| Entity Name: | MADISON COUNTY HOSPITAL HEALTH SYSTEMS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 07 Apr 1983 (42 years ago) |
| Document Number: | 767866 |
| FEI/EIN Number | 592319288 |
| Address: | 224 NW Crane Ave., MADISON, FL, 32340, US |
| Mail Address: | 224 NW Crane Ave., MADISON, FL, 32340, US |
| ZIP code: | 32340 |
| County: | Madison |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083684856 | 2006-01-25 | 2015-01-05 | 224 NW CRANE AVENUE, MADISON, FL, 323401400, US | 224 NW CRANE AVENUE, MADISON, FL, 323401400, US | |||||||||||||||||||||||||
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| Phone | +1 850-973-2271 |
| Fax | 8509732818 |
Authorized person
| Name | MR. PATRICK MCGEE |
| Role | C.F.O. |
| Phone | 8509732271 |
Taxonomy
| Taxonomy Code | 275N00000X - Medicare Defined Swing Bed Hospital Unit |
| License Number | 4346 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 020053100 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MADISON COUNTY MEMORIAL HOSPITAL 401(K) SAVINGS PLAN | 2023 | 592319288 | 2024-10-02 | MADISON COUNTY HOSPITAL HEALTH SYSTEMS, INC. | 140 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-02 |
| Name of individual signing | PATRICK MCGEE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| McGee PATRICK C | Agent | 224 NW Crane Ave., MADISON, FL, 32340 |
| Name | Role | Address |
|---|---|---|
| SALE JAMES | Director | PO BOX 732, MADISON, FL, 32341 |
| HARRIS BEN | Director | 5340 S. SR 53, MADISON, FL, 32340 |
| JOHNSON ANNETTE | Director | 4773 WEST US HWY. 90, MADISON, FL, 32340 |
| Name | Role | Address |
|---|---|---|
| JOSEPH SHIRLEY | Chairman | 111 S.E. TOMPKINS AVENUE, MADISON, FL, 32340 |
| Name | Role | Address |
|---|---|---|
| RICHARDSON ROSA | Secretary | 259 SE BAMBOO TRAIL, MADISON, FL, 32340 |
| Name | Role | Address |
|---|---|---|
| FICO JUANITA | Vice Chairman | 248 NE College Terrace, Madison, FL, 32340 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000038781 | MADISON COUNTY MEMORIAL HOSPITAL | ACTIVE | 2018-03-23 | 2028-12-31 | No data | 224 NW CRANE AVENUE, MADISON, FL, 32340 |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14000553817 | LAPSED | 1000000613107 | MADISON | 2014-04-17 | 2024-05-01 | $ 5,959.17 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKE CITY SERVICE CENTER, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
