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  5. POCATELLO CHILDREN AND ADOLESCENT CLINIC, P.A.

POCATELLO CHILDREN AND ADOLESCENT CLINIC, P.A.

Company Details

Name: POCATELLO CHILDREN AND ADOLESCENT CLINIC, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 28 Dec 1985 (39 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 250670
Place of Formation: IDAHO
File Number: 250670
ZIP code: 83201
County: Bannock County
Mailing Address: JESSICA PERRY 1151 HOSPITAL WAY BLDG F POCATELLO, ID 83201-5091

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
G2M4K8PBEHC7 2022-10-03 1151 HOSPITAL WAY STE F, POCATELLO, ID, 83201, 5091, USA 1151 HOSPITAL WAY STE F, POCATELLO, ID, 83201, 5091, USA

Business Information
Doing Business As (AFF: PORTNEUF MEDICAL CENTER )
Congressional District 02
State/Country of Incorporation ID, USA
Activation Date 2021-09-10
Initial Registration Date 2021-09-03
Entity Start Date 1985-12-28
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name JESSICA L PERRY
Address 1151 HOSPITAL WAY STE F, POCATELLO, ID, 83201, 5091, USA
Title ALTERNATE POC
Name KARIANNE RAMIREZ
Address 1151 HOSPITAL WAY STE F, POCATELLO, ID, 83201, USA
Government Business
Title PRIMARY POC
Name JESSICA L PERRY
Address 1151 HOSPITAL WAY STE F, POCATELLO, ID, 83201, 5091, USA
Title ALTERNATE POC
Name KARIANNE RAMIREZ
Address 1151 HOSPITAL WAY STE F, POCATELLO, ID, 83201, USA
Past Performance
Title PRIMARY POC
Name KARIANNE RAMIREZ
Address 1151 HOSPITAL WAY STE F, POCATELLO, ID, 83201, USA
Title ALTERNATE POC
Name KARIANNE RAMIREZ
Address 1151 HOSPITAL WAY STE F, POCATELLO, ID, 83201, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2023 820401908 2024-08-23 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 51
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2022 820401908 2023-07-26 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 51
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2021 820401908 2022-10-15 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 53
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2020 820401908 2021-10-05 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 54
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2019 820401908 2020-10-15 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 48
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2018 820401908 2019-10-15 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 48
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2017 820401908 2018-07-13 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 46
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2016 820401908 2017-10-12 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 48
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2015 820401908 2016-10-11 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 44
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201
POCATELLO CHILDREN AND ADOLESCENT CLINIC 401K PLAN 2014 820401908 2015-10-14 POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A. 44
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1986-03-01
Business code 621111
Sponsor’s telephone number 2082321443
Plan sponsor’s address 1151 HOSPITAL WAY BLDG. F, POCATELLO, ID, 83201

Plan administrator’s name and address
Administrator’s EIN 820401908
Plan administrator’s name POCATELLO CHILDREN AND ADOLESCENT CLINIC P.A.
Plan administrator’s address 500 S. 11TH AVENUE, SUITE 204, POCATELLO, ID, 83201
Administrator’s telephone number 2022321443

Signature of
Role Plan administrator
Date 2015-10-14
Name of individual signing JESSICA PERRY
Valid signature Filed with authorized/valid electronic signature

President

Name Role Address Appointed On
Matthew Murdoch President 1151 HOSPITAL WAY, BLDG F, 83201, ID 83201 2020-11-05

Director

Name Role Address Appointed On Resigned On
Gentry Yost Director 1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201 2023-11-06 2023-11-06
Don McInturff Director 1151 HOSPITAL WAY, BLDG F, 83201, ID 83201 2023-11-06 2023-11-06
Laura Duty Director 1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201 2023-11-06 2023-11-06
Shaun Summerill Director 1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201 2023-11-06 2023-11-06
Cindy Parsons Director 1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201 2023-11-06 2023-11-06
Matthew Stelzer Director 1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201 2023-11-06 2023-11-06
David Larsen Director 1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201 2023-11-06 2023-11-06

Secretary

Name Role Address Appointed On Resigned On
David Denton Secretary 1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201 2023-11-06 2023-11-06

Vice President

Name Role Address Appointed On Resigned On
Brian Fulks Vice President 1151 HOSPITAL WAY, BLDG F, POCATELLO, ID 83201 2023-11-06 2023-11-06

Agent

Name Role Address
JESSICA PERRY Agent 1151 HOSPITAL WAY, BUILDING F, POCATELLO, ID 83201

Filing

Filing Name Filing Number Filing date
Annual Report 0005969492 2024-11-06
Annual Report 0005466246 2023-11-06
Annual Report 0004970051 2022-11-03
Annual Report 0004478037 2021-11-03
Annual Report 0004060110 2020-11-05
Annual Report 0003703248 2019-12-09
Annual Report 0003365366 2018-12-07
Annual Report 0001946941 2017-10-30
Annual Report 0001946940 2016-12-23
Annual Report 0001946938 2015-10-27

Related by officers

Matthew Murdoch

PCC, LLC St. Paul's Episcopal Church Inc

Gentry Yost

PCC, LLC High Altitude Triathlon Enthusiasts, LLC HATEr Swim Shorts, LLC

Don McInturff

PCC, LLC

David Denton

PCC, LLC

Laura Duty

PCC, LLC

Shaun Summerill

PCC, LLC

Matthew Stelzer

PCC, LLC

David Larsen

PCC, LLC LARSEN LAW PLLC TECHNICAL GLASS SERVICE, INC. LARSEN LAND HOLDINGS, LLC GOSSNER FOODS INC.

JESSICA PERRY

OLYMPUS HEIGHTS HOMEOWNERS ASSOCIATION

Related by address

JESSICA PERRY 1151 HOSPITAL WAY BLDG F POCATELLO, ID 83201-5091

POCATELLO CHILDREN'S CLINIC

Date of last update: 07 Dec 2024

Sources: Idaho Secretary of State

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