Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. Bonner County
    4. ›
  4. 83852
    5. ›
  5. MICHAEL R. DIBENEDETTO, M.D., PLLC

MICHAEL R. DIBENEDETTO, M.D., PLLC

Company Details

Name: MICHAEL R. DIBENEDETTO, M.D., PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 19 Aug 2002 (22 years ago)
Financial Date End: 31 Aug 2025
Entity Number: 74829
Place of Formation: IDAHO
File Number: 74829
ZIP code: 83852
County: Bonner County
Principal Address: 30544 HWY 200 STE 102 PONDERAY, ID 83852
Mailing Address: STE 102 30544 HIGHWAY 200 PONDERAY, ID 83852-5005

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2023 753077363 2024-02-19 MICHAEL R. DIBENEDETTO, M.D., PLLC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2024-02-19
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2022 753077363 2023-02-21 MICHAEL R. DIBENEDETTO, M.D., PLLC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2023-02-21
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2021 753077363 2022-02-07 MICHAEL R. DIBENEDETTO, M.D., PLLC 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2022-02-07
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2020 753077363 2021-10-14 MICHAEL R. DIBENEDETTO, M.D., PLLC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2019 753077363 2020-10-07 MICHAEL R. DIBENEDETTO, M.D., PLLC 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2020-10-07
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2018 753077363 2019-08-07 MICHAEL R. DIBENEDETTO, M.D., PLLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2019-08-07
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2017 753077363 2018-05-23 MICHAEL R. DIBENEDETTO, M.D., PLLC 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2018-05-23
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2016 753077363 2017-05-17 MICHAEL R. DIBENEDETTO, M.D., PLLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2017-05-17
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2015 753077363 2016-06-15 MICHAEL R. DIBENEDETTO, M.D., PLLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2016-06-15
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature
MICHAEL R. DIBENEDETTO, M.D., PLLC 401(K) PLAN 2014 753077363 2015-06-03 MICHAEL R. DIBENEDETTO, M.D., PLLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 2082659817
Plan sponsor’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852

Plan administrator’s name and address
Administrator’s EIN 753077363
Plan administrator’s name MICHAEL R. DIBENEDETTO, M.D., PLLC
Plan administrator’s address 30544 HWY 200 STE 102, PONDERAY, ID, 83852
Administrator’s telephone number 2082659817

Signature of
Role Plan administrator
Date 2015-06-03
Name of individual signing MICHAEL R. DIBENEDETTO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MICHAEL R DIBENEDETTO Agent 30544 HWY 200, STE 102, PONDERAY, ID 83852

Manager

Name Role Address Appointed On
Michael DiBenedetto Manager 30544 HWY 200, STE 102, PONDERAY, ID 83852 2020-09-10
Joan Bloom Manager 30544 HWY 200, STE 102, PONDERAY, ID 83852-5005 2023-08-01
Michael Schicker Manager 30544 HWY 200, STE 102, PONDERAY, ID 83852-5005 2023-08-01
JONATHAN FISHER Manager 30544 HWY 200, STE 102, SANDPOINT, ID 83864 2023-08-01
Travis Taylor Manager 30544 HWY 200, PONDERAY, ID 83852 2023-08-01

Filing

Filing Name Filing Number Filing date
Annual Report 0005835127 2024-08-01
Annual Report 0005336642 2023-08-01
Annual Report 0004834702 2022-07-29
Annual Report 0004428474 2021-09-27
Annual Report 0004001004 2020-09-10
Annual Report 0003577007 2019-07-23
Annual Report 0001198050 2018-06-20
Annual Report 0001198049 2017-07-05
Annual Report 0001198048 2016-06-22
Annual Report 0001198047 2015-06-24

Related by officers

MICHAEL R DIBENEDETTO

PEND OREILLE WELLNESS CENTER, PLLC MEDICAL VILLAGE CONDOMINIUM OWNERS' ASSOCIATION, INC.

Michael DiBenedetto

SANDPOINT PROPERTIES, LLC PEND OREILLE SURGERY CENTER, LLC

Michael Schicker

PEND OREILLE SURGERY CENTER, LLC

Travis Taylor

North Idaho Ice (NIICE) Corp

Related by address

30544 HWY 200 STE 102 PONDERAY, ID 83852

NORTH IDAHO PHYSICIANS, INC.

Date of last update: 29 Nov 2024

Sources: Idaho Secretary of State

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 idorgs.com, Part of Big Data Integrated