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  5. FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC.

FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. - Florida Company Profile

Company Details

Entity Name: FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 17 Oct 1980 (44 years ago)
Date of dissolution: 06 Jan 2014 (11 years ago)
Last Event: CORPORATE MERGER
Event Date Filed: 06 Jan 2014 (11 years ago)
Document Number: 754720
FEI/EIN Number 592086283

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 173 ALBRITTON LN, LAKE CITY, FL, 32055, US
Mail Address: P O BOX 249, LAKE CITY, FL, 32056-7249
ZIP code: 32055
County: Columbia
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1962464248 2006-04-04 2010-10-15 PO BOX 249, LAKE CITY, FL, 320560249, US 173 NW ALBRITTON LN, LAKE CITY, FL, 320550249, US

Contacts
Phone +1 386-758-5552
Fax 3867529143

Authorized person
Name MR. JOHN T MYLES
Role CEO
Phone 3867585552

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number ME92183
State FL
Is Primary No
Taxonomy Code 261Q00000X - Clinic/Center
License Number 5080000065
State FL
Is Primary Yes
Taxonomy Code 363A00000X - Physician Assistant
License Number PA0003548
State FL
Is Primary No
Taxonomy Code 363A00000X - Physician Assistant
License Number PA9101298
State FL
Is Primary No
Taxonomy Code 363L00000X - Nurse Practitioner
License Number 1181972
State FL
Is Primary No
Taxonomy Code 363L00000X - Nurse Practitioner
License Number ARNP2908802
State FL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 023552300
State FL
Issuer MEDICAID
Number 292277100
State FL
Issuer STATE LICENSE
Number ME92183
State FL
Issuer MEDICAID
Number 033364600
State FL
Issuer FLORIDA LICENSE
Number PA9101298
State FL
Issuer ORIGINAL LICENSE
Number 5080000065
State FL
Issuer FLORIDA LICENSE
Number PA0003548
State FL
Issuer FLORIDA LICENSE
Number 1181972
State FL
Issuer MEDICAID
Number 273713200
State FL
Issuer MEDICAID
Number 290374100
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. 403(B) 2011 592086283 2013-04-22 FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-10-01
Business code 621498
Sponsor’s telephone number 3867554020
Plan sponsor’s address P.O. BOX 249, LAKE CITY, FL, 32056

Plan administrator’s name and address
Administrator’s EIN 592086283
Plan administrator’s name FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC.
Plan administrator’s address P.O. BOX 249, LAKE CITY, FL, 32056
Administrator’s telephone number 3867554020

Signature of
Role Plan administrator
Date 2013-04-22
Name of individual signing JOHN MYLES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-22
Name of individual signing JOHN MYLES
Valid signature Filed with authorized/valid electronic signature
FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. 403(B) 2010 592086283 2012-04-27 FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-10-01
Business code 621498
Sponsor’s telephone number 3867554020
Plan sponsor’s address P.O. BOX 249, LAKE CITY, FL, 32056

Plan administrator’s name and address
Administrator’s EIN 592086283
Plan administrator’s name FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC.
Plan administrator’s address P.O. BOX 249, LAKE CITY, FL, 32056
Administrator’s telephone number 3867554020

Signature of
Role Plan administrator
Date 2012-04-27
Name of individual signing JOHN MYLES
Valid signature Filed with authorized/valid electronic signature
FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. 403(B) 2009 592086283 2011-04-14 FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-10-01
Business code 621498
Sponsor’s telephone number 3867554020
Plan sponsor’s address P.O. BOX 249, LAKE CITY, FL, 320560249

Plan administrator’s name and address
Administrator’s EIN 592086283
Plan administrator’s name FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC.
Plan administrator’s address P.O. BOX 249, LAKE CITY, FL, 320560249
Administrator’s telephone number 3867554020

Signature of
Role Plan administrator
Date 2011-04-14
Name of individual signing JOHN MYLES
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
PATTISON DOROTHY Vice President 576 NW SPRING HOLLOW BLVD, LAKE CITY, FL, 32055
HERDEGEN BETTY Secretary 245 SE RACHEL WAY, LAKE CITY, FL, 32025
ALBURY PATRICIA A Treasurer 21298 S. US HWY.441, HIGH SPRINGS,, FL, 32346
SCHAAFSMA C. KEITH President 4451 SW 102ND AVE., LAKE BUTLER, FL, 32054
SCHAAFSMA C. KEITH Director 4451 SW 102ND AVE., LAKE BUTLER, FL, 32054
SCHAAFSMA C. KEITH Agent 4451 SW 102ND AVE., LAKE BUTLER, FL, 32054

Events

Event Type Filed Date Value Description
MERGER 2014-01-06 - CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS N24356. MERGER NUMBER 900000137389
REGISTERED AGENT NAME CHANGED 2011-01-24 SCHAAFSMA, C. KEITH -
REGISTERED AGENT ADDRESS CHANGED 2011-01-24 4451 SW 102ND AVE., LAKE BUTLER, FL 32054 -
CHANGE OF PRINCIPAL ADDRESS 2007-04-02 173 ALBRITTON LN, LAKE CITY, FL 32055 -
CHANGE OF MAILING ADDRESS 1992-03-26 173 ALBRITTON LN, LAKE CITY, FL 32055 -
NAME CHANGE AMENDMENT 1986-06-19 FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. -

Documents

Name Date
ANNUAL REPORT 2013-02-06
ANNUAL REPORT 2012-02-02
ANNUAL REPORT 2011-01-24
ANNUAL REPORT 2010-05-21
ANNUAL REPORT 2010-01-26
ANNUAL REPORT 2009-02-26
ANNUAL REPORT 2008-03-03
ANNUAL REPORT 2007-04-02
ANNUAL REPORT 2006-03-01
ANNUAL REPORT 2005-04-08

USAspending Awards. Financial Assistance

FAIN Awarding Agency Assistance Listings Start Date End Date Description
C81CS13700 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 FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC
Recipient Name Raw FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC
Recipient UEI KJK7MYNQ6N79
Recipient DUNS 796048585
Recipient Address P.O. BOX 249, LAKE CITY, COLUMBIA, FLORIDA, 32056-0249, UNITED STATES
Obligated Amount 402740.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
H80CS00545 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) 2002-06-01 2009-05-31 HEALTH CENTER CLUSTER
Recipient FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC
Recipient Name Raw FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC
Recipient UEI KJK7MYNQ6N79
Recipient DUNS 796048585
Recipient Address POST OFFICE BOX 249, LAKE CITY, COLUMBIA, FLORIDA, 32056
Obligated Amount 4924499.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page

Companies related by officers

No other companies in our directory share the same officers as FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC.

Companies related by address

No other companies in our directory share the same address as FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC.

Date of last update: 01 Mar 2025

Sources: Florida Department of State

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