTA, POCATELLO, ID, 83201
Administrator’s telephone number 2084781704

Signature of
Role Plan administrator
Date 2019-07-31
Name of individual signing JANELLE LARSEN
Valid signature Filed with authorized/valid electronic signature
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2017 262792159 2018-06-13 SKYLINE SURGERY CENTER, LLC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Plan administrator’s name and address
Administrator’s EIN 262792159
Plan administrator’s name SKYLINE SURGERY CENTER,
Plan administrator’s address 285 VISTA, POCATELLO, ID, 83201
Administrator’s telephone number 2084781704

Signature of
Role Plan administrator
Date 2018-06-13
Name of individual signing RYAN HOPE
Valid signature Filed with authorized/valid electronic signature
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2016 262792159 2017-09-13 SKYLINE SURGERY CENTER, LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Plan administrator’s name and address
Administrator’s EIN 262792159
Plan administrator’s name SKYLINE SURGERY CENTER,
Plan administrator’s address 285 VISTA, POCATELLO, ID, 83201
Administrator’s telephone number 2084781704

Signature of
Role Plan administrator
Date 2017-09-13
Name of individual signing RYAN HOPE
Valid signature Filed with authorized/valid electronic signature
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2015 262792159 2016-05-05 SKYLINE SURGERY CENTER, LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Plan administrator’s name and address
Administrator’s EIN 262792159
Plan administrator’s name SKYLINE SURGERY CENTER,
Plan administrator’s address 285 VISTA, POCATELLO, ID, 83201
Administrator’s telephone number 2084781704

Signature of
Role Plan administrator
Date 2016-05-05
Name of individual signing RYAN HOPE
Valid signature Filed with authorized/valid electronic signature
SKYLINE SURGERY CENTER, LLC RETIREMENT PLAN 2014 262792159 2015-09-16 SKYLINE SURGERY CENTER, LLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-05-01
Business code 622000
Sponsor’s telephone number 2084781704
Plan sponsor’s address 285 VISTA, POCATELLO, ID, 83201

Plan administrator’s name and address
Administrator’s EIN 262792159
Plan administrator’s name SKYLINE SURGERY CENTER,
Plan administrator’s address 285 VISTA, POCATELLO, ID, 83201
Administrator’s telephone number 2084781704

Signature of
Role Plan administrator
Date 2015-09-16
Name of individual signing RYAN HOPE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Deborah L Meyer Agent 285 VISTA DRIVE, C, POCATELLO, ID 83201

Member

Name Role Address Appointed On Resigned On
Skyline ASC Holdings, LLC Member 777 HOSPITAL WAY, POCATELLO, ID 83201 2021-06-23 2022-06-03
Skyline ASC Holdings Inc Member 285 VISTA DRIVE, POCATELLO, ID 83201 2024-06-04 No data

Filing

Filing Name Filing Number Filing date
Annual Report 0005758762 2024-06-04
Application for Reinstatement 0005502566 2023-12-07
Dissolution/Revocation - Administrative 0005426448 2023-10-04
Annual Report 0004767744 2022-06-03
Annual Report 0004323068 2021-06-23
Annual Report 0003914368 2020-06-23
Annual Report 0003533636 2019-06-07
Annual Report 0002517643 2018-05-21
Annual Report 0002517641 2017-05-23
Annual Report 0002517639 2016-06-01

Related by officers

No related officers

Related by address

285 VISTA DR POCATELLO, ID 83201-4987

Golden Investors, LLC

Date of last update: 13 Dec 2024

Sources: Idaho Secretary of State

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