ISLAND DERMATOLOGY, PLLC

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Company Details

Legal Name:	ISLAND DERMATOLOGY, PLLC
Jurisdiction:	WASHINGTON
Entity Type:	WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category:	DOMESTIC ENTITY
Status:	Administratively Dissolved
Formation/ Registration Date:	September 11th 2000
Date of Dissolution:	February 3rd 2021
Expiration date:	30 Sep 2020
UBI Number:	602 064 488
ZIP code:	98040
City:	Mercer Island
County:	KING
Home State:	WASHINGTON
Principal Office Street Address:	8435 SE 68TH ST STE 118, MERCER ISLAND, WA, 98040, UNITED STATES
Supporting healthcare providers fighting with COVID-19:	$8,438

Nature of Business

MEDICAL PRACTICE DERMATOLOGY

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Registered Agent Information

Name	Role	Address
CORPORATION SERVICE COMPANY	Registered Agent	300 DESCHUTES WAY SW STE 208 MC-CSC1, TUMWATER, WA, 98501, UNITED STATES

Key Officers & Management

Name	Role
FRANK BARON	Governing Person

National Provider Identifier

NPI Number:

1215966635

Link:

View on NPI website

Authorized Person:

Name:

MS. BETTY J HEUPEL

Role:

OFFICE MANAGER

Phone:

4254862340

Taxonomy:

Selected Taxonomy:

207N00000X - Dermatology Physician

Is Primary:

Yes

Contacts:

Phone:

+1 206-232-7546

Fax:

2062750805

Form 5500 Series

Employer Identification Number (EIN):

912060674

Plan Year:

2021

Number Of Participants:

20

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

2062327546

File:

Plan Administrator / Signatory:

KARI THOMAS(Plan administrator)

Plan Year:

2020

Number Of Participants:

20

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

2062327546

File:

Plan Administrator / Signatory:

JENNIFER HALL(Plan administrator)

Plan Year:

2019

Number Of Participants:

20

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

2062327546

File:

Plan Administrator / Signatory:

JENNIFER HALL(Plan administrator)

Plan Year:

2019

Number Of Participants:

20

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

2062327546

Plan Administrator / Signatory:

JHALL5961(Plan administrator)

Plan Year:

2018

Number Of Participants:

20

Plan Name:

RETIREMENT PLAN

Sponsor's telephone number:

2062327546

File:

Plan Administrator / Signatory:

JENNIFER HALL(Plan administrator)

Paycheck Protection Program

Jobs Reported:

9

Initial Approval Amount:

$110,800

Date Approved:

2020-04-28

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$110,800

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Unanswered

Veteran:

Unanswered

Forgiveness Amount:

$111,965.68

Servicing Lender:

HomeStreet Bank

Use of Proceeds:

Payroll: $110,800

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