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  5. SPIRIT LAKE FAMILY DENTAL, INC.

SPIRIT LAKE FAMILY DENTAL, INC.

Company Details

Name: SPIRIT LAKE FAMILY DENTAL, INC.
Jurisdiction: Idaho
Legal type: General Business Corporation (D)
Status: Active-Good Standing
Date of registration: 25 Apr 2007 (18 years ago)
Financial Date End: 30 Apr 2025
Entity Number: 523117
Place of Formation: IDAHO
File Number: 523117
ZIP code: 83869
County: Kootenai County
Mailing Address: PO BOX 1389 SPIRIT LAKE, ID 83869-1389

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2023 208939825 2024-10-15 SPIRIT LAKE FAMILY DENTAL 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 83869

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing DALE STEVENS
Valid signature Filed with authorized/valid electronic signature
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2022 208939825 2023-10-09 SPIRIT LAKE FAMILY DENTAL 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 83869
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2021 208939825 2022-10-17 SPIRIT LAKE FAMILY DENTAL 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 83869

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing DALE STEVENS
Valid signature Filed with authorized/valid electronic signature
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2020 208939825 2021-10-12 SPIRIT LAKE FAMILY DENTAL 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 83869
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2019 208939825 2020-10-15 SPIRIT LAKE FAMILY DENTAL 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 83869
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2018 208939825 2019-10-15 SPIRIT LAKE FAMILY DENTAL 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 83869

Signature of
Role Plan administrator
Date 2019-10-15
Name of individual signing DALE STEVENS
Valid signature Filed with authorized/valid electronic signature
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2017 208939825 2018-10-10 SPIRIT LAKE FAMILY DENTAL 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 83869
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2016 208939825 2017-10-16 SPIRIT LAKE FAMILY DENTAL 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 83869
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2015 208939825 2016-08-08 SPIRIT LAKE FAMILY DENTAL 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 838691389

Signature of
Role Plan administrator
Date 2016-08-01
Name of individual signing TERRY DEVORE
Valid signature Filed with authorized/valid electronic signature
SPIRIT LAKE FAMILY DENTAL 401K PLAN 2014 208939825 2015-10-15 SPIRIT LAKE FAMILY DENTAL 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 2086236400
Plan sponsor’s address PO BOX 1389, SPIRIT LAKE, ID, 83869

Plan administrator’s name and address
Administrator’s EIN 208939825
Plan administrator’s name SPIRIT LAKE FAMILY DENTAL
Plan administrator’s address PO BOX 1389, SPIRIT LAKE, ID, 83869
Administrator’s telephone number 2086236400

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing TERRY DEVORE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
TERRY DE VORE Agent 6070 W JACKSON ST, SPIRIT LAKE, ID 83858

President

Name Role Address Appointed On Resigned On
TERRY T DEVORE Dr. President 6070 W JACKSON ST, SPIRIT LAKE, ID 83869 2021-03-03 No data
TERRY DeVore President 5667 WEST LAKEVIEW COURT, RATHDRUM, ID 83858 2020-07-06 2021-03-03

Filing

Filing Name Filing Number Filing date
Annual Report 0005634994 2024-03-05
Annual Report 0005176853 2023-04-03
Annual Report 0004662398 2022-03-16
Annual Report 0004189346 2021-03-03
Application for Reinstatement 0003931435 2020-07-06
Dissolution/Revocation - Administrative 0003927278 2020-07-03
Annual Report 0003496092 2019-04-29
Annual Report 0003121950 2018-04-16
Annual Report 0003121948 2017-05-25
Annual Report 0003121947 2016-04-26

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 23 Dec 2024

Sources: Idaho Secretary of State

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