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  5. CENTRAL PENINSULA GENERAL HOSPITAL, INC.

CENTRAL PENINSULA GENERAL HOSPITAL, INC.

Contents

Company Details

Name: CENTRAL PENINSULA GENERAL HOSPITAL, INC.
Jurisdiction: Alaska
Legal type: Nonprofit Corporation
Status: Good Standing
Date of registration: 07 Dec 1992 (32 years ago)
Entity Number: 50675D
ZIP code: 99669
County: Kenai Peninsula
Place of Formation: ALASKA
Address: 250 HOSPITAL PLACE, SOLDOTNA, AK 99669

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

622110 GENERAL MEDICAL AND SURGICAL HOSPITALS

Officers

Name Role
Steve Horn Director
Carrie Couey Treasurer
Silverio Mattero Director
Steve Horn President
Max Best Director
Paul Ostrander Director
Paul Ostrander Vice President
Trena Richardson Director
Carrie Couey Secretary
Carrie Couey Director

Unique Entity ID

Unique Entity ID Expiration Date Physical Address
YER6XJDDTND9 2024-10-23 250 HOSPITAL PL, SOLDOTNA, AK, 99669, 7559, USA
Mailing Address 250 HOSPITAL PL, SOLDOTNA, AK, 99669, 7559, USA

Business Information
URL http://www.cpgh.org
Division Name CENTRAL PENINSULA GENERAL HOSPITAL, INC.
Congressional District 00
State/Country of Incorporation AK, USA
Activation Date 2023-10-26
Initial Registration Date 2004-06-17
Entity Start Date 1971-06-21
Fiscal Year End Close Date Jun 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name MICHAEL J HAGGERTY
Role CFO
Address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669, 7559, USA
Title ALTERNATE POC
Name NICKI MCKINNEY
Role CONTROLLER
Address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669, 7559, USA
Government Business
Title PRIMARY POC
Name MICHAEL J HAGGERTY
Role CFO
Address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669, 7559, USA
Title ALTERNATE POC
Name SHAUN KEEF
Role CEO
Address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669, 7559, USA
Past Performance
Title PRIMARY POC
Name MICHAEL J HAGGERTY
Role CFO
Address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669, 7559, USA
Title ALTERNATE POC
Name NICKI MCKINNEY
Role CONTROLLER
Address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669, 7559, USA

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
3WUX8 Obsolete Non-Manufacturer 2004-06-18 2023-10-26 - 2024-10-23

Contact Information
POC MICHAEL J. HAGGERTY
Phone +1 907-714-4722
Fax +1 907-714-4969
Address 250 HOSPITAL PL, SOLDOTNA, AK, 99669 7559, 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
CENTRAL PENINSULA GENERAL HOSPITAL LIFE, AD&D, DEPENDENT LIFE, SHORT-TERM DISABILITY 2012 920077523 2013-12-18 583
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1994-07-01
Sponsor CENTRAL PENINSULA GENERAL HOSPITAL
Business code 622000
Sponsor’s telephone number 9077144404
Plan sponsor’s mailing address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Plan sponsor’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669

Number of participants as of the end of the plan year
Active participants 620

Signature of
Role Plan administrator
Date 2013-12-17
Name of individual signing DEBI HONER
Valid signature Filed with authorized/valid electronic signature
CENTRAL PENINSULA GENERAL HOSPITAL FLEXIBLE BENEFIT PLAN 2012 920077523 2013-12-18 146
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1989-11-01
Sponsor CENTRAL PENINSULA GENERAL HOSPITAL
Business code 622000
Sponsor’s telephone number 9077144404
Plan sponsor’s mailing address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Plan sponsor’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669

Plan administrator’s name and address
Administrator’s EIN 920077523
Plan administrator’s name CENTRAL PENINSULA GENERAL HOSPITAL
Plan administrator’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Administrator’s telephone number 9077144404

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2013-12-17
Name of individual signing DEBI HONER
Valid signature Filed with authorized/valid electronic signature
CENTRAL PENINSULA GENERAL HOSPITAL LIFE, AD&D, DEPENDENT LIFE, SHORT-TERM DISABILITY 2011 920077523 2013-03-05 588
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1994-07-01
Sponsor CENTRAL PENINSULA GENERAL HOSPITAL
Business code 622000
Sponsor’s telephone number 9077144404
Plan sponsor’s mailing address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Plan sponsor’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669

Plan administrator’s name and address
Administrator’s EIN 920077523
Plan administrator’s name CENTRAL PENINSULA GENERAL HOSPITAL
Plan administrator’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Administrator’s telephone number 9077144404

Number of participants as of the end of the plan year
Active participants 583

Signature of
Role Plan administrator
Date 2013-03-05
Name of individual signing DEBI HONER
Valid signature Filed with authorized/valid electronic signature
CENTRAL PENINSULA GENERAL HOSPITAL FLEXIBLE BENEFIT PLAN 2011 920077523 2013-03-05 169
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1989-11-01
Sponsor CENTRAL PENINSULA GENERAL HOSPITAL
Business code 622000
Sponsor’s telephone number 9077144404
Plan sponsor’s mailing address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Plan sponsor’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669

Plan administrator’s name and address
Administrator’s EIN 920077523
Plan administrator’s name CENTRAL PENINSULA GENERAL HOSPITAL
Plan administrator’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Administrator’s telephone number 9077144404

Number of participants as of the end of the plan year
Active participants 146

Signature of
Role Plan administrator
Date 2013-03-05
Name of individual signing DEBI HONER
Valid signature Filed with authorized/valid electronic signature
CENTRAL PENINSULA GENERAL HOSPITAL FLEXIBLE BENEFIT PLAN 2010 920077523 2012-01-16 134
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1989-11-01
Sponsor CENTRAL PENINSULA GENERAL HOSPITAL
Business code 622000
Sponsor’s telephone number 9077144404
Plan sponsor’s mailing address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Plan sponsor’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669

Plan administrator’s name and address
Administrator’s EIN 920077523
Plan administrator’s name CENTRAL PENINSULA GENERAL HOSPITAL
Plan administrator’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Administrator’s telephone number 9077144404

Number of participants as of the end of the plan year
Active participants 169

Signature of
Role Plan administrator
Date 2012-01-16
Name of individual signing DEBI HONER
Valid signature Filed with authorized/valid electronic signature
CENTRAL PENINSULA GENERAL HOSPITAL LIFE, AD&D, DEPENDENT LIFE, SHORT-TERM DISABILITY 2010 920077523 2012-01-23 551
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1994-07-01
Sponsor CENTRAL PENINSULA GENERAL HOSPITAL
Business code 622000
Sponsor’s telephone number 9077144404
Plan sponsor’s mailing address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Plan sponsor’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669

Plan administrator’s name and address
Administrator’s EIN 920077523
Plan administrator’s name CENTRAL PENINSULA GENERAL HOSPITAL
Plan administrator’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Administrator’s telephone number 9077144404

Number of participants as of the end of the plan year
Active participants 588

Signature of
Role Plan administrator
Date 2012-01-23
Name of individual signing DEBI HONER
Valid signature Filed with authorized/valid electronic signature
CENTRAL PENINSULA GENERAL HOSPITAL LIFE, AD&D, DEPENDENT LIFE, SHORT-TERM DISABILITY 2009 920077523 2010-12-15 533
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1994-07-01
Sponsor CENTRAL PENINSULA GENERAL HOSPITAL
Business code 622000
Sponsor’s telephone number 9077144404
Plan sponsor’s mailing address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Plan sponsor’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669

Plan administrator’s name and address
Administrator’s EIN 920077523
Plan administrator’s name CENTRAL PENINSULA GENERAL HOSPITAL
Plan administrator’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Administrator’s telephone number 9077144404

Number of participants as of the end of the plan year
Active participants 551
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2010-12-15
Name of individual signing DEBI HONER
Valid signature Filed with authorized/valid electronic signature
CENTRAL PENINSULA GENERAL HOSPITAL FLEXIBLE BENEFIT PLAN 2009 920077523 2010-12-15 158
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1989-11-01
Sponsor CENTRAL PENINSULA GENERAL HOSPITAL
Business code 622000
Sponsor’s telephone number 9077144404
Plan sponsor’s mailing address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Plan sponsor’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669

Plan administrator’s name and address
Administrator’s EIN 920077523
Plan administrator’s name CENTRAL PENINSULA GENERAL HOSPITAL
Plan administrator’s address 250 HOSPITAL PLACE, SOLDOTNA, AK, 99669
Administrator’s telephone number 9077144404

Number of participants as of the end of the plan year
Active participants 134
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2010-12-15
Name of individual signing DEBI HONER
Valid signature Filed with authorized/valid electronic signature

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 227830 Active 1996-06-18 2022-12-02 2024-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 622110 - GENERAL MEDICAL AND SURGICAL HOSPITALS
Pharmacy PHAR437 Active 2007-03-09 - 2026-06-30 -
Telemedicine Business Registry 159954 Active 2020-03-31 - - -
Telemedicine Business Registry 159956 Active 2020-03-31 - - -
Telemedicine Business Registry 159957 Active 2020-03-31 - - -
Telemedicine Business Registry 159959 Active 2020-03-31 - - -
Telemedicine Business Registry 159961 Active 2020-03-31 - - -
Telemedicine Business Registry 159983 Active 2020-03-31 - - -
Telemedicine Business Registry 159984 Active 2020-03-31 - - -
Telemedicine Business Registry 159986 Active 2020-03-31 - - -

Awards

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
- IDV VA26012A0100 2012-10-01 - -
Unique Award Key CONT_IDV_VA26012A0100_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title NURSING HOME SERVICES
NAICS Code 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product and Service Codes Q401: MEDICAL- NURSING

Recipient Details
Recipient CENTRAL PENINSULA GENERAL HOSPITAL INC
UEI YER6XJDDTND9
Legacy DUNS 145406034
Recipient Address UNITED STATES, 250 HOSPITAL PL, SOLDOTNA, 996696999

Date of last update: 10 Jan 2025

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

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