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  5. Fort Collins Skin Clinic, P.C.

Fort Collins Skin Clinic, P.C.

Company Details

Name: Fort Collins Skin Clinic, P.C.
Jurisdiction: Colorado
Legal type: Domestic profit corporation
Status: Voluntarily Dissolved
Date of registration: 01 Oct 1976 (48 years ago)
Date dissolved: 15 Oct 2021
Entity Number: 19871311037
ZIP code: 80528
County: Larimer County
Place of Formation: COLORADO
Principal Address: 2808 Sunset View Drive Fort Collins CO 80528 US

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FORT COLLINS SKIN CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2014 840719841 2015-10-26 FORT COLLINS SKIN CLINIC, P.C. 27
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 9704846303
Plan sponsor’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524

Signature of
Role Plan administrator
Date 2015-10-26
Name of individual signing BRAD R. BAACK
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS SKIN CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2014 840719841 2015-09-25 FORT COLLINS SKIN CLINIC, P.C. 30
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 9704846303
Plan sponsor’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524

Plan administrator’s name and address
Administrator’s EIN 840719841
Plan administrator’s name FORT COLLINS SKIN CLINIC, P.C.
Plan administrator’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524
Administrator’s telephone number 9704846303

Signature of
Role Plan administrator
Date 2015-09-25
Name of individual signing BRAD R. BAACK
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS SKIN CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2014 840719841 2015-09-24 FORT COLLINS SKIN CLINIC, P.C. 30
Three-digit plan number (PN) 002
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 9704846303
Plan sponsor’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524

Plan administrator’s name and address
Administrator’s EIN 840719841
Plan administrator’s name FORT COLLINS SKIN CLINIC, P.C.
Plan administrator’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524
Administrator’s telephone number 9704846303

Signature of
Role Plan administrator
Date 2015-09-24
Name of individual signing BRAD R. BAACK
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS SKIN CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2013 840719841 2014-07-29 FORT COLLINS SKIN CLINIC, P.C. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 9704846303
Plan sponsor’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524

Plan administrator’s name and address
Administrator’s EIN 840719841
Plan administrator’s name FORT COLLINS SKIN CLINIC, P.C.
Plan administrator’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524
Administrator’s telephone number 9704846303

Signature of
Role Plan administrator
Date 2014-07-29
Name of individual signing BRAD R. BAACK
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS SKIN CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2012 840719841 2013-10-15 FORT COLLINS SKIN CLINIC, P.C. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 9704846303
Plan sponsor’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524

Plan administrator’s name and address
Administrator’s EIN 840719841
Plan administrator’s name FORT COLLINS SKIN CLINIC, P.C.
Plan administrator’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524
Administrator’s telephone number 9704846303

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing BRAD R. BAACK
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS SKIN CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2011 840719841 2015-07-06 FORT COLLINS SKIN CLINIC, P.C. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 9704846303
Plan sponsor’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524

Plan administrator’s name and address
Administrator’s EIN 840719841
Plan administrator’s name FORT COLLINS SKIN CLINIC, P.C.
Plan administrator’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524
Administrator’s telephone number 9704846303

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing BRAD R. BAACK
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS SKIN CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2011 840719841 2012-08-13 FORT COLLINS SKIN CLINIC, P.C. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 9704846303
Plan sponsor’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524

Plan administrator’s name and address
Administrator’s EIN 840719841
Plan administrator’s name FORT COLLINS SKIN CLINIC, P.C.
Plan administrator’s address 1120 E. ELIZABETH, BLDG G, SUITE 2, FORT COLLINS, CO, 80524
Administrator’s telephone number 9704846303

Signature of
Role Plan administrator
Date 2012-08-13
Name of individual signing BRAD R. BAACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-13
Name of individual signing BRAD R. BAACK
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS SKIN CLINIC, P.C. 401K PROFIT SHARING PLAN 2010 840719841 2011-05-18 FORT COLLINS SKIN CLINIC, P.C. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 9704846303
Plan sponsor’s address 1120 E. ELIZABETH BLDG G STE 2, FORT COLLINS, CO, 80524

Plan administrator’s name and address
Administrator’s EIN 840719841
Plan administrator’s name FORT COLLINS SKIN CLINIC, P.C.
Plan administrator’s address 1120 E. ELIZABETH BLDG G STE 2, FORT COLLINS, CO, 80524
Administrator’s telephone number 9704846303

Signature of
Role Plan administrator
Date 2011-05-18
Name of individual signing BRAD BAACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-18
Name of individual signing BRAD BAACK
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS SKIN CLINIC, P.C. 401K PROFIT SHARING PLAN 2009 840719841 2010-09-24 FORT COLLINS SKIN CLINIC, P.C. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 9704846303
Plan sponsor’s address 1120 E. ELIZABETH BLDG G STE 2, FORT COLLINS, CO, 80524

Plan administrator’s name and address
Administrator’s EIN 840719841
Plan administrator’s name FORT COLLINS SKIN CLINIC, P.C.
Plan administrator’s address 1120 E. ELIZABETH BLDG G STE 2, FORT COLLINS, CO, 80524
Administrator’s telephone number 9704846303

Signature of
Role Plan administrator
Date 2010-09-24
Name of individual signing BRAD BAACK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-24
Name of individual signing BRAD BAACK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BRAD R BAACK Agent 1120 E ELIZABETH, BLDG G STE 2 FORT COLLINS CO 80524 US

Transaction History

Transaction ID Type Date Effective date Name Comment
20211930940 Dissolve a Profit Corporation 2021-10-07 2021-10-15 Fort Collins Skin Clinic, P.C., Dissolved October 15, 2021 No data
20211404448 Statement of Change Changing the Principal Office Address 2021-04-26 2021-04-26 No data Principal address changed;
20211175216 Articles of Reinstatement 2021-02-23 2021-02-23 Fort Collins Skin Clinic, P.C. No data
20161881864 Dissolve a Profit Corporation 2016-12-28 2016-12-31 Fort Collins Skin Clinic, P.C., Dissolved December 31, 2016 No data
20151796099 File Report 2015-12-15 2015-12-15 No data No data
20141637630 File Report 2014-10-22 2014-10-22 No data No data
20141530490 Amend and Restate Articles of Incorporation for a Profit Corporation 2014-08-29 2014-08-29 No data No data
20141492550 Amend Articles of Incorporation for a Profit Corporation 2014-08-14 2014-08-14 No data No data
20131552186 File Report 2013-09-24 2013-09-24 No data No data
20121536622 File Report 2012-09-26 2012-09-26 No data No data

Related by officers

No related officers

Related by address

2808 Sunset View Drive Fort Collins CO 80528 US

Pereon, LLC Flex Derm, PLLC

Date of last update: 13 Jan 2025

Sources: Colorado's Secretary of State

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