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  5. BLACKFOOT PHYSICIANS & SURGEONS PLLC

BLACKFOOT PHYSICIANS & SURGEONS PLLC

Company Details

Name: BLACKFOOT PHYSICIANS & SURGEONS PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 18 Apr 2016 (9 years ago)
Financial Date End: 30 Apr 2025
Entity Number: 500994
Place of Formation: IDAHO
File Number: 500994
ZIP code: 83404
County: Bonneville County
Principal Address: 2105 CORONADO ST IDAHO FALLS, ID 83404
Mailing Address: 1441 PARKWAY DR BLACKFOOT, ID 83221-1667

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2023 812462129 2024-09-12 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 28
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 2087858121
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2022 812462129 2023-09-14 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 27
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 2087858121
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2021 812462129 2022-10-13 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 26
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 2087858121
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2020 812462129 2021-10-15 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 21
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 2087858121
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2020 812462129 2021-10-15 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 21
Three-digit plan number (PN) 003
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 2087858121
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2019 812462129 2020-10-14 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 28
Three-digit plan number (PN) 003
Effective date of plan 2003-03-01
Business code 621111
Sponsor’s telephone number 2087858121
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2019 812462129 2021-10-15 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 28
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2003-03-01
Business code 621111
Sponsor’s telephone number 2087858121
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2018 812462129 2019-10-09 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 27
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2003-03-01
Business code 621111
Sponsor’s telephone number 2087852600
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221

Signature of
Role Plan administrator
Date 2019-10-09
Name of individual signing KIRT M. MCKINLAY
Valid signature Filed with authorized/valid electronic signature
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2017 812462129 2019-10-09 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 44
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2003-03-01
Business code 621111
Sponsor’s telephone number 2087852600
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221

Signature of
Role Plan administrator
Date 2019-10-09
Name of individual signing KIRT M. MCKINLAY
Valid signature Filed with authorized/valid electronic signature
BLACKFOOT PHYSICIANS & SURGEONS 401(K) PROFIT SHARING PLAN 2016 812462129 2019-10-09 BLACKFOOT PHYSICIANS & SURGEONS, PLLC 85
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2003-03-01
Business code 621111
Sponsor’s telephone number 2087852600
Plan sponsor’s address 1441 PARKWAY DRIVE, BLACKFOOT, ID, 83221

Signature of
Role Plan administrator
Date 2019-10-09
Name of individual signing KIRT M. MCKINLAY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GUARDIAN REGISTERED AGENTS LLC Agent 955 PIER VIEW DR, IDAHO FALLS, ID 83402

Member

Name Role Address Appointed On
Kirt M. Mckinlay MD Member 1441 PARKWAY DR., BLACKFOOT, ID 83221 2021-04-30
Matthew Fackrell Member 1441 PARKWAY DR., BLACKFOOT, ID 83221 2024-05-01
Gary Soucie Member 1441 PARKWAY DR., BLACKFOOT, ID 83221 2024-05-01
Paul Beckett Member 1441 PARKWAY DR., BLACKFOOT, ID 83221 2024-05-01

Filing

Filing Name Filing Number Filing date
Annual Report 0005709067 2024-05-01
Annual Report 0005213280 2023-04-27
Annual Report 0004718998 2022-04-28
Annual Report 0004261012 2021-04-30
Annual Report 0003854212 2020-04-28
Annual Report 0003513544 2019-05-15
Annual Report 0003064208 2018-04-30
Annual Report 0003064207 2017-04-26
Initial Filing 0000500994 2016-04-18

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2105 CORONADO ST IDAHO FALLS, ID 83404

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Date of last update: 22 Dec 2024

Sources: Idaho Secretary of State

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