| Entity Name: | IHS ACQUISITION NO. 103, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit Corporation |
| Status: | Inactive |
| Date Filed: | 21 Nov 1997 (27 years ago) |
| Date of dissolution: | 21 Feb 2012 (13 years ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 21 Feb 2012 (13 years ago) |
| Document Number: | F97000006190 |
| FEI/EIN Number | 52-2066123 |
| Address: | 7150 COLUMBIA GATEWAY DRIVE, SUITE J, COLUMBIA, MD 21046 |
| Mail Address: | 7150 COLUMBIA GATEWAY DRIVE, SUITE J, COLUMBIA, MD 21046 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528131513 | 2006-11-16 | 2007-11-13 | 1350 S NOVA RD, DAYTONA BEACH, FL, 321145812, US | 1350 S NOVA RD, DAYTONA BEACH, FL, 321145812, US | |||||||||||||||||||||||||
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| Phone | +1 386-258-5544 |
| Fax | 3862555623 |
Authorized person
| Name | MR. TIM TRYBUS |
| Role | CFO |
| Phone | 4435392354 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL6110 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 223905 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NICHOLSON, TIMOTHY | Director | 7150 COLUMBIA GATEWAY DRIVE, COLUMBIA, MD 21046 |
| AUMAN, MATTHEW | Director | 7150 COLUMBIA GATEWAY DRIVE, COLUMBIA, MD 21046 |
| Name | Role | Address |
|---|---|---|
| POOLE, JOHN | President | 7150 COLUMBIA GATEWAY DRIVE, COLUMBIA, MD 21046 |
| Name | Role | Address |
|---|---|---|
| TRYBUS, TIMOTHY | Treasurer | 7150 COLUMBIA GATEWAY DRIVE, COLUMBIA, MD 21046 |
| Name | Role | Address |
|---|---|---|
| FALLON, JOHN | Secretary | 7150 COLUMBIA GATEWAY DRIVE, COLUMBIA, MD 21046 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2012-02-21 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-01-05 | 7150 COLUMBIA GATEWAY DRIVE, SUITE J, COLUMBIA, MD 21046 | No data |
| CHANGE OF MAILING ADDRESS | 2011-01-05 | 7150 COLUMBIA GATEWAY DRIVE, SUITE J, COLUMBIA, MD 21046 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000740236 | TERMINATED | 1000000311875 | LEON | 2012-10-19 | 2032-10-25 | $ 330.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| Name | Date |
|---|---|
| Withdrawal | 2012-02-21 |
| ANNUAL REPORT | 2011-01-05 |
| ANNUAL REPORT | 2010-01-11 |
| ANNUAL REPORT | 2009-02-05 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-01-23 |
| ANNUAL REPORT | 2006-01-26 |
| ANNUAL REPORT | 2005-02-22 |
| Reg. Agent Change | 2004-10-19 |
| ANNUAL REPORT | 2004-01-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
