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  5. MAT-SU MIDWIFERY, INC.

MAT-SU MIDWIFERY, INC.

Contents

Company Details

Name: MAT-SU MIDWIFERY, INC.
Jurisdiction: Alaska
Legal type: Business Corporation
Status: Good Standing
Date of registration: 08 Nov 1993 (31 years ago)
Entity Number: 52608D
ZIP code: 99654
County: Matanuska Susitna
Place of Formation: ALASKA
Address: 5000 E SHENNUM DR, WASILLA, AK 99654

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621399 OFFICES OF ALL OTHER MISCELLANEOUS HEALTH PRACTITIONERS

Officers

Name Role
Darcy Lucey Shareholder
Darcy Lucey Director
Jessica Sawyer Shareholder
Jessica Sawyer Director
Jessica Sawyer Vice President
Rachel Adams Director
TIFFANY MOURITSEN Treasurer
TIFFANY MOURITSEN Director
Vanessa Williams Director
Marilyn Vink Director

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
MAT-SU MIDWIFERY, INC. 401(K) PLAN 2023 920148309 2024-05-29 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor MAT-SU MIDWIFERY, INC.
Business code 621399
Sponsor’s telephone number 9073733420
Plan sponsor’s address 5000 E SHENNUM DR, WASILLA, AK, 99654

Signature of
Role Plan administrator
Date 2024-05-29
Name of individual signing JESSICA SAWYER
MAT-SU MIDWIFERY, INC. 401(K) PLAN 2022 920148309 2023-07-27 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor MAT-SU MIDWIFERY, INC.
Business code 621399
Sponsor’s telephone number 9073733420
Plan sponsor’s address 5000 E SHENNUM DR, WASILLA, AK, 99654

Signature of
Role Plan administrator
Date 2023-07-27
Name of individual signing JESSICA SAWYER
MAT-SU MIDWIFERY, INC. 401(K) PLAN 2021 920148309 2022-08-03 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor MAT-SU MIDWIFERY, INC.
Business code 621399
Sponsor’s telephone number 9073733420
Plan sponsor’s address 5000 E SHENNUM DR, WASILLA, AK, 99654

Signature of
Role Plan administrator
Date 2022-08-03
Name of individual signing JESSICA SAWYER
MAT-SU MIDWIFERY, INC. 401(K) PLAN 2020 920148309 2021-04-10 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor MAT-SU MIDWIFERY, INC.
Business code 621399
Sponsor’s telephone number 9073733420
Plan sponsor’s address 5000 E SHENNUM DR, WASILLA, AK, 99654

Signature of
Role Plan administrator
Date 2021-04-10
Name of individual signing JESSICA SAWYER
MAT-SU MIDWIFERY, INC. 401(K) PLAN 2019 920148309 2020-04-29 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor MAT-SU MIDWIFERY, INC.
Business code 621399
Sponsor’s telephone number 9073733420
Plan sponsor’s address 2650 E. BROADVIEW AVE., WASILLA, AK, 99654

Signature of
Role Plan administrator
Date 2020-04-29
Name of individual signing JESSICA SAWYER
MAT-SU MIDWIFERY, INC. 401(K) PLAN 2018 920148309 2019-07-31 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor MAT-SU MIDWIFERY, INC.
Business code 621399
Sponsor’s telephone number 9073733420
Plan sponsor’s address 2650 E. BROADVIEW AVE., WASILLA, AK, 99654
MAT-SU MIDWIFERY, INC. 401(K) PLAN 2017 920148309 2018-07-05 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor MAT-SU MIDWIFERY, INC.
Business code 621399
Sponsor’s telephone number 9073733420
Plan sponsor’s address 2650 E. BROADVIEW AVE., WASILLA, AK, 99654

Signature of
Role Plan administrator
Date 2018-07-05
Name of individual signing JESSICA SAWYER
MAT-SU MIDWIFERY, INC. 401(K) PLAN 2016 920148309 2017-07-25 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Sponsor MAT-SU MIDWIFERY, INC.
Business code 621399
Sponsor’s telephone number 9073733420
Plan sponsor’s address 2650 E. BROADVIEW AVE., WASILLA, AK, 99654

Signature of
Role Plan administrator
Date 2017-07-25
Name of individual signing JESSICA SAWYER

Business Licenses

License Number Type Status Issue Date Date of renewal Expiration date Description
293196 Business License Active 2003-01-15 2024-10-08 2026-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621399 - OFFICES OF ALL OTHER MISCELLANEOUS HEALTH PRACTITIONERS

Professional Licenses

License Number Program Type Status Issue Date Effective Date Expiration Date
133642 Telemedicine Business Registry Telemedicine Business Registry Active 2018-05-11 2018-05-11 -

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
345022461 1050210 2020-10-30 5000 E SHENNUM DRIVE, WASILLA AK 99654, WASILLA, AK, 99654
Inspection Type Planned
Scope Partial
Safety/Health Health
Close Conference 2020-10-30
Emphasis P: HEALTHCARE, S: HEALTHCARE
Case Closed 2021-04-12

Violation Items
Citation ID 01001A
Citaton Type Serious
Standard Cited 19101030 C01 I
Issuance Date 2021-03-17
Abatement Due Date 2021-05-03
Current Penalty 1735.0
Initial Penalty 3470.04
Final Order 2021-04-05
Nr Instances 1
Nr Exposed 20
Gravity 5
FTA Current Penalty 0.0
Citation ID 01001B
Citaton Type Other
Standard Cited 19101030 G01 I H
Issuance Date 2021-03-17
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2021-04-05
Nr Instances 2
Nr Exposed 15
Gravity 5
FTA Current Penalty 0.0
Citation ID 01001C
Citaton Type Serious
Standard Cited 19101030 G02 VII D
Issuance Date 2021-03-17
Abatement Due Date 2021-05-03
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2021-04-05
Nr Instances 3
Nr Exposed 15
Gravity 5
FTA Current Penalty 0.0
Citation ID 01002A
Citaton Type Serious
Standard Cited 19101200 E01
Issuance Date 2021-03-17
Abatement Due Date 2021-05-03
Current Penalty 1755.0
Initial Penalty 3470.04
Final Order 2021-04-05
Nr Instances 1
Nr Exposed 25
Gravity 5
FTA Current Penalty 0.0
Citation ID 01002B
Citaton Type Serious
Standard Cited 19101200 H01
Issuance Date 2021-03-17
Abatement Due Date 2021-05-03
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2021-04-05
Nr Instances 2
Nr Exposed 20
Gravity 5
FTA Current Penalty 0.0
Citation ID 01002C
Citaton Type Serious
Standard Cited 19101200 G08
Issuance Date 2021-03-17
Abatement Due Date 2021-05-03
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2021-04-05
Nr Instances 3
Nr Exposed 20
Gravity 5
FTA Current Penalty 0.0
Citation ID 02001
Citaton Type Other
Standard Cited 19100037 B04
Issuance Date 2021-03-17
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2021-04-05
Nr Instances 2
Nr Exposed 25
FTA Current Penalty 0.0
Citation ID 02002
Citaton Type Other
Standard Cited 19101030 H01 II B
Issuance Date 2021-03-17
Abatement Due Date 2021-05-03
Current Penalty 0.0
Initial Penalty 0.0
Final Order 2021-04-05
Nr Instances 2
Nr Exposed 20
FTA Current Penalty 0.0

Date of last update: 24 Jan 2025

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

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