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  5. LifeMed Alaska LLC

LifeMed Alaska LLC

Contents

Company Details

Name: LifeMed Alaska LLC
Jurisdiction: Alaska
Legal type: Limited Liability Company
Status: Good Standing
Date of registration: 28 Apr 2008 (17 years ago)
Entity Number: 115715
ZIP code: 99502
County: Anchorage
Place of Formation: ALASKA
Address: 3838 W 50TH AVE, ANCHORAGE, AK 99502
Mailing Address: PO BOX 190026, ANCHORAGE, AK 99519-0026

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621999 ALL OTHER MISCELLANEOUS AMBULATORY HEALTH CARE SERVICES

Officers

Name Role
YUKON-KUSKOKWIM HEALTH CORPORATION Member
Ella Goss Manager
DANIEL WILKELMAN Manager
STANLEY "STOSH" HOFFMAN JR Manager
Amy Miller Manager
PROVIDENCE HEALTH SYSTEM-WASHINGTON Member
Patrick Tall Manager
Scott J. Gerlach Registered Agent

Unique Entity ID

Unique Entity ID Expiration Date Physical Address
HF35NNLM3JQ9 2025-02-21 6320 S AIRPARK PL, ANCHORAGE, AK, 99502, 1865, USA
Mailing Address 3838 W 50TH AVENUE, ANCHORAGE, AK, 99502, 1865, USA

Business Information
URL www.lifemedalaska.com
Division Name LIFEMED ALASKA, LLC
Division Number LIFEMED AL
Congressional District 00
State/Country of Incorporation AK, USA
Activation Date 2024-02-26
Initial Registration Date 2012-08-21
Entity Start Date 2008-11-01
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 621910

Points of Contacts
Electronic Business
Title PRIMARY POC
Name GRACE GREENE
Address 3838 W 50TH AVE, ANCHORAGE, AK, 99502, USA
Government Business
Title PRIMARY POC
Name GRACE GREENE
Address 3838 W 50TH AVE, ANCHORAGE, AK, 99502, USA
Past Performance -

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
LIFEMED ALASKA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2010 262512960 2012-09-25 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Sponsor LIFEMED ALASKA, LLC
Business code 621900
Sponsor’s telephone number 9072498401
Plan sponsor’s address 6320 SOUTH AIRPARK PLACE, ANCHORAGE, AK, 99502

Plan administrator’s name and address
Administrator’s EIN 262512960
Plan administrator’s name LIFEMED ALASKA, LLC
Plan administrator’s address 6320 SOUTH AIRPARK PLACE, ANCHORAGE, AK, 99502
Administrator’s telephone number 9072498401

Signature of
Role Plan administrator
Date 2012-09-25
Name of individual signing JARED SHERMAN
Role Employer/plan sponsor
Date 2012-09-25
Name of individual signing JARED SHERMAN
LIFEMED ALASKA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2010 262512960 2011-10-17 76
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Sponsor LIFEMED ALASKA, LLC
Business code 621900
Sponsor’s telephone number 9072498401
Plan sponsor’s address 6320 SOUTH AIRPARK PLACE, ANCHORAGE, AK, 99502

Plan administrator’s name and address
Administrator’s EIN 262512960
Plan administrator’s name LIFEMED ALASKA, LLC
Plan administrator’s address 6320 SOUTH AIRPARK PLACE, ANCHORAGE, AK, 99502
Administrator’s telephone number 9072498401

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing JARED SHERMAN
Role Employer/plan sponsor
Date 2011-10-17
Name of individual signing JARED SHERMAN
LIFEMED ALASKA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2009 262512960 2011-10-06 60
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Sponsor LIFEMED ALASKA, LLC
Business code 621900
Sponsor’s telephone number 9072498401
Plan sponsor’s address 6320 SOUTH AIRPARK PLACE, ANCHORAGE, AK, 99502

Plan administrator’s name and address
Administrator’s EIN 262512960
Plan administrator’s name LIFEMED ALASKA, LLC
Plan administrator’s address 6320 SOUTH AIRPARK PLACE, ANCHORAGE, AK, 99502
Administrator’s telephone number 9072498401

Signature of
Role Plan administrator
Date 2011-10-06
Name of individual signing JARED SHERMAN
Role Employer/plan sponsor
Date 2011-10-06
Name of individual signing JARED SHERMAN
LIFEMED ALASKA, LLC 401(K) PROFIT SHARING PLAN AND TRUST 2009 262512960 2010-10-14 60
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Sponsor LIFEMED ALASKA, LLC
Business code 621900
Sponsor’s telephone number 9072498401
Plan sponsor’s address P.O. BOX 190026, ANCHORAGE, AK, 99519

Plan administrator’s name and address
Administrator’s EIN 262512960
Plan administrator’s name LIFEMED ALASKA, LLC
Plan administrator’s address P.O. BOX 190026, ANCHORAGE, AK, 99519
Administrator’s telephone number 9072498401

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing LUKE WELLES
Role Employer/plan sponsor
Date 2010-10-14
Name of individual signing LUKE WELLES

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 915056 Active 2008-05-01 2023-11-08 2024-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621999 - ALL OTHER MISCELLANEOUS AMBULATORY HEALTH CARE SERVICES

Date of last update: 10 Jan 2025

Sources: State of Alaska - Department of Commerce, Community, and Economic Development

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