| Name: | Henry's Fork Surgery Center, PLLC |
| Jurisdiction: | Idaho |
| Legal type: | Limited Liability Company (D) |
| Status: | Active-Existing |
| Date of registration: | 24 Mar 2020 (5 years ago) |
| Financial Date End: | 31 Mar 2025 |
| Entity Number: | 3818624 |
| Place of Formation: | IDAHO |
| File Number: | 704124 |
| ZIP code: | 83440 |
| County: | Madison County |
| Principal Address: | 23 SAWTELLE AVENUE REXBURG, ID 83440 |
| Mailing Address: | PO BOX 6 REXBURG, ID 83440-0006 |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KHH1N9GDYRD1 | 2024-08-01 | 23 SAWTELLE AVE, STE 101, REXBURG, ID, 83440, 1499, USA | PO BOX 6, REXBURG, ID, 83440, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Doing Business As | HENRY & APOSS FORK SURGERY CENTER PLLC |
| Congressional District | 02 |
| State/Country of Incorporation | ID, USA |
| Activation Date | 2023-08-04 |
| Initial Registration Date | 2023-08-01 |
| Entity Start Date | 2021-07-01 |
| Fiscal Year End Close Date | Dec 31 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | HOLLY S ALLEN |
| Role | ADMINISTRATOR |
| Address | 23 SAWTELLE AVE, STE 101, REXBURG, ID, 83440, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | HOLLY S ALLEN |
| Role | CEO |
| Address | 23 SAWTELLE AVE, STE 101, REXBURG, ID, 83440, USA |
| Past Performance | |
|---|---|
| Title | PRIMARY POC |
| Name | JOSHUA R FULLMER |
| Role | OWNER |
| Address | 23 SAWTELLE AVE, STE 101, REXBURG, ID, 83440, USA |
| Name | Role | Address |
|---|---|---|
| JOSHUA R FULLMER | Agent | 2200 S 6000 W, REXBURG, ID 83440 |
| Name | Role | Address | Appointed On |
|---|---|---|---|
| Kyle G. Thompson | Member | 2100 PROVIDENCE WAY, IDAHO FALLS, ID 83404 | 2024-04-05 |
| Jason G. Hooton | Member | 2100 PROVIDENCE WAY, IDAHO FALLS, ID 83404 | 2024-04-05 |
| Joshua R. Fullmer | Member | 23 SAWTELLE, REXBURG, ID 83440 | 2020-07-16 |
| Matthew P. Traynor | Member | 2100 PROVIDENCE WAY, IDAHO FALLS, ID 83404 | 2024-04-05 |
| Filing Name | Filing Number | Filing date |
|---|---|---|
| Annual Report | 0005675863 | 2024-04-05 |
| Annual Report | 0005172921 | 2023-03-31 |
| Annual Report | 0004679924 | 2022-03-31 |
| Annual Report | 0004223809 | 2021-03-31 |
| Amendment to Certificate | 0003941776 | 2020-07-16 |
| Initial Filing | 0003818624 | 2020-03-24 |
Date of last update: 01 Jan 2025
Sources: Idaho Secretary of State
