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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

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Related by address

No related companies by address

Date of last update: 23 Dec 2024

Sources: Idaho Secretary of State

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