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ADAMS COUNTY HEALTH CENTER, INC.

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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

Director

Name Role Address Appointed On Resigned On
Nello Jenkins Director PO BOX 72, COUNCIL, ID 83612 2020-12-24 2022-12-05
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
Tamera Casey Director 4480 COUNCIL CUPRUM RD, COUNCIL, ID 83612 2024-01-10 No data

Agent

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

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

CAGE Code:
3S3U2
UEI Expiration Date:
2020-10-20

Business Information

Activation Date:
2019-10-21
Initial Registration Date:
2004-03-22

Commercial and government entity program

The The Commercial And Government Entity Code (CAGE) is assigned by the Department of Defense's Defense Logistics Agency (DLA) and represents your company's physical address for GSA's mailings, payments, and administrative records.

Note: A CAGE Code enables a company to contract with the U.S. government, allowing bid on government contracts and to receive government payments. Also for business this means that it's a Verified business entity and Has a validated physical address.

CAGE number:
3S3U2
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2025-06-25
SAM Expiration:
2026-06-23

Contact Information

POC:
WENDY J. MOTT
Corporate URL:
https://achcid.org/

National Provider Identifier

NPI Number:
1164964219

Authorized Person:

Name:
MARY ANN DOMECQ
Role:
CHIEF FINANCIAL OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
333600000X - Pharmacy
Is Primary:
No
Selected Taxonomy:
3336C0003X - Community/Retail Pharmacy
Is Primary:
Yes

Contacts:

Fax:
2082534958

Form 5500 Series

Employer Identification Number (EIN):
208341138
Plan Year:
2023
Number Of Participants:
80
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
73
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
71
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
66
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
63
Sponsors Telephone Number:

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

USAspending Awards / Financial Assistance

Date:
2023-08-28
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2023 BRIDGE ACCESS PROGRAM
Obligated Amount:
15967.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2023-05-18
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2023 EXPANDING COVID-19 VACCINATION
Obligated Amount:
100413.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2022-04-01
Awarding Agency Name:
Department of Agriculture
Transaction Description:
ARP ECONOMIC DEVELOPMENT GRANT FOR RURAL HEALTH CARE FACILITIES
Obligated Amount:
1000000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2021-09-23
Awarding Agency Name:
Department of Agriculture
Transaction Description:
DIRECT COMMUNITY FACILITY LOANS
Obligated Amount:
0.00
Face Value Of Loan:
2065000.00
Total Face Value Of Loan:
2065000.00
Date:
2021-09-20
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
HEALTH CENTER INFRASTRUCTURE SUPPORT
Obligated Amount:
525806.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Tax Exempt

Employer Identification Number (EIN) :
20-8341138
In Care Of Name:
% DENISE LANGSTON-GROVES
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)
Ruling Date:
2007-09
National Taxonomy Of Exempt Entities:
Health Care: Health Treatment Facilities, Primarily Outpatient
Deductibility:
Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Paycheck Protection Program

Date Approved:
2020-04-16
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
360800
Current Approval Amount:
360800
Race:
Unanswered
Ethnicity:
Not Hispanic or Latino
Gender:
Female Owned
Veteran:
Non-Veteran
Forgiveness Amount:
362707.79

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Date of last update: 03 Jul 2025

Sources: Idaho Secretary of State