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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

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
300204898 1032500 1997-07-15 500 S. 11TH AVENUE, POCATELLO, ID, 83205
Inspection Type Complaint
Scope Complete
Safety/Health Health
Close Conference 1997-07-15
Case Closed 1997-10-02

Related Activity
Type Complaint
Activity Nr 200223915
Safety Yes
Health Yes

Violation Items
Citation ID 01001A
Citaton Type Serious
Standard Cited 19100106 D02 III
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Current Penalty 275.0
Initial Penalty 525.0
Nr Instances 1
Nr Exposed 3
Gravity 01
Citation ID 01001B
Citaton Type Serious
Standard Cited 19100106 D05 III
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 3
Gravity 01
Citation ID 02001
Citaton Type Other
Standard Cited 19040002 A
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 30
Gravity 00
Citation ID 02002
Citaton Type Other
Standard Cited 19101030 C01 IIB
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 2
Nr Exposed 30
Related Event Code (REC) Complaint
Gravity 01
Citation ID 02003
Citaton Type Other
Standard Cited 19101030 C01 III
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 30
Related Event Code (REC) Complaint
Gravity 01
Citation ID 02004
Citaton Type Other
Standard Cited 19101030 C01 IV
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 30
Related Event Code (REC) Complaint
Gravity 01
Citation ID 02005
Citaton Type Other
Standard Cited 19101030 D04 I
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 30
Related Event Code (REC) Complaint
Gravity 01
Citation ID 02006
Citaton Type Other
Standard Cited 19101030 G02 IIC
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 30
Related Event Code (REC) Complaint
Gravity 01
Citation ID 02007
Citaton Type Other
Standard Cited 19101200 E01
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 30
Gravity 01
Citation ID 02008
Citaton Type Other
Standard Cited 19101200 E01 I
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 30
Gravity 01
Citation ID 02009
Citaton Type Other
Standard Cited 19101200 G08
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 30
Gravity 01
Citation ID 02010
Citaton Type Other
Standard Cited 19101200 H01 I
Issuance Date 1997-08-08
Abatement Due Date 1997-09-25
Nr Instances 1
Nr Exposed 30
Gravity 01

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
7529837009 2020-04-07 1087 PPP 1151 Hospital Way Building F, POCATELLO, ID, 83201-2763
Loan Status Date 2021-02-05
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 522800
Loan Approval Amount (current) 514000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 20158
Servicing Lender Name Bank of Idaho
Servicing Lender Address 399 N Capital Ave, IDAHO FALLS, ID, 83402-3632
Rural or Urban Indicator U
Hubzone Y
LMI N
Business Age Description New Business or 2 years or less
Project Address POCATELLO, BANNOCK, ID, 83201-2763
Project Congressional District ID-02
Number of Employees 42
NAICS code 621111
Borrower Race White
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 20158
Originating Lender Name Bank of Idaho
Originating Lender Address IDAHO FALLS, ID
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 517731.78
Forgiveness Paid Date 2021-01-07

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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: 10 Mar 2025

Sources: Idaho Secretary of State

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