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  5. LAKE HARBOR DENTAL, PLLC

LAKE HARBOR DENTAL, PLLC

Company Details

Name: LAKE HARBOR DENTAL, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 04 Feb 2014 (11 years ago)
Financial Date End: 28 Feb 2026
Entity Number: 409248
Place of Formation: IDAHO
File Number: 409248
ZIP code: 83703
County: Ada County
Principal Address: 5355 W STATE ST BOISE, ID 83703
Mailing Address: 5355 W STATE ST BOISE, ID 83703-3333

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKE HARBOR DENTAL 401(K) PLAN 2023 464776064 2024-09-04 LAKE HARBOR DENTAL 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 621210
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703

Signature of
Role Plan administrator
Date 2024-09-04
Name of individual signing ERIC BALLOU
Valid signature Filed with authorized/valid electronic signature
LAKE HARBOR DENTAL 401(K) PLAN 2022 464776064 2023-07-18 LAKE HARBOR DENTAL 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 621210
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703

Signature of
Role Plan administrator
Date 2023-07-18
Name of individual signing ERIC BALLOU
Valid signature Filed with authorized/valid electronic signature
LAKE HARBOR DENTAL 401(K) PLAN 2021 464776064 2022-06-21 LAKE HARBOR DENTAL 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 621210
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703

Signature of
Role Plan administrator
Date 2022-06-21
Name of individual signing ERIC BALLOU
Valid signature Filed with authorized/valid electronic signature
LAKE HARBOR DENTAL 401(K) PLAN 2020 464776064 2021-04-23 LAKE HARBOR DENTAL 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 621210
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703

Signature of
Role Plan administrator
Date 2021-04-23
Name of individual signing ERIC BALLOU
Valid signature Filed with authorized/valid electronic signature
LAKE HARBOR DENTAL 401(K) PLAN 2019 464776064 2020-07-31 LAKE HARBOR DENTAL 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 621210
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703

Signature of
Role Plan administrator
Date 2020-07-31
Name of individual signing ERIC BALLOU
Valid signature Filed with authorized/valid electronic signature
LAKE HARBOR DENTAL 401(K) PLAN 2018 464776064 2019-04-29 LAKE HARBOR DENTAL 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 621210
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703

Signature of
Role Plan administrator
Date 2019-04-29
Name of individual signing ERIC BALLOU
Valid signature Filed with authorized/valid electronic signature
LAKE HARBOR DENTAL 401(K) PLAN 2017 464776064 2018-05-31 LAKE HARBOR DENTAL 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 621210
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703

Signature of
Role Plan administrator
Date 2018-05-31
Name of individual signing ERIC BALLOU
Valid signature Filed with authorized/valid electronic signature
LAKE HARBOR DENTAL 401(K) PLAN 2016 464776064 2017-09-12 LAKE HARBOR DENTAL 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 621210
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703

Signature of
Role Plan administrator
Date 2017-09-12
Name of individual signing ERIC BALLOU
Valid signature Filed with authorized/valid electronic signature
LAKE HARBOR DENTAL 401(K) PLAN 2015 464776064 2016-09-09 LAKE HARBOR DENTAL 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 621210
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703
LAKE HARBOR DENTAL 401(K) PLAN 2014 464776064 2015-07-06 LAKE HARBOR DENTAL 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-09-15
Business code 812990
Sponsor’s telephone number 2088534687
Plan sponsor’s address 5355 W STATE ST, BOISE, ID, 83703

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing DR. ERIC BALLOU
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ERIC BALLOU Agent 5355 W STATE ST, BOISE, ID 83703

Member

Name Role Address Appointed On Resigned On
MICHAEL PETERSON Member 5355 W STATE ST, BOISE, ID 83706 2021-03-04 2023-02-09
ERIC BALLOU Member 5355 W STATE ST, BOISE, ID 83702 2023-02-09 No data

Filing

Filing Name Filing Number Filing date
Annual Report 0006154581 2025-03-10
Annual Report 0005602931 2024-02-13
Annual Report 0005105438 2023-02-09
Annual Report 0004674548 2022-03-28
Annual Report 0004196365 2021-03-04
Dissolution/Revocation - Administrative 0003869933 2020-05-07
Application for Reinstatement 0003871959 2020-05-07
Annual Report 0003438969 2019-02-28
Annual Report 0002751186 2018-02-08
Annual Report 0002751184 2017-03-16

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
9013978304 2021-01-30 1087 PPS 5355 W State St, Boise, ID, 83703-3333
Loan Status Date 2022-01-31
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 143000
Loan Approval Amount (current) 143000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 74899
Servicing Lender Name Washington Trust Bank
Servicing Lender Address 717 W Sprague Ave, SPOKANE, WA, 99201-3915
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Boise, ADA, ID, 83703-3333
Project Congressional District ID-02
Number of Employees 12
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Partnership
Originating Lender ID 74899
Originating Lender Name Washington Trust Bank
Originating Lender Address SPOKANE, WA
Gender Male Owned
Veteran Veteran
Forgiveness Amount 144030.38
Forgiveness Paid Date 2021-11-03

Related by officers

ERIC BALLOU

HNB Properties LLC LH Building LLC

MICHAEL PETERSON

MICHAEL E. PETERSON, D.D.S., P.A. NEXIS IT, LLC PETERSON LAKE HARBOR PROPERTIES LLC K&M MOBILE RV REPAIR LLC DTEX HOME INSPECTIONS LLC HERITAGE TILE & STONE, LLC

Related by address

5355 W STATE ST BOISE, ID 83703

LAKE HARBOR DENTAL PETERSON LAKE HARBOR PROPERTIES LLC IDAHO RECOVERY OUTREACH, INC.

5355 W STATE ST BOISE, ID 83703-3333

MICHAEL E. PETERSON, D.D.S., P.A. HEALTHY SMILES LLC PETERSON LAKE HARBOR PROPERTIES LLC LH Building LLC

Date of last update: 06 Apr 2025

Sources: Idaho Secretary of State

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