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  5. Tri-County Medical Center, P.C.

Tri-County Medical Center, P.C.

Company Details

Name: Tri-County Medical Center, P.C.
Jurisdiction: Colorado
Legal type: Domestic profit corporation
Status: Delinquent
Date of registration: 01 Oct 2002 (22 years ago)
Entity Number: 20021201893
ZIP code: 80516
County: Weld County
Place of Formation: COLORADO
Principal Address: 720 Austin Ave Ste 103 Erie CO 80516 US

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2023 562281693 2024-09-26 TRI-COUNTY MEDICAL CENTER, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038289355
Plan sponsor’s address 4081 NIBLICK DR, NIWOT, CO, 805038317
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2022 562281693 2023-06-27 TRI-COUNTY MEDICAL CENTER, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038289355
Plan sponsor’s address 4081 NIBLICK DR, NIWOT, CO, 805038317
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2021 562281693 2022-10-13 TRI-COUNTY MEDICAL CENTER, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038289355
Plan sponsor’s address 4081 NIBLICK DR, NIWOT, CO, 805038317

Signature of
Role Plan administrator
Date 2022-10-13
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2020 562281693 2021-10-04 TRI-COUNTY MEDICAL CENTER, P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038289355
Plan sponsor’s address 4081 NIBLICK DR, NIWOT, CO, 805038317

Signature of
Role Plan administrator
Date 2021-10-04
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2019 562281693 2020-10-15 TRI-COUNTY MEDICAL CENTER, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038079396
Plan sponsor’s DBA name JOHN M SPINE
Plan sponsor’s address 4081 NIBLICK DR, NIWOT, CO, 805038317

Signature of
Role Plan administrator
Date 2020-10-15
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2019 562281693 2020-10-14 TRI-COUNTY MEDICAL CENTER, P.C. 7
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038289355
Plan sponsor’s address 4081 NIBLICK DR, NIWOT, CO, 805038317

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2018 562281693 2019-03-21 TRI-COUNTY MEDICAL CENTER, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038289355
Plan sponsor’s address 4081 NIBLICK DR, NIWOT, CO, 805038317

Signature of
Role Plan administrator
Date 2019-03-18
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-03-18
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2017 562281693 2018-03-16 TRI-COUNTY MEDICAL CENTER, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038289355
Plan sponsor’s address 4081 NIBLICK DR, NIWOT, CO, 805038317

Signature of
Role Plan administrator
Date 2018-03-15
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-03-15
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2016 562281693 2017-03-08 TRI-COUNTY MEDICAL CENTER, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038289355
Plan sponsor’s address 4081 NIBLICK DR, NIWOT, CO, 805038317

Signature of
Role Plan administrator
Date 2017-03-07
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-03-07
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
DOC SPINE FAMILY MEDICINE, P.C. 401K PLAN 2015 562281693 2016-02-08 TRI-COUNTY MEDICAL CENTER, P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3038289355
Plan sponsor’s address 4267 AMBER STREET, BOULDER, CO, 80304

Signature of
Role Plan administrator
Date 2016-02-08
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-02-08
Name of individual signing JOHN SPINE, M.D.
Valid signature Filed with authorized/valid electronic signature

Transaction History

Transaction ID Type Date Effective date Name Comment
20231456336 File Report 2023-04-26 2023-04-26 No data Principal address changed, Change in registered agent information
20221310869 File Report 2022-03-24 2022-03-24 No data No data
20211381934 File Report 2021-04-23 2021-04-23 No data No data
20201675535 File Report 2020-08-03 2020-08-03 No data No data
20191343130 File Report 2019-04-23 2019-04-23 No data No data
20181757084 File Report 2018-09-25 2018-09-25 No data No data
20171307467 File Report 2017-04-24 2017-04-24 No data No data
20161286300 File Report 2016-04-25 2016-04-25 No data No data
20151279041 File Report 2015-04-24 2015-04-24 No data No data
20141263712 File Report 2014-04-24 2014-04-24 No data No data

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Related by address

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Date of last update: 13 Jan 2025

Sources: Colorado's Secretary of State

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