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  5. Peninsula Community Health Services of Alaska, Inc.

Peninsula Community Health Services of Alaska, Inc.

Contents

Company Details

Name: Peninsula Community Health Services of Alaska, Inc.
Jurisdiction: Alaska
Legal type: Nonprofit Corporation
Status: Good Standing
Date of registration: 24 Dec 2001 (23 years ago)
Entity Number: 75113D
ZIP code: 99669
County: Kenai Peninsula
Place of Formation: ALASKA
Address: 230 E MARYDALE AVE, SOLDOTNA, AK 99669-7648
Mailing Address: 230 E. MARYDALE AVE., SOLDOTNA, AK 99669-7648

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621498 ALL OTHER OUTPATIENT CARE CENTERS

Officers

Name Role
Mitch Michaud Vice President
Ted Wellman Director
Charlene Tautfest Director
Benjamin Wright Registered Agent
Josh Cooley Director
Romi Haseo Director
Blaine Gilman President
Jennifer Kreider Director
Jordan Chilson Treasurer
Donna Cotman Director

Unique Entity ID

Unique Entity ID Expiration Date Physical Address
PDXEH5443L71 2024-08-28 230 E MARYDALE AVE, SOLDOTNA, AK, 99669, 7648, USA
Mailing Address 230 E MARYDALE AVE, SOLDOTNA, AK, 99669, 7648, USA

Business Information
URL www.pchsak.org
Congressional District 00
State/Country of Incorporation AK, USA
Activation Date 2023-08-31
Initial Registration Date 2004-03-30
Entity Start Date 2008-10-27
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name BENJAMIN WRIGHT
Role CHIEF EXECUTIVE OFFICER
Address 230 MARYDALE AVENUE, SOLDOTNA, AK, 99669, 2949, USA
Government Business
Title PRIMARY POC
Name CRISTINA LEE
Role COO
Address 230 MARYDALE AVENUE, SOLDOTNA, AK, 99669, 2949, USA
Past Performance -

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
3TED8 Obsolete Non-Manufacturer 2004-03-31 2024-07-23 - 2025-07-19

Contact Information
POC CRISTINA LEE
Phone +1 907-260-7309
Fax +1 907-260-7301
Address 230 E MARYDALE AVE, SOLDOTNA, AK, 99669 7648, 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
PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA INC 2019 920177803 2020-07-06 99
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-01-01
Sponsor PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA INC
Business code 621112
Sponsor’s telephone number 9072607300
Plan sponsor’s mailing address PO BOX 2949, SOLDOTNA, AK, 996692949
Plan sponsor’s address 230 E MARYDALE AVE, SOLDOTNA, AK, 99669

Number of participants as of the end of the plan year
Active participants 82

Signature of
Role Plan administrator
Date 2020-07-06
Name of individual signing CORBI RHOADES
Valid signature Filed with authorized/valid electronic signature
PENINSULA COMMUNITY HEALTH SERVICES OF ALASK INC 2018 920177803 2019-07-18 96
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2015-01-01
Sponsor PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA INC
Business code 621112
Sponsor’s telephone number 9072607300
Plan sponsor’s mailing address PO BOX 2949, SOLDOTNA, AK, 996692949
Plan sponsor’s address 230 E MARYDALE AVE, SOLDOTNA, AK, 99669

Number of participants as of the end of the plan year
Active participants 100

Signature of
Role Plan administrator
Date 2019-07-18
Name of individual signing CORBI RHOADES
Valid signature Filed with authorized/valid electronic signature
403 B THRIFT PLAN OF PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA INC 2017 920177803 2018-07-23 170
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1992-01-01
Sponsor PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA INC
Business code 621112
Sponsor’s telephone number 9072607300
Plan sponsor’s mailing address PO BOX 2949, SOLDOTNA, AK, 996692949
Plan sponsor’s address 230 E MARYDALE AVE, SOLDOTNA, AK, 99669

Number of participants as of the end of the plan year
Active participants 72
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 95
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 164
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 10

Signature of
Role Plan administrator
Date 2018-07-23
Name of individual signing CORBI RHOADES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-23
Name of individual signing CORBI RHOADES
Valid signature Filed with authorized/valid electronic signature
PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA INC 2016 920177803 2017-07-20 92
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2015-01-01
Sponsor PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA INC
Business code 621112
Sponsor’s telephone number 9072607300
Plan sponsor’s mailing address PO BOX 2949, SOLDOTNA, AK, 996692949
Plan sponsor’s address 230 E MARYDALE AVE, SOLDOTNA, AK, 99669

Number of participants as of the end of the plan year
Active participants 91

Signature of
Role Plan administrator
Date 2017-07-20
Name of individual signing CORBI RHOADES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-20
Name of individual signing CORBI RHOADES
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC. 2016 920177803 2017-07-20 167
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1992-01-01
Sponsor PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Business code 621112
Sponsor’s telephone number 9072607300
Plan sponsor’s mailing address PO BOX 2949, SOLDOTNA, AK, 99669
Plan sponsor’s address 230 E MARYDALE AVE, SOLDOTNA, AK, 99669

Number of participants as of the end of the plan year
Active participants 73
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 97
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 169
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 18

Signature of
Role Plan administrator
Date 2017-07-20
Name of individual signing CORBI RHOADES
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC. 2010 920177803 2011-04-19 -
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1992-01-01
Sponsor PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Business code 621112
Sponsor’s telephone number 9072607308
Plan sponsor’s mailing address PO BOX 2949, SOLDOTNA, AK, 996692949
Plan sponsor’s address 230 E. MARYDALE AVE, STE. 3, SOLDOTNA, AK, 99669

Plan administrator’s name and address
Plan administrator’s name SAME

Signature of
Role Plan administrator
Date 2011-04-19
Name of individual signing PATTY EISSLER
Valid signature Filed with authorized/valid electronic signature

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 920499 Active 2008-10-01 2023-11-07 2025-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621498 - ALL OTHER OUTPATIENT CARE CENTERS
Telemedicine Business Registry 128488 Active 2017-11-22 - - -

Date of last update: 10 Jan 2025

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

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