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  5. INTERIOR COMMUNITY HEALTH CENTER

INTERIOR COMMUNITY HEALTH CENTER

Contents

Company Details

Name: INTERIOR COMMUNITY HEALTH CENTER
Jurisdiction: Alaska
Legal type: Nonprofit Corporation
Status: Good Standing
Date of registration: 17 May 1993 (32 years ago)
Entity Number: 51691D
ZIP code: 99701
County: Fairbanks North Star
Place of Formation: ALASKA
Address: 1606 23RD AVENUE, 23RD AVENUE, FAIRBANKS, AK 99701
Mailing Address: 1606 23RD AVE, FAIRBANKS, AK 99701

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621498 ALL OTHER OUTPATIENT CARE CENTERS

Officers

Name Role
Scott Kawasaki Director
LaVada Bush Secretary
Cheryl Kilgore Registered Agent
FANTA LEE-SANKOH Director
Joan Stepovich Vice President
MAMIE BROWN Director
Nakeda Allen Treasurer
ALLIE SCHAFER Director
AMY MAY Director
Ellen Ganley President

Unique Entity ID

Unique Entity ID Expiration Date Physical Address
ZYHNNEX43KA6 2024-11-08 1606 23RD AVE, FAIRBANKS, AK, 99701, 6407, USA
Mailing Address 1606 23RD AVE, FAIRBANKS, AK, 99701, 6407, USA

Business Information
URL www.interiorcommunityhealth.org
Congressional District 00
State/Country of Incorporation AK, USA
Activation Date 2023-11-13
Initial Registration Date 2018-01-25
Entity Start Date 1993-05-17
Fiscal Year End Close Date Jun 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name TRACI YECKLEY
Role CFO
Address 1606 23RD AVE, FAIRBANKS, AK, 99701, USA
Title ALTERNATE POC
Name CHERYL KILGORE
Role CEO
Address 1606 23RD AVE, FAIRBANKS, AK, 99701, USA
Government Business
Title PRIMARY POC
Name CHERYL KILGORE
Role CEO
Address 1606 23RD AVE, FAIRBANKS, AK, 99701, USA
Past Performance -

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
4C123 Obsolete Non-Manufacturer 2006-03-13 2023-11-13 - 2024-11-08

Contact Information
POC CHERYL KILGORE
Phone +1 907-458-1558
Address 1606 23RD AVE, FAIRBANKS, AK, 99701 6407, 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
INTERIOR CHC 401(K) RETIREMENT PLAN 2023 920147354 2024-09-10 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2024-09-10
Name of individual signing TRACI YECKLEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-09-10
Name of individual signing TRACI YECKLEY
Valid signature Filed with authorized/valid electronic signature
INTERIOR CHC 401(K) RETIREMENT PLAN 2022 920147354 2023-11-13 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2023-11-13
Name of individual signing TRACI YECKLEY
Role Employer/plan sponsor
Date 2023-11-13
Name of individual signing TRACI YECKLEY
INTERIOR CHC 401(K) RETIREMENT PLAN 2021 920147354 2023-01-19 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2023-01-19
Name of individual signing THOMAS MARTIN
Role Employer/plan sponsor
Date 2023-01-19
Name of individual signing THOMAS MARTIN
INTERIOR CHC 401(K) RETIREMENT PLAN 2020 920147354 2022-03-17 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2022-03-17
Name of individual signing THOMAS MARTIN
INTERIOR CHC 401(K) RETIREMENT PLAN 2019 920147354 2021-01-06 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2021-01-06
Name of individual signing THOMAS MARTIN
INTERIOR CHC 401(K) RETIREMENT PLAN 2018 920147354 2019-12-20 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2019-12-20
Name of individual signing THOMAS MARTIN
Role Employer/plan sponsor
Date 2019-12-20
Name of individual signing THOMAS MARTIN
INTERIOR CHC 401(K) RETIREMENT PLAN 2017 920147354 2018-11-28 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2018-11-28
Name of individual signing THOMAS MARTIN
Role Employer/plan sponsor
Date 2018-11-28
Name of individual signing THOMAS MARTIN
INTERIOR CHC 401(K) RETIREMENT PLAN 2016 920147354 2018-04-18 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2018-04-18
Name of individual signing THOMAS MARTIN
Role Employer/plan sponsor
Date 2018-04-18
Name of individual signing THOMAS MARTIN
INTERIOR CHC 401(K) RETIREMENT PLAN 2016 920147354 2018-01-09 40
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2018-01-09
Name of individual signing THOMAS MARTIN
Role Employer/plan sponsor
Date 2018-01-09
Name of individual signing THOMAS MARTIN
INTERIOR CHC 401(K) RETIREMENT PLAN 2015 920147354 2016-12-16 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-09-01
Sponsor INTERIOR COMMUNITY HEALTH CENTER
Business code 621111
Sponsor’s telephone number 9074554567
Plan sponsor’s address 1606 23RD AVE, FAIRBANKS, AK, 997016407

Signature of
Role Plan administrator
Date 2016-12-16
Name of individual signing THOMAS MARTIN
Role Employer/plan sponsor
Date 2016-12-16
Name of individual signing THOMAS MARTIN

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 292292 Active 2002-11-29 2024-03-12 2025-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621498 - ALL OTHER OUTPATIENT CARE CENTERS
Telemedicine Business Registry 140521 Active 2018-11-16 - - -

Date of last update: 10 Jan 2025

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

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