| Name: | PEDIATRIC NEUROLOGY OF IDAHO, PLLC |
| Jurisdiction: | Idaho |
| Legal type: | Limited Liability Company (D) |
| Status: | Inactive-Dissolved (Administrative) |
| Date of registration: | 04 Jan 1999 (26 years ago) |
| Expiration date: | 31 Dec 2028 |
| Financial Date End: | 31 Jan 2023 |
| Date dissolved: | 13 Apr 2023 |
| Entity Number: | 39237 |
| Place of Formation: | IDAHO |
| File Number: | 39237 |
| ZIP code: | 83706 |
| County: | Ada County |
| Principal Address: | 502 OLD SAYBROOK DR BOISE, ID 83706 |
| Mailing Address: | 502 E OLD SAYBROOK DR BOISE, ID 83706-4983 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PEDIATRIC NEUROLOGY OF IDAHO, P.L.L.C. 401(K) PROFIT SHARING PLAN AND TRUST | 2009 | 820421308 | 2010-10-29 | PEDIATRIC NEUROLOGY OF IDAHO PLLC | 4 | |||||||||||||||||||||||||||||||
|
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| Administrator’s EIN | 820421308 |
| Plan administrator’s name | PEDIATRIC NEUROLOGY OF IDAHO PLLC |
| Plan administrator’s address | 100 EAST IDAHO STREET, SUITE 201, BOISE, ID, 83712 |
| Administrator’s telephone number | 2083815180 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-29 |
| Name of individual signing | KEVIN BOERCKER |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1989-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2083815180 |
| Plan sponsor’s address | 100 EAST IDAHO STREET, SUITE 201, BOISE, ID, 83712 |
Plan administrator’s name and address
| Administrator’s EIN | 820421308 |
| Plan administrator’s name | PEDIATRIC NEUROLOGY OF IDAHO PLLC |
| Plan administrator’s address | 100 EAST IDAHO STREET, SUITE 201, BOISE, ID, 83712 |
| Administrator’s telephone number | 2083815180 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-29 |
| Name of individual signing | KEVIN BOERCKER |
| Valid signature | Filed with incorrect/unrecognized electronic signature |
| Name | Role | Address |
|---|---|---|
| DAVID B BETTIS, M.D. | Agent | 502 OLD SAYBROOK DR, BOISE, ID 83706 |
| Name | Role | Address | Appointed On |
|---|---|---|---|
| Lisa Wheelock Bettis | Member | 502 E OLD SAYBROOK DRIVE, BOISE, ID 83706 | 2022-08-03 |
| Filing Name | Filing Number | Filing date |
|---|---|---|
| Dissolution/Revocation - Administrative | 0005197072 | 2023-04-13 |
| Application for Reinstatement | 0004841063 | 2022-08-03 |
| Dissolution/Revocation - Administrative | 0003510669 | 2019-05-15 |
| Annual Report | 0001074816 | 2018-01-01 |
| Application for Reinstatement | 0001074815 | 2017-03-21 |
| Application for Reinstatement | 0000660119 | 2017-03-10 |
| Application for Reinstatement | 0001074813 | 2015-03-12 |
| Statement of Change of Business Mailing Address | 0001074814 | 2015-03-12 |
| Application for Reinstatement | 0000660118 | 2015-03-09 |
| Annual Report | 0001074808 | 2011-12-30 |
Date of last update: 13 Jan 2025
Sources: Idaho Secretary of State
