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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 2025
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 0005602931 2024-02-13
Annual Report 0005105438 2023-02-09
Annual Report 0004674548 2022-03-28
Annual Report 0004196365 2021-03-04
Application for Reinstatement 0003871959 2020-05-07
Dissolution/Revocation - Administrative 0003869933 2020-05-07
Annual Report 0003438969 2019-02-28
Annual Report 0002751186 2018-02-08
Annual Report 0002751184 2017-03-16
Annual Report 0002751182 2015-12-23

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: 18 Dec 2024

Sources: Idaho Secretary of State

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