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  5. ANCHORAGE PEDIATRIC GROUP LLC

ANCHORAGE PEDIATRIC GROUP LLC

Contents

Company Details

Name: ANCHORAGE PEDIATRIC GROUP LLC
Jurisdiction: Alaska
Legal type: Limited Liability Company
Status: Good Standing
Date of registration: 28 Dec 1998 (26 years ago)
Entity Number: 65652D
ZIP code: 99508
County: Anchorage
Place of Formation: ALASKA
Address: 3340 PROVIDENCE DR STE A500, ANCHORAGE, AK 99508

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621111 OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)

Officers

Name Role
JODI ELLIOTT Member
WILLOW MONTERROSA Registered Agent
WILLOW MONTERROSA Member
JOHN HEIMERL Member

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
ANCHORAGE PEDIATRIC GROUP PROFIT SHARING PLAN AND TRUST 2012 920022544 2013-06-18 54
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Sponsor ANCHORAGE PEDIATRIC GROUP, LLC
Business code 621111
Sponsor’s telephone number 9072223555
Plan sponsor’s mailing address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508
Plan sponsor’s address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508

Plan administrator’s name and address
Administrator’s EIN 920022544
Plan administrator’s name ANCHORAGE PEDIATRIC GROUP, LLC
Plan administrator’s address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508
Administrator’s telephone number 9072223555

Number of participants as of the end of the plan year
Active participants 40
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 9
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 48
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2

Signature of
Role Plan administrator
Date 2013-06-18
Name of individual signing BRICE ALEXANDER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-18
Name of individual signing BRICE ALEXANDER
Valid signature Filed with authorized/valid electronic signature
ANCHORAGE PEDIATRIC GROUP PROFIT SHARING PLAN AND TRUST 2011 920022544 2012-05-22 49
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Sponsor ANCHORAGE PEDIATRIC GROUP, LLC
Business code 621111
Sponsor’s telephone number 9075622423
Plan sponsor’s mailing address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508
Plan sponsor’s address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508

Plan administrator’s name and address
Administrator’s EIN 920022544
Plan administrator’s name ANCHORAGE PEDIATRIC GROUP, LLC
Plan administrator’s address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508
Administrator’s telephone number 9075622423

Number of participants as of the end of the plan year
Active participants 45
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 7
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 38
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 3

Signature of
Role Plan administrator
Date 2012-05-22
Name of individual signing CHARLES RYAN
Valid signature Filed with authorized/valid electronic signature
ANCHORAGE PEDIATRIC GROUP PROFIT SHARING PLAN AND TRUST 2010 920022544 2011-10-05 38
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Sponsor ANCHORAGE PEDIATRIC GROUP, LLC
Business code 621111
Sponsor’s telephone number 9075622423
Plan sponsor’s mailing address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508
Plan sponsor’s address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508

Plan administrator’s name and address
Administrator’s EIN 920022544
Plan administrator’s name ANCHORAGE PEDIATRIC GROUP, LLC
Plan administrator’s address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508
Administrator’s telephone number 9075622423

Number of participants as of the end of the plan year
Active participants 45
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 4
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 39
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2

Signature of
Role Plan administrator
Date 2011-10-05
Name of individual signing CHARLES RYAN
Valid signature Filed with authorized/valid electronic signature
ANCHORAGE PEDIATRIC GROUP PROFIT SHARING PLAN AND TRUST 2009 920022544 2010-08-02 33
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Sponsor ANCHORAGE PEDIATRIC GROUP, LLC
Business code 621111
Sponsor’s telephone number 9072223555
Plan sponsor’s mailing address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508
Plan sponsor’s address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508

Plan administrator’s name and address
Administrator’s EIN 920022544
Plan administrator’s name ANCHORAGE PEDIATRIC GROUP, LLC
Plan administrator’s address 3340 PROVIDENCE DR. STE. 500, ANCHORAGE, AK, 99508
Administrator’s telephone number 9072223555

Number of participants as of the end of the plan year
Active participants 35
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 3
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 36
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-08-02
Name of individual signing CHARLES RYAN MD
Valid signature Filed with authorized/valid electronic signature

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 196526 Active - 2022-12-09 2024-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621111 - OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Telemedicine Business Registry 159165 Active 2020-03-20 - - -

Date of last update: 11 Jan 2025

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

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