| Name: | PacificSource Community Health Plans, Inc. |
| Jurisdiction: | Idaho |
| Legal type: | Foreign Nonprofit Corporation |
| Status: | Active-Good Standing |
| Date of registration: | 17 Jan 2020 (5 years ago) |
| Financial Date End: | 31 Jan 2025 |
| Entity Number: | 3749315 |
| Place of Formation: | OREGON |
| File Number: | 695317 |
| Principal Address: | LEGAL DEPT 2965 NE CONNERS AVENUE BEND, OR 97701 |
| Mailing Address: | LEGAL DEPT PO BOX 7068 SPRINGFIELD, OR 97475-0068 |
| Name | Role | Address |
|---|---|---|
| MERRI HELMS | Agent | 408 E PARKCENTER BLVD, SUITE 100, BOISE, ID 83706 |
| Name | Role | Address | Appointed On |
|---|---|---|---|
| Kristin Kernutt | Secretary | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-04-03 |
| Name | Role | Address | Appointed On | Resigned On |
|---|---|---|---|---|
| Kenneth Provencher | President | PO BOX 7068, SPRINGFIELD, OR 97477 | 2020-12-03 | 2023-04-03 |
| John Espinola MD | President | PO BOX 7068, SPRINGFIELD, OR 97475 | 2023-12-11 | No data |
| Name | Role | Address | Appointed On |
|---|---|---|---|
| Jeff Barber | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| Rick Wright | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| Jack Friedman | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| Claire Spain-Remy | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| David Vinson | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| Mark Werner | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| Divya Sharma | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| George Brown | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| Patricia Schmitt | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| Roger Saydack | Director | PO BOX 7068, SPRINGFIELD, OR 97477 | 2023-12-11 |
| Filing Name | Filing Number | Filing date |
|---|---|---|
| Annual Report | 0005507565 | 2023-12-11 |
| Annual Report Amendment | 0005176395 | 2023-04-03 |
| Annual Report | 0005011415 | 2022-12-05 |
| Annual Report | 0004512044 | 2021-12-03 |
| Annual Report | 0004083674 | 2020-12-03 |
| Initial Filing | 0003749315 | 2020-01-17 |
Date of last update: 01 Jan 2025
Sources: Idaho Secretary of State
