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  5. PETERSBURG MENTAL HEALTH SERVICES, INC.

PETERSBURG MENTAL HEALTH SERVICES, INC.

Contents

Company Details

Name: PETERSBURG MENTAL HEALTH SERVICES, INC.
Jurisdiction: Alaska
Legal type: Nonprofit Corporation
Status: Good Standing
Date of registration: 01 Aug 1994 (30 years ago)
Entity Number: 54411D
ZIP code: 99833
County: Petersburg
Place of Formation: ALASKA
Address: 100 FRAM, PETERSBURG, AK 99833
Mailing Address: PO BOX 1309, PETERSBURG, AK 99833

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621498 ALL OTHER OUTPATIENT CARE CENTERS

Officers

Name Role
Michelle Brock Director
Michelle Brock Vice President
Bridget Wittstock Director
Bridget Wittstock Secretary
Bridget Wittstock Treasurer
ERIN MICHAEL Director
ERIN MICHAEL President
Rexanne Stafford Director
Susan Ohmer Registered Agent

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
7AT71 Active Non-Manufacturer 2015-01-22 2023-02-06 2027-01-14 2023-02-06

Contact Information
POC SUSAN OHMER
Phone +1 907-772-3332
Address 100 FRAM ST STE 2, PETERSBURG, AK, 99833, 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
PETERSBURG MENTAL HEALTH 403(B) PLAN 2022 920151413 2024-01-29 3
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC.
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address P.O. BOX 1309, PETERSBURG, AK, 998331309

Signature of
Role Plan administrator
Date 2023-12-06
Name of individual signing KATHY O'REAR
Role Employer/plan sponsor
Date 2023-12-06
Name of individual signing KATHY O'REAR
PETERSBURG MENTAL HEALTH 403(B) PLAN 2021 920151413 2023-01-16 18
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC.
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address P.O. BOX 1309, PETERSBURG, AK, 998331309

Signature of
Role Plan administrator
Date 2022-11-14
Name of individual signing KATHY O'REAR
Role Employer/plan sponsor
Date 2022-11-14
Name of individual signing KATHY O'REAR
PETERSBURG MENTAL HEALTH 403(B) PLAN 2020 920151413 2022-01-31 20
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC.
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address P.O. BOX 1309, PETERSBURG, AK, 998331309

Signature of
Role Plan administrator
Date 2022-01-05
Name of individual signing KATHY O'REAR
Role Employer/plan sponsor
Date 2022-01-05
Name of individual signing KATHY O'REAR
PETERSBURG MENTAL HEALTH 403(B) PLAN 2019 920151413 2021-01-27 20
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC.
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address P.O. BOX 1309, PETERSBURG, AK, 99833

Signature of
Role Plan administrator
Date 2021-01-14
Name of individual signing KATHY O'REAR
PETERSBURG MENTAL HEALTH 403(B) PLAN 2018 920151413 2020-01-21 20
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC.
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address P.O. BOX 1309, PETERSBURG, AK, 99833

Signature of
Role Plan administrator
Date 2020-01-20
Name of individual signing KATHY O'REAR
PETERSBURG MENTAL HEALTH 403(B) PLAN 2017 920151413 2019-01-28 19
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address PO BOX 1309, PETERSBURG, AK, 99833

Signature of
Role Plan administrator
Date 2019-01-28
Name of individual signing KATHY O'REAR
PETERSBURG MENTAL HEALTH 403(B) PLAN 2016 920151413 2017-10-24 32
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address PO BOX 1309, PETERSBURG, AK, 99833

Signature of
Role Plan administrator
Date 2017-10-24
Name of individual signing KATHY O'REAR
PETERSBURG MENTAL HEALTH 403(B) PLAN 2015 920151413 2017-01-19 30
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address PO BOX 1309, PETERSBURG, AK, 99833

Signature of
Role Plan administrator
Date 2017-01-19
Name of individual signing KATHY O'REAR
PETERSBURG MENTAL HEALTH 403(B) PLAN 2014 920151413 2015-10-21 16
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address PO BOX 1309, PETERSBURG, AK, 99833

Signature of
Role Plan administrator
Date 2015-10-21
Name of individual signing KATHY O'REAR
PETERSBURG MENTAL HEALTH 403(B) PLAN 2013 920151413 2015-04-13 16
File View Page
Three-digit plan number (PN) 101
Effective date of plan 1996-10-28
Sponsor PETERSBURG MENTAL HEALTH SERVICES, INC
Business code 621330
Sponsor’s telephone number 9077723332
Plan sponsor’s address PO BOX 1309, PETERSBURG, AK, 99833

Signature of
Role Plan administrator
Date 2015-04-13
Name of individual signing FRAN JONES

Business Licenses

License Number Type Status Issue Date Date of renewal Expiration date Description
972075 Business License Active 2012-03-27 2023-10-06 2025-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621498 - ALL OTHER OUTPATIENT CARE CENTERS

Professional Licenses

License Number Program Type Status Issue Date Effective Date Expiration Date
126347 Telemedicine Business Registry Telemedicine Business Registry Active 2017-09-07 2017-09-07 -

Date of last update: 24 Jan 2025

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

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