| Name: | Eastern Idaho Physiatry, PLLC |
| Jurisdiction: | Idaho |
| Legal type: | Limited Liability Company (D) |
| Status: | Active-Existing |
| Date of registration: | 06 May 2020 (5 years ago) |
| Financial Date End: | 31 May 2025 |
| Entity Number: | 3868474 |
| Place of Formation: | IDAHO |
| File Number: | 708611 |
| ZIP code: | 83404 |
| County: | Bonneville County |
| Principal Address: | SARAH VLACH 2730 HOMESTEAD LANE IDAHO FALLS, ID 83404 |
| Mailing Address: | JENNA BAKER 5812 S CEDARWOOD LN AMMON, ID 83406-4303 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EASTERN IDAHO PHYSIATRY 401(K) PLAN | 2023 | 851394166 | 2024-08-22 | EASTERN IDAHO PHYSIATRY PLLC | 7 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-08-22 |
| Name of individual signing | MARK HOLBROOK |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-08-22 |
| Name of individual signing | MARK HOLBROOK |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2085690504 |
| Plan sponsor’s address | 2730 HOMESTEAD LANE, IDAHO FALLS, ID, 83404 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-18 |
| Name of individual signing | MARK HOLBROOK |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2023-09-18 |
| Name of individual signing | MARK HOLBROOK |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2085690504 |
| Plan sponsor’s address | 2730 HOMESTEAD LANE, IDAHO FALLS, ID, 83404 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-14 |
| Name of individual signing | MARK HOLBROOK |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2022-10-14 |
| Name of individual signing | SARAH A VLACH |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2085690504 |
| Plan sponsor’s address | 2730 HOMESTEAD LANE, IDAHO FALLS, ID, 83404 |
Signature of
| Role | Plan administrator |
| Date | 2021-06-04 |
| Name of individual signing | MARK HOLBROOK |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2021-06-04 |
| Name of individual signing | SARAH A VLACH |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Jacob S. Wessel | Agent | 1000 RIVERWALK DRIVE, SUITE 300, IDAHO FALLS, ID 83402 |
| Name | Role | Address | Appointed On |
|---|---|---|---|
| Andrew Cooper | Member | 1571 N. 885 E., SHELLY, ID 83274 | 2023-04-03 |
| Bryan Baker | Member | 5812 S CEDARWOOD LN, AMMON, ID 83406 | 2024-07-22 |
| Sarah A Vlach | Member | 2730 HOMESTEAD LN, IDAHO FALLS, ID 83404-7149 | 2020-09-04 |
| Filing Name | Filing Number | Filing date |
|---|---|---|
| Annual Report Amendment | 0005826256 | 2024-07-22 |
| Statement of Change of Business Mailing Address | 0005826247 | 2024-07-22 |
| Annual Report | 0005666807 | 2024-04-03 |
| Annual Report | 0005174136 | 2023-04-03 |
| Change of Registered Office/Agent/Both (by Entity) | 0005125966 | 2023-02-27 |
| Change of Registered Office/Agent/Both (by Entity) | 0004957164 | 2022-10-19 |
| Annual Report | 0004681867 | 2022-04-03 |
| Annual Report | 0004229400 | 2021-04-05 |
| Amendment to Certificate | 0003996176 | 2020-09-04 |
| Initial Filing | 0003868474 | 2020-05-06 |
Date of last update: 01 Jan 2025
Sources: Idaho Secretary of State
