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  5. BETHEL FAMILY CLINIC

BETHEL FAMILY CLINIC

Company Details

Name: BETHEL FAMILY CLINIC
Jurisdiction: Alaska
Legal type: Nonprofit Corporation
Status: Good Standing
Date of registration: 01 Nov 1982 (42 years ago)
Entity Number: 28260D
ZIP code: 99559
County: Bethel
Place of Formation: ALASKA
Address: 631 MAIN ST, BETHEL, AK 99559
Mailing Address: PO BOX 1908, BETHEL, AK 99559-1908

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621498 ALL OTHER OUTPATIENT CARE CENTERS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
YLNGDQKYAT95 2025-04-03 631 MAIN ST, BETHEL, AK, 99559, USA BOX 1908, BETHEL, AK, 99559, 1908, USA

Business Information
URL www.bethelfamilyclinic.org
Division Name BETHEL FAMILY CLINIC
Congressional District 00
State/Country of Incorporation AK, USA
Activation Date 2024-04-05
Initial Registration Date 2006-08-04
Entity Start Date 1982-11-01
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name MOHAMMAD ENAYET CHOWDHURY
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Title ALTERNATE POC
Name VALERA BRICKEL
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Government Business
Title PRIMARY POC
Name MOHAMMAD ENAYET CHOWDHURY
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Title ALTERNATE POC
Name VALERA BRICKEL
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Past Performance
Title PRIMARY POC
Name MOHAMMAD ENAYET CHOWDHURY
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA
Title ALTERNATE POC
Name VALERA BRICKEL
Address PO BOX 1908, BETHEL, AK, 99559, 1908, USA

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
4HAG0 Obsolete Non-Manufacturer 2006-08-07 2024-04-05 No data 2025-04-03

Contact Information
POC MOHAMMAD ENAYET CHOWDHURY
Phone +1 907-543-9851
Fax +1 907-543-9859
Address 631 MAIN ST, BETHEL, AK, 99559, UNITED STATES

Ownership of Offeror Information
Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SAFE-HARBOR 401(K) PROFIT SHARING PLAN FOR EMPLOYEES OF BETHEL FAMILY CLINIC 2023 920089260 2024-07-08 BETHEL FAMILY CLINIC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2024-07-08
Name of individual signing MOHAMMAD ENAYET CHOWDHURY
SAFE-HARBOR 401(K) PROFIT SHARING PLAN FOR EMPLOYEES OF BETHEL FAMILY CLINIC 2022 920089260 2023-07-06 BETHEL FAMILY CLINIC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2023-07-06
Name of individual signing MOHAMMAD ENAYET CHOWDHURY
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2021 920089260 2022-08-30 BETHEL FAMILY CLINIC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2022-08-30
Name of individual signing MOHAMMAD ENAYET CHOWDHURY
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2020 920089260 2021-02-25 BETHEL FAMILY CLINIC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2021-02-25
Name of individual signing DON BLACK
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2019 920089260 2020-07-29 BETHEL FAMILY CLINIC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2020-07-29
Name of individual signing DON BLACK
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2018 920089260 2019-06-14 BETHEL FAMILY CLINIC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2019-06-14
Name of individual signing MARY LARAUX
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC 2017 920089260 2018-10-05 BETHEL FAMILY CLINIC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address PO BOX 1908, BETHEL, AK, 995591908

Signature of
Role Plan administrator
Date 2018-10-05
Name of individual signing JEHONA KADRIU
EMPLOYEE BENEFIT PLAN OF BETHEL FAMILY CLINIC BETHEL FAMILY CLINIC 2016 920089260 2017-07-18 BETHEL FAMILY CLINIC 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address 631 MAIN STREET, BETHEL, AK, 99559

Signature of
Role Plan administrator
Date 2017-07-18
Name of individual signing LATESIA GUINN
Role Employer/plan sponsor
Date 2017-07-18
Name of individual signing LATESIA GUINN
BETHEL FAMILY CLINIC 401(K) P/S PLAN 2015 920089260 2016-02-17 BETHEL FAMILY CLINIC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address 631 MAIN ST., BETHEL, AK, 99559

Plan administrator’s name and address
Administrator’s EIN 920089260
Plan administrator’s name BETHEL FAMILY CLINIC
Plan administrator’s address 631 MAIN ST., BETHEL, AK, 99559
Administrator’s telephone number 9075433773

Signature of
Role Plan administrator
Date 2016-02-17
Name of individual signing LATESIA GUINN
BETHEL FAMILY CLINIC 401(K) P/S PLAN 2014 920089260 2015-04-16 BETHEL FAMILY CLINIC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621112
Sponsor’s telephone number 9075433773
Plan sponsor’s address 631 MAIN ST., BETHEL, AK, 99559

Plan administrator’s name and address
Administrator’s EIN 920089260
Plan administrator’s name BETHEL FAMILY CLINIC
Plan administrator’s address 631 MAIN ST., BETHEL, AK, 99559
Administrator’s telephone number 9075433773

Signature of
Role Plan administrator
Date 2015-04-16
Name of individual signing LATESIA GUINN

Director

Name Role
Jody Brand Director
Gloria Benson Director
Rebecca Lanham Director
Elondre Johnson Director
Charlene Wuya Director

Vice President

Name Role
Minnie Fritts Vice President

Secretary

Name Role
Jessica Haines Secretary

Registered Agent

Name Role
MOHAMMAD CHOWDHURY Registered Agent

Treasurer

Name Role
SUSAN TAYLOR Treasurer

President

Name Role
Dean Swope President

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 308552 Active 2005-02-09 2022-11-30 2024-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621498 - ALL OTHER OUTPATIENT CARE CENTERS

Related by officers

SUSAN TAYLOR

Laughing Raven Lodge, LLC

Related by address

No related companies by address

Date of last update: 23 Dec 2024

Sources: State of Alaska - Department of Commerce, Community, and Economic Development

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