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  5. PENINSULA INTERNAL MEDICINE, P.C.

PENINSULA INTERNAL MEDICINE, P.C.

Contents

Company Details

Name: PENINSULA INTERNAL MEDICINE, P.C.
Jurisdiction: Alaska
Legal type: Professional Corporation
Status: Non-Compliant
Date of registration: 14 Mar 1994 (31 years ago)
Entity Number: 53405D
ZIP code: 99669
County: Kenai Peninsula
Place of Formation: ALASKA
Address: 247 N FIREWEED STREET, 247 N FIREWEED ST, STE A, SOLDOTNA, AK 99669
Mailing Address: 247 N FIREWEED, STE A, SOLDOTNA, AK 99669

Officers

Name Role
GAIL POKORNEY Shareholder
GAIL POKORNEY Vice President
Kristin Mitchell Director
Kristin Mitchell Secretary
Kristin Mitchell Shareholder
WILLIAM KELLEY Registered Agent
William Kelley Director
William Kelley President
William Kelley Shareholder
JOHN BRAMANTE Director

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
PENINSULA INTERNAL MEDICINE, P. C. 401(K) 2020 920149336 2021-01-30 38
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET SUITE A, SOLDOTNA, AK, 99669

Signature of
Role Plan administrator
Date 2021-01-30
Name of individual signing WILLIAM J. KELLEY
Role Employer/plan sponsor
Date 2021-01-30
Name of individual signing JOHN P. BRAMANTE
PENINSULA INTERNAL MEDICINE, P. C. 401(K) 2020 920149336 2021-01-30 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET SUITE A, SOLDOTNA, AK, 99669

Signature of
Role Plan administrator
Date 2021-01-30
Name of individual signing WILLIAM J. KELLEY
Role Employer/plan sponsor
Date 2021-01-30
Name of individual signing JOHN P. BRAMANTE
PENINSULA INTERNAL MEDICINE, P. C. 401(K) 2019 920149336 2020-05-13 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET SUITE A, SOLDOTNA, AK, 99669

Signature of
Role Plan administrator
Date 2020-05-13
Name of individual signing WILLIAM J. KELLEY
PENINSULA INTERNAL MEDICINE, P. C. 401(K) 2018 920149336 2019-07-22 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET SUITE A, SOLDOTNA, AK, 99669

Signature of
Role Plan administrator
Date 2019-07-22
Name of individual signing WILLIAM J. KELLEY
PENINSULA INTERNAL MEDICINE, P. C. 401(K) 2017 920149336 2018-07-16 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET SUITE A, SOLDOTNA, AK, 99669

Signature of
Role Plan administrator
Date 2018-07-16
Name of individual signing JOHN BRAMANTE
Role Employer/plan sponsor
Date 2018-07-16
Name of individual signing JOHN BRAMANTE
PENINSULA INTERNAL MEDICINE, P. C. 401(K) 2016 920149336 2017-07-28 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET SUITE A, SOLDOTNA, AK, 99669

Signature of
Role Plan administrator
Date 2017-07-28
Name of individual signing WILLIAM KELLEY
PENINSULA INTERNAL MEDICINE, P.C. 401(K) PLAN 2015 920149336 2016-05-23 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET, SUITE A, SOLDOTNA, AK, 99669
PENINSULA INTERNAL MEDICINE, P.C. 401(K) PLAN 2014 920149336 2015-08-18 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET, SUITE A, SOLDOTNA, AK, 99669
PENINSULA INTERNAL MEDICINE, P.C. 401(K) PLAN 2013 920149336 2014-08-25 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET, SUITE A, SOLDOTNA, AK, 99669
PENINSULA INTERNAL MEDICINE, P.C. 401(K) PLAN 2012 920149336 2013-06-19 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Sponsor PENINSULA INTERNAL MEDICINE, P.C.
Business code 621111
Sponsor’s telephone number 9072628597
Plan sponsor’s address 247 N. FIREWEED STREET, SUITE A, SOLDOTNA, AK, 99669

Plan administrator’s name and address
Administrator’s EIN 920149336
Plan administrator’s name PENINSULA INTERNAL MEDICINE, P.C.
Plan administrator’s address 247 N. FIREWEED STREET, SUITE A, SOLDOTNA, AK, 99669
Administrator’s telephone number 9072628597

Signature of
Role Plan administrator
Date 2013-06-19
Name of individual signing DIANE HEBERT

Date of last update: 24 Jan 2025

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

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