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  5. BRIAN W. FORTUIN, MD-PA

BRIAN W. FORTUIN, MD-PA

Company Details

Name: BRIAN W. FORTUIN, MD-PA
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 14 Mar 2002 (23 years ago)
Financial Date End: 31 Mar 2018
Date dissolved: 29 Jun 2018
Entity Number: 435697
Place of Formation: IDAHO
File Number: 0000435697
ZIP code: 83301
County: Twin Falls County
Mailing Address: 139 RIVER VISTA PLACE #202 TWIN FALLS, ID 83301

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BRIAN W. FORTUIN, MD, PA 401(K) PROFIT SHARING PLAN AND TRUST 2023 753042224 2025-02-14 BRIAN W. FORTUIN, MD, PA 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 625 POLELINE ROAD, SUITE 2A, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2025-02-14
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2025-02-14
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
BRIAN W. FORTUIN, MD, PA 401(K) PROFIT SHARING PLAN AND TRUST 2022 753042224 2024-04-12 BRIAN W. FORTUIN, MD, PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 625 POLELINE ROAD, SUITE 2A, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2024-04-12
Name of individual signing BRIAN W FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-04-12
Name of individual signing BRIAN W FORTUIN
Valid signature Filed with authorized/valid electronic signature
BRIAN W. FORTUIN, MD-PA DEFINED BENEFIT PLAN AND TRUST 2022 753042224 2024-04-12 BRIAN W. FORTUIN, MD, PA 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 625 POLELINE ROAD, SUITE 2A, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2024-04-12
Name of individual signing BRIAN W FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-04-12
Name of individual signing BRIAN W FORTUIN
Valid signature Filed with authorized/valid electronic signature
BRIAN W. FORTUIN, MD, PA 401(K) PROFIT SHARING PLAN AND TRUST 2021 753042224 2023-03-30 BRIAN W. FORTUIN, MD, PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 625 POLELINE ROAD, SUITE 2A, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2023-03-30
Name of individual signing BRIAN W FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-03-30
Name of individual signing BRIAN W FORTUIN
Valid signature Filed with authorized/valid electronic signature
BRIAN W. FORTUIN, MD, PA DEFINED BENEFIT PLAN AND TRUST 2021 753042224 2023-04-26 BRIAN W. FORTUIN, MD, PA 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 625 POLELINE ROAD, SUITE 2A, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2023-04-26
Name of individual signing BRIAN W FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-04-26
Name of individual signing BRIAN W FORTUIN
Valid signature Filed with authorized/valid electronic signature
BRIAN W. FORTUIN, MD, PA 401(K) PROFIT SHARING PLAN AND TRUST 2020 753042224 2022-01-04 BRIAN W. FORTUIN, MD, PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 625 POLELINE ROAD, SUITE 2A, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2022-01-04
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-01-04
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
BRIAN W. FORTUIN, MD, PA DEFINED BENEFIT PLAN AND TRUST 2020 753042224 2022-04-11 BRIAN W. FORTUIN, MD, PA 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 625 POLELINE ROAD, SUITE 2A, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2022-04-09
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-04-09
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
BRIAN W. FORTUIN, MD, PA DEFINED BENEFIT PLAN AND TRUST 2019 753042224 2021-07-12 BRIAN W. FORTUIN, MD, PA 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 775 POLELINE ROAD, SUITE 312, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2021-07-10
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-10
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
BRIAN W. FORTUIN, MD, PA 401(K) PROFIT SHARING PLAN AND TRUST 2019 753042224 2021-07-10 BRIAN W. FORTUIN, MD, PA 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 775 POLELINE ROAD, SUITE 312, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2021-07-10
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-10
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
BRIAN W. FORTUIN, MD, PA DEFINED BENEFIT PLAN AND TRUST 2018 753042224 2020-04-27 BRIAN W. FORTUIN, MD, PA 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-10-01
Business code 621111
Sponsor’s telephone number 2088148600
Plan sponsor’s address 775 POLELINE ROAD, SUITE 312, TWIN FALLS, ID, 83301

Signature of
Role Plan administrator
Date 2020-04-23
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-04-23
Name of individual signing BRIAN FORTUIN
Valid signature Filed with authorized/valid electronic signature

Filing

Filing Name Filing Number Filing date
Legacy Amendment 0002852351 2018-04-18
Legacy Amendment 0002852350 2018-03-02
Annual Report 0002852348 2017-01-23
Annual Report 0002852346 2016-01-21
Annual Report 0002852344 2015-01-16
Annual Report 0002852343 2014-02-13
Annual Report 0002852342 2013-01-16
Annual Report 0002852341 2012-01-12
Annual Report 0002852340 2011-01-19
Annual Report 0002852339 2010-01-13

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2423667310 2020-04-29 1087 PPP 3819N 2538E, Twin Falls, ID, 83301
Loan Status Date 2021-06-19
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 39500
Loan Approval Amount (current) 39500
Undisbursed Amount 0
Franchise Name -
Lender Location ID 79430
Servicing Lender Name Banner Bank
Servicing Lender Address 10 S First Ave, WALLA WALLA, WA, 99362-1942
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Twin Falls, TWIN FALLS, ID, 83301-0001
Project Congressional District ID-02
Number of Employees 4
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 79430
Originating Lender Name Banner Bank
Originating Lender Address WALLA WALLA, WA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 39890.67
Forgiveness Paid Date 2021-05-05

Related by officers

No related officers

Related by address

139 RIVER VISTA PLACE #202 TWIN FALLS, ID 83301

COUNTRY CORNER SUBDIVISION OWNERS ASSOCIATION, INC.

Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State

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