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SNAKE RIVER DERMATOLOGY, P.A.

Company Details

Name: SNAKE RIVER DERMATOLOGY, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 13 Apr 2004 (21 years ago)
Financial Date End: 30 Apr 2025
Entity Number: 468524
Place of Formation: IDAHO
File Number: 468524
ZIP code: 83619
County: Payette County
Mailing Address: Brock Andersen 2101 N WHITLEY DR FRUITLAND, ID 83619-2132

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SNAKE RIVER DERMATOLOGY, P.A., 401(K) PLAN 2023 161697626 2024-09-11 SNAKE RIVER DERMATOLOGY, P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2084525999
Plan sponsor’s address 2101 N WHITNEY DRIVE, FRUITLAND, ID, 83619
SNAKE RIVER DERMATOLOGY, P.A., 401(K) PLAN 2022 161697626 2023-04-04 SNAKE RIVER DERMATOLOGY, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2084525999
Plan sponsor’s address 2101 N WHITNEY DRIVE, FRUITLAND, ID, 83619
SNAKE RIVER DERMATOLOGY, P.A., 401(K) PLAN 2021 161697626 2022-06-02 SNAKE RIVER DERMATOLOGY, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2084525999
Plan sponsor’s address 1118 NW 16TH ST., STE. A, FRUITLAND, ID, 83619
SNAKE RIVER DERMATOLOGY, P.A., 401(K) PLAN 2020 161697626 2021-08-11 SNAKE RIVER DERMATOLOGY, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2084525999
Plan sponsor’s address 1118 NW 16TH ST., STE. A, FRUITLAND, ID, 83619
SNAKE RIVER DERMATOLOGY, P.A., 401(K) PLAN 2019 161697626 2020-08-13 SNAKE RIVER DERMATOLOGY, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2084525999
Plan sponsor’s address 1118 NW 16TH ST., STE. A, FRUITLAND, ID, 83619
SNAKE RIVER DERMATOLOGY, P.A., 401(K) PLAN 2018 161697626 2019-02-12 SNAKE RIVER DERMATOLOGY, P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2084525999
Plan sponsor’s address 1118 NW 16TH ST., STE. A, FRUITLAND, ID, 83619
SNAKE RIVER DERMATOLOGY, P.A., 401(K) PLAN 2017 161697626 2018-03-22 SNAKE RIVER DERMATOLOGY, P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2084525999
Plan sponsor’s address 1118 NW 16TH ST., STE. A, FRUITLAND, ID, 83619
SNAKE RIVER DERMATOLOGY, P.A., 401(K) PLAN 2016 161697626 2017-02-21 SNAKE RIVER DERMATOLOGY, P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 2084525999
Plan sponsor’s address 1118 NW 16TH ST., STE. A, FRUITLAND, ID, 83619

Agent

Name Role Address
BROCK ANDERSEN Agent 2101 N. WHITLEY DR, FRUITLAND, ID 83619

President

Name Role Address Appointed On
Brock Andersen President 5016 SARAH CT., FRUITLAND, ID 83619 2021-03-03

Filing

Filing Name Filing Number Filing date
Annual Report 0005639236 2024-03-06
Annual Report 0005208747 2023-04-22
Annual Report 0004649342 2022-03-08
Annual Report 0004189965 2021-03-03
Annual Report 0003874423 2020-05-11
Statement of Change of Business Mailing Address 0003540094 2019-06-17
Annual Report 0003470647 2019-04-03
Annual Report 0002966628 2018-02-28
Annual Report 0002966626 2017-02-28
Annual Report 0002966633 2016-02-25

Date of last update: 21 Dec 2024

Sources: Idaho Secretary of State