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  5. ADAMS COUNTY HEALTH CENTER, INC.

ADAMS COUNTY HEALTH CENTER, INC.

Company Details

Name: ADAMS COUNTY HEALTH CENTER, INC.
Jurisdiction: Idaho
Legal type: Non-Profit Corporation (D)
Status: Active-Good Standing
Date of registration: 17 Jan 2007 (18 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 517965
Place of Formation: IDAHO
File Number: 517965
ZIP code: 83612
County: Adams County
Mailing Address: WENDY MOTT PO BOX 428 COUNCIL, ID 83612-0428

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
TLPNVJW7PCJ2 2025-01-09 205 N BERKLEY ST, COUNCIL, ID, 83612, 5015, USA PO BOX 428, COUNCIL, ID, 83612, 0428, USA

Business Information
Congressional District 01
State/Country of Incorporation ID, USA
Activation Date 2024-01-12
Initial Registration Date 2004-03-22
Entity Start Date 1985-01-28
Fiscal Year End Close Date Sep 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name WENDY J MOTT
Role CFO
Address PO BOX 428, COUNCIL, ID, 83612, 0428, USA
Title ALTERNATE POC
Name MENDY STANFORD
Role CEO
Address PO BOX 428, COUNCIL, ID, 83612, 0428, USA
Government Business
Title PRIMARY POC
Name WENDY J MOTT
Role CFO
Address PO BOX 428, COUNCIL, ID, 83612, USA
Title ALTERNATE POC
Name MENDY STANFORD
Role CEO
Address PO BOX 428, COUNCIL, ID, 83612, 0428, USA
Past Performance
Title PRIMARY POC
Name MARY ANN DOMECQ
Role CFO
Address PO BOX 428, COUNCIL, ID, 83612, USA
Title ALTERNATE POC
Name KIM SMITH
Role CEO
Address PO BOX 428, COUNCIL, ID, 83612, 0428, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2023 208341138 2024-07-11 ADAMS COUNTY HEALTH CENTER, INC. 80
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address PO BOX 428, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2024-07-11
Name of individual signing WENDY MOTT
Valid signature Filed with authorized/valid electronic signature
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2022 208341138 2023-09-05 ADAMS COUNTY HEALTH CENTER, INC. 73
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address PO BOX 428, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2023-09-05
Name of individual signing WENDY MOTT
Valid signature Filed with authorized/valid electronic signature
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2021 208341138 2022-07-06 ADAMS COUNTY HEALTH CENTER, INC. 71
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address PO BOX 428, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2022-07-06
Name of individual signing MARYANN DOMECQ
Valid signature Filed with authorized/valid electronic signature
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2020 208341138 2021-07-19 ADAMS COUNTY HEALTH CENTER, INC. 66
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address 205 N. BERKLEY, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2021-07-19
Name of individual signing MARYANN DOMECQ
Valid signature Filed with authorized/valid electronic signature
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2019 208341138 2020-05-04 ADAMS COUNTY HEALTH CENTER, INC. 63
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address 205 N. BERKLEY, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2020-05-04
Name of individual signing MARYANN DOMECQ
Valid signature Filed with authorized/valid electronic signature
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2018 208341138 2019-07-08 ADAMS COUNTY HEALTH CENTER, INC. 61
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address 205 N. BERKLEY, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2019-07-08
Name of individual signing MARYANN DOMECQ
Valid signature Filed with authorized/valid electronic signature
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2017 208341138 2018-06-07 ADAMS COUNTY HEALTH CENTER, INC. 55
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address 205 N. BERKLEY, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2018-06-07
Name of individual signing MARYANN DOMEC
Valid signature Filed with authorized/valid electronic signature
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2016 208341138 2017-06-12 ADAMS COUNTY HEALTH CENTER, INC. 47
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address 205 N. BERKLEY, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2017-06-12
Name of individual signing MARY ANN DOMECQ
Valid signature Filed with authorized/valid electronic signature
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2015 208341138 2016-06-21 ADAMS COUNTY HEALTH CENTER, INC. 41
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address 205 N. BERKLEY, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2016-06-21
Name of individual signing MARY ANN DOMECQ
Valid signature Filed with authorized/valid electronic signature
ADAMS COUNTY HEALTH CENTER, INC. 403(B) PLAN 2014 208341138 2015-05-14 ADAMS COUNTY HEALTH CENTER, INC. 36
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621399
Sponsor’s telephone number 2082534242
Plan sponsor’s address 205 N. BERKLEY, COUNCIL, ID, 83612

Signature of
Role Plan administrator
Date 2015-05-14
Name of individual signing DENISE LANGSTON-GROVES
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Mendy Stanford Agent 205 N BERKLEY ST, COUNCIL, ID 83612

Director

Name Role Address Appointed On Resigned On
Nello Jenkins Director PO BOX 72, COUNCIL, ID 83612 2020-12-24 2022-12-05
Doris Crossley Director 1684 GOODRICH CREEK ROAD, COUNCIL, ID 83612 2022-12-05 No data
Pam Anderson Director 1689 GOODRICH CREEK, COUNCIL, ID 83612 2024-01-10 2024-01-10
Heather Lawrence Director PO BOX 648, COUNCIL, ID 83612 2024-01-10 2024-01-10
Vicki White Director 3713 HWY 95, NEW MEADOWS, ID 83654 2024-01-10 2024-01-10
Edward Kalinowski Director PO BOX 127, NEW MEADOWS, ID 83654 2024-01-10 2024-01-10
Charlie Veselka Director 2378 S GRAYS CREEK RD, INDIAN VALLEY, ID 83632 2024-01-10 2024-01-10
Jack Rubelt Director 2280 OLD HORNET ROAD, COUNCIL, ID 83612 2024-01-10 2024-01-10
Craig White Director 3713 HWY 95, NEW MEADOWS, ID 83654 2024-01-10 No data
John Bonner Director 2009 WIDNER ROAD, MIDVALE, ID 83645 2024-01-10 No data

Filing

Filing Name Filing Number Filing date
Annual Report 0005999119 2024-12-03
Annual Report 0005557587 2024-01-10
Annual Report 0005010559 2022-12-05
Annual Report 0004538759 2021-12-23
Annual Report 0004107294 2020-12-24
Annual Report 0003730508 2020-01-06
Annual Report 0003399797 2019-01-17
Annual Report 0003109469 2018-01-17
Change of Registered Office/Agent/Both (by Entity) 0003109467 2017-01-26
Annual Report 0003109466 2017-01-17

USAspending Awards. Financial Assistance

FAIN Awarding Agency Assistance Listings Start Date End Date Description
C81CS13542 Department of Health and Human Services 93.703 - ARRA – GRANTS TO HEALTH CENTER PROGRAMS 2009-06-29 2011-06-28 ARRA - CAPITAL IMPROVEMENT PROGRAM
Recipient ADAMS COUNTY HEALTH CENTER INC
Recipient Name Raw ADAMS COUNTY HEALTH CENTER, INC.
Recipient UEI TLPNVJW7PCJ2
Recipient DUNS 020924403
Recipient Address 205 NORTH BERKLEY, COUNCIL, ADAMS, IDAHO, 83612, UNITED STATES
Obligated Amount 355035.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
H8BCS12498 Department of Health and Human Services 93.703 - ARRA – GRANTS TO HEALTH CENTER PROGRAMS 2009-03-27 2011-03-26 ARRA - INCREASE SERVICES TO HEALTH CENTERS
Recipient ADAMS COUNTY HEALTH CENTER INC
Recipient Name Raw ADAMS COUNTY HEALTH CENTER, INC.
Recipient UEI TLPNVJW7PCJ2
Recipient DUNS 020924403
Recipient Address 205 NORTH BERKLEY, COUNCIL, ADAMS, IDAHO, 83612, UNITED STATES
Obligated Amount 136961.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
H80CS08329 Department of Health and Human Services 93.224 - CONSOLIDATED HEALTH CENTERS (COMMUNITY HEALTH CENTERS, MIGRANT HEALTH CENTERS, HEALTH CARE FOR THE HOMELESS, PUBLIC HOUSING PRIMARY CARE, AND SCHOOL BASED HEALTH CENTERS) 2007-07-01 2012-11-30 HEALTH CENTER CLUSTER
Recipient ADAMS COUNTY HEALTH CENTER INC
Recipient Name Raw ADAMS COUNTY HEALTH CENTER, INC.
Recipient UEI TLPNVJW7PCJ2
Recipient DUNS 020924403
Recipient Address 205 NORTH BERKLEY, COUNCIL, ADAMS, IDAHO, 83612
Obligated Amount 9606087.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
H80CS04198 Department of Health and Human Services 93.224 - CONSOLIDATED HEALTH CENTERS (COMMUNITY HEALTH CENTERS, MIGRANT HEALTH CENTERS, HEALTH CARE FOR THE HOMELESS, PUBLIC HOUSING PRIMARY CARE, AND SCHOOL BASED HEALTH CENTERS) 2004-12-01 2007-06-30 HEALTH CENTER CLUSTER
Recipient ADAMS COUNTY HEALTH CENTER INC
Recipient Name Raw COUNCIL COMMUNITY HOSPITAL
Recipient UEI TLPNVJW7PCJ2
Recipient DUNS 020924403
Recipient Address PO BOX 428, COUNCIL, ADAMS, IDAHO, 83612
Obligated Amount 336000.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
20-8341138 Corporation Unconditional Exemption PO BOX 428, COUNCIL, ID, 83612-0428 2007-09
In Care of Name % DENISE LANGSTON-GROVES
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2023-09
Asset 5,000,000 to 9,999,999
Income 5,000,000 to 9,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Sep
Asset Amount 7422507
Income Amount 6923274
Form 990 Revenue Amount 6923274
National Taxonomy of Exempt Entities Health Care: Health Treatment Facilities, Primarily Outpatient
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name ADAMS COUNTY HEALTH CENTER INC
EIN 20-8341138
Tax Period 202309
Filing Type E
Return Type 990
File View File
Organization Name ADAMS COUNTY HEALTH CENTER INC
EIN 20-8341138
Tax Period 202209
Filing Type E
Return Type 990
File View File
Organization Name ADAMS COUNTY HEALTH CENTER INC
EIN 20-8341138
Tax Period 202109
Filing Type E
Return Type 990
File View File
Organization Name ADAMS COUNTY HEALTH CENTER INC
EIN 20-8341138
Tax Period 202009
Filing Type E
Return Type 990
File View File
Organization Name ADAMS COUNTY HEALTH CENTER INC
EIN 20-8341138
Tax Period 201909
Filing Type E
Return Type 990
File View File
Organization Name ADAMS COUNTY HEALTH CENTER INC
EIN 20-8341138
Tax Period 201809
Filing Type E
Return Type 990
File View File
Organization Name ADAMS COUNTY HEALTH CENTER INC
EIN 20-8341138
Tax Period 201709
Filing Type E
Return Type 990
File View File
Organization Name ADAMS COUNTY HEALTH CENTER INC
EIN 20-8341138
Tax Period 201609
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3097667210 2020-04-16 1087 PPP 205 N. Berkley, Council, ID, 83612
Loan Status Date 2022-03-19
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 360800
Loan Approval Amount (current) 360800
Undisbursed Amount 0
Franchise Name -
Lender Location ID 96211
Servicing Lender Name Idaho Central CU
Servicing Lender Address 4400 Central Way, CHUBBUCK, ID, 83202-5096
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Council, ADAMS, ID, 83612-0001
Project Congressional District ID-01
Number of Employees 41
NAICS code 621999
Borrower Race Unanswered
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 96211
Originating Lender Name Idaho Central CU
Originating Lender Address CHUBBUCK, ID
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 362707.79
Forgiveness Paid Date 2020-11-03

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Date of last update: 10 Apr 2025

Sources: Idaho Secretary of State

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