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  5. BETHEL FAMILY CLINIC

BETHEL FAMILY CLINIC

Contents

Company Details

Name: BETHEL FAMILY CLINIC
Jurisdiction: Alaska
Legal type: Nonprofit Corporation
Status: Good Standing
Date of registration: 01 Nov 1982 (42 years ago)
Entity Number: 28260D
ZIP code: 99559
County: Bethel
Place of Formation: ALASKA
Address: 631 MAIN ST, BETHEL, AK 99559
Mailing Address: PO BOX 1908, BETHEL, AK 99559-1908

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621498 ALL OTHER OUTPATIENT CARE CENTERS

Officers

Name Role
Jody Brand Director
Rebecca Lanham Director
MOHAMMAD CHOWDHURY Registered Agent
Gloria Benson Director
Minnie Fritts Vice President
Elondre Johnson Director
Jessica Haines Secretary
SUSAN TAYLOR Treasurer
Dean Swope President
Charlene Wuya Director

Unique Entity ID

Unique Entity ID Expiration Date Physical Address
YLNGDQKYAT95 2025-04-03 631 MAIN ST, BETHEL, AK, 99559, USA
Mailing Address BOX 1908, BETHEL, AK, 99559, 1908, USA

Business Information
URL www.bethelfamilyclinic.org
Division Name BETHEL FAMILY CLINIC
Congressional District 00
State/Country of Incorporation AK, USA
Activation Date 2024-04-05
Initial Registration Date 2006-08-04
Entity Start Date 1982-11-01
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name MOHAMMAD ENAYET CHOWDHURY
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Title ALTERNATE POC
Name VALERA BRICKEL
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Government Business
Title PRIMARY POC
Name MOHAMMAD ENAYET CHOWDHURY
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Title ALTERNATE POC
Name VALERA BRICKEL
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Past Performance
Title PRIMARY POC
Name MOHAMMAD ENAYET CHOWDHURY
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Title ALTERNATE POC
Name VALERA BRICKEL
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
4HAG0 Obsolete Non-Manufacturer 2006-08-07 2024-04-05 - 2025-04-03

Contact Information
POC MOHAMMAD ENAYET CHOWDHURY
Phone +1 907-543-9851
Fax +1 907-543-9859
Address 631 MAIN ST, BETHEL, AK, 99559, UNITED STATES

Ownership of Offeror Information
Highest Level Owner -
Immediate Level Owner -
List of Offerors (0) -

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
SAFE-HARBOR 401(K) PROFIT SHARING PLAN FOR EMPLOYEES OF BETHEL FAMILY CLINIC 2023 920089260 2024-07-08 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2024-07-08
Name of individual signing MOHAMMAD ENAYET CHOWDHURY
SAFE-HARBOR 401(K) PROFIT SHARING PLAN FOR EMPLOYEES OF BETHEL FAMILY CLINIC 2022 920089260 2023-07-06 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2023-07-06
Name of individual signing MOHAMMAD ENAYET CHOWDHURY
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2021 920089260 2022-08-30 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2022-08-30
Name of individual signing MOHAMMAD ENAYET CHOWDHURY
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2020 920089260 2021-02-25 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2021-02-25
Name of individual signing DON BLACK
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2019 920089260 2020-07-29 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2020-07-29
Name of individual signing DON BLACK
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2018 920089260 2019-06-14 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2019-06-14
Name of individual signing MARY LARAUX
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2017 920089260 2018-10-05 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2018-10-05
Name of individual signing JEHONA KADRIU
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC BETHEL FAMILY CLINIC 2016 920089260 2017-07-18 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address 631 MAIN STREET, BETHEL, AK, 99559

Signature of
Role Plan administrator
Date 2017-07-18
Name of individual signing LATESIA GUINN
Role Employer/plan sponsor
Date 2017-07-18
Name of individual signing LATESIA GUINN
BETHEL FAMILY CLINIC 401(K) P/S PLAN 2015 920089260 2016-02-17 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address 631 MAIN ST., BETHEL, AK, 99559

Plan administrator’s name and address
Administrator’s EIN 920089260
Plan administrator’s name BETHEL FAMILY CLINIC
Plan administrator’s address 631 MAIN ST., BETHEL, AK, 99559
Administrator’s telephone number 9075433773

Signature of
Role Plan administrator
Date 2016-02-17
Name of individual signing LATESIA GUINN
BETHEL FAMILY CLINIC 401(K) P/S PLAN 2014 920089260 2015-04-16 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Sponsor BETHEL FAMILY CLINIC
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address 631 MAIN ST., BETHEL, AK, 99559

Plan administrator’s name and address
Administrator’s EIN 920089260
Plan administrator’s name BETHEL FAMILY CLINIC
Plan administrator’s address 631 MAIN ST., BETHEL, AK, 99559
Administrator’s telephone number 9075433773

Signature of
Role Plan administrator
Date 2015-04-16
Name of individual signing LATESIA GUINN

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 308552 Active 2005-02-09 2022-11-30 2024-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621498 - ALL OTHER OUTPATIENT CARE CENTERS
Telemedicine Business Registry 155342 Active 2019-12-09 - - -

Date of last update: 10 Jan 2025

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

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