| Name: | PRESBYTERIAN HOSPITALITY HOUSE, INC. |
| Jurisdiction: | Alaska |
| Legal type: | Nonprofit Corporation |
| Status: | Good Standing |
| Date of registration: | 01 Apr 1977 (48 years ago) |
| Entity Number: | 16777D |
| ZIP code: | 99701 |
| County: | Fairbanks North Star |
| Place of Formation: | ALASKA |
| Address: | 209 FORTY MILE AVENUE, SUITE 100, FAIRBANKS, AK 99701 |
| Supporting healthcare providers fighting with COVID-19: | $211,446 |
Line of Business
62 Health Care and Social AssistanceNAICS
623990 OTHER RESIDENTIAL CARE FACILITIES| Name | Role |
|---|---|
| Dave Mongold | Director |
| Dave Mongold | President |
| Adam Mokelke | Director |
| Adam Mokelke | Vice President |
| Matt Cooper | Director |
| Melissa Prine Crew | Director |
| Brian Goodlataw-George | Director |
| Misty Dennis | Director |
| Misty Dennis | Secretary |
| Misty Dennis | Treasurer |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | PRESBYTERIAN HOSPITALITY HOUSE, INC., Alabama | 001-094-899 | Alabama |
| Unique Entity ID | Expiration Date | Physical Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GCUHVKNDJBL4 | 2024-08-03 | 209 FORTY MILE AVE, FAIRBANKS, AK, 99701, 3110, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Congressional District | 00 |
| State/Country of Incorporation | AK, USA |
| Activation Date | 2023-08-08 |
| Initial Registration Date | 2007-04-16 |
| Entity Start Date | 1977-01-01 |
| Fiscal Year End Close Date | Jun 30 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | LISA ROCHA |
| Address | 209 FORTY MILE AVENUE, FAIRBANKS, AK, 99701, 3110, USA |
| Title | ALTERNATE POC |
| Name | APRIL DAVISSON |
| Role | ADMINISTRATIVE COORDINATOR |
| Address | 209 FORTY MILE AVENUE, FAIRBANKS, AK, 99701, 3110, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | TYRHEN TIGNER |
| Address | 209 FORTY MILE AVENUE, FAIRBANKS, AK, 99701, 3110, USA |
| Title | ALTERNATE POC |
| Name | LISA ROCHA |
| Address | 209 FORTY MILE AVENUE, FAIRBANKS, AK, 99701, 3110, USA |
| Past Performance | |
|---|---|
| Title | PRIMARY POC |
| Name | TYRHEN TIGNER |
| Address | 209 FORTY MILE AVENUE, FAIRBANKS, AK, 99701, 3110, USA |
| Title | ALTERNATE POC |
| Name | APRIL DAVISSON |
| Role | ADMINISTRATIVE COORDINATOR |
| Address | 209 FORTY MILE AVENUE, FAIRBANKS, AK, 99701, 3110, USA |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4QLU8 | Obsolete | Non-Manufacturer | 2007-04-16 | 2024-07-17 | - | 2025-07-15 | |||||||||||||||
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| POC | TYRHEN TIGNER |
| Phone | +1 907-456-6445 |
| Fax | +1 907-456-6402 |
| Address | 209 FORTY MILE AVE, FAIRBANKS, AK, 99701 3110, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | - |
|---|
| Immediate Level Owner | - |
|---|
| List of Offerors (0) | - |
|---|
| Plan Name | Plan Year | EIN/PN | Received | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PRESBYTERIAN HOSPITALITY HOUSE, INC. | 2010 | 920022770 | 2012-03-10 | 23 | |||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 920022770 |
| Plan administrator’s name | DRENDA TIGNER |
| Plan administrator’s address | 209 FORTY MILE AVE, STE 100, FAIRBANKS, AK, 99701 |
| Administrator’s telephone number | 9074566445 |
Number of participants as of the end of the plan year
| Active participants | 14 |
| Other retired or separated participants entitled to future benefits | 10 |
| Number of participants with account balances as of the end of the plan year | 24 |
Signature of
| Role | Plan administrator |
| Date | 2012-03-02 |
| Name of individual signing | DRENDA TIGNER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1990-01-01 |
| Sponsor | PRESBYTERIAN HOSPITALITY HOUSE INC |
| Business code | 623000 |
| Sponsor’s telephone number | 9074566445 |
| Plan sponsor’s mailing address | 209 FORTY MILE AVE, STE 100, FAIRBANKS, AK, 99701 |
| Plan sponsor’s address | 209 FORTY MILE AVE, STE 100, FAIRBANKS, AK, 99701 |
Plan administrator’s name and address
| Administrator’s EIN | 920022770 |
| Plan administrator’s name | DRENDA TIGNER |
| Plan administrator’s address | 209 FORTY MILE AVE, STE 100, FAIRBANKS, AK, 99701 |
| Administrator’s telephone number | 9074566445 |
Number of participants as of the end of the plan year
| Active participants | 12 |
| Other retired or separated participants entitled to future benefits | 11 |
| Number of participants with account balances as of the end of the plan year | 23 |
Signature of
| Role | Plan administrator |
| Date | 2011-03-22 |
| Name of individual signing | DRENDA TIGNER |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1990-01-01 |
| Sponsor | PRESBYTERIAN HOSPITALITY HOUSE INC |
| Business code | 623000 |
| Sponsor’s telephone number | 9074566445 |
| Plan sponsor’s mailing address | 209 FORTY MILE AVE, STE 100, FAIRBANKS, AK, 99701 |
| Plan sponsor’s address | 209 FORTY MILE AVE, STE 100, FAIRBANKS, AK, 99701 |
Plan administrator’s name and address
| Administrator’s EIN | 920022770 |
| Plan administrator’s name | DRENDA TIGNER |
| Plan administrator’s address | 209 FORTY MILE AVE, STE 100, FAIRBANKS, AK, 99701 |
| Administrator’s telephone number | 9074566445 |
Number of participants as of the end of the plan year
| Active participants | 12 |
| Other retired or separated participants entitled to future benefits | 11 |
| Number of participants with account balances as of the end of the plan year | 23 |
Signature of
| Role | Plan administrator |
| Date | 2011-03-22 |
| Name of individual signing | DRENDA TIGNER |
| Valid signature | Filed with incorrect/unrecognized electronic signature |
| License Number | Type | Status | Issue Date | Date of renewal | Expiration date | Description |
|---|---|---|---|---|---|---|
| 302129 | Business License | Active | 2000-03-06 | 2023-11-29 | 2025-12-31 | LOB: 62 - Health Care and Social Assistance, NAICS: 623990 - OTHER RESIDENTIAL CARE FACILITIES |
| License Number | Program | Type | Status | Issue Date | Effective Date | Expiration Date |
|---|---|---|---|---|---|---|
| 126642 | Telemedicine Business Registry | Telemedicine Business Registry | Active | 2017-09-18 | 2017-09-18 | - |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 344043898 | 1050210 | 2019-06-03 | 779 7TH AVE., FAIRBANKS, AK, 99701 | |||||||||||||||||||||||||||||||||||||||||||||
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| Type | Complaint |
| Activity Nr | 1459716 |
| Safety | Yes |
Violation Items
| Citation ID | 01001 |
| Citaton Type | Other |
| Standard Cited | 19030002 A01 |
| Issuance Date | 2019-11-25 |
| Current Penalty | 0.0 |
| Initial Penalty | 0.0 |
| Final Order | 2019-12-19 |
| Nr Instances | 5 |
| Nr Exposed | 103 |
| Related Event Code (REC) | Complaint |
| FTA Current Penalty | 0.0 |
| Inspection Type | Complaint |
| Scope | Complete |
| Safety/Health | Safety |
| Close Conference | 2019-06-11 |
| Emphasis | S: HEALTHCARE |
| Case Closed | 2019-11-25 |
Related Activity
| Type | Complaint |
| Activity Nr | 1459716 |
| Safety | Yes |
| Inspection Type | Complaint |
| Scope | Complete |
| Safety/Health | Safety |
| Close Conference | 2019-06-11 |
| Emphasis | S: HEALTHCARE |
| Case Closed | 2019-11-25 |
Related Activity
| Type | Complaint |
| Activity Nr | 1459716 |
| Safety | Yes |
| Inspection Type | Complaint |
| Scope | Complete |
| Safety/Health | Safety |
| Close Conference | 2019-06-11 |
| Emphasis | S: HEALTHCARE |
| Case Closed | 2019-11-25 |
Related Activity
| Type | Complaint |
| Activity Nr | 1459716 |
| Safety | Yes |
| Inspection Type | Complaint |
| Scope | Complete |
| Safety/Health | Safety |
| Close Conference | 2019-06-11 |
| Emphasis | S: HEALTHCARE |
| Case Closed | 2019-11-25 |
Related Activity
| Type | Complaint |
| Activity Nr | 1459716 |
| Safety | Yes |
Date of last update: 24 Jan 2025
Sources: State of Alaska - Department of Commerce, Community, and Economic Development
