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  5. XINIM CORPORATION

XINIM CORPORATION

Company Details

Entity Name: XINIM CORPORATION
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 19 Apr 1983 (42 years ago)
Document Number: G33883
FEI/EIN Number 592280609
Address: % THOMAS E HILL, 1702 RIDGEWOOD AVENUE, HOLLY HILL, FL, 32117, US
Mail Address: % THOMAS E HILL, 1702 RIDGEWOOD AVENUE, HOLLY HILL, FL, 32117, US
ZIP code: 32117
County: Volusia
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1932109667 2005-07-22 2021-04-19 1702 RIDGEWOOD AVE, SUITE C, HOLLY HILL, FL, 321175416, US 1702 RIDGEWOOD AVE, SUITE A - G, HOLLY HILL, FL, 321175416, US

Contacts
Phone +1 386-677-7377
Fax 3866770739

Authorized person
Name THOMAS HILL
Role DPT
Phone 3866777377

Taxonomy
Taxonomy Code 251E00000X - Home Health Agency
License Number 299994706
State FL
Is Primary No
Taxonomy Code 251F00000X - Home Infusion Agency
Is Primary No
Taxonomy Code 261QI0500X - Infusion Therapy Clinic/Center
Is Primary No
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
License Number PH9050
State FL
Is Primary No
Taxonomy Code 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME)
License Number PH9050
State FL
Is Primary No
Taxonomy Code 332BX2000X - Oxygen Equipment & Supplies (DME)
License Number PH9050
State FL
Is Primary No
Taxonomy Code 333600000X - Pharmacy
License Number PH 9050
State FL
Is Primary Yes
Taxonomy Code 3336H0001X - Home Infusion Therapy Pharmacy
License Number PH9050
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 103813400
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
XINIM CORPORATION 401(K) PLAN 2023 592280609 2024-05-10 XINIM CORPORATION 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 446110
Sponsor’s telephone number 3869312457
Plan sponsor’s address 1702 RIDGEWOOD AVENUE, STE C, HOLLY HILL, FL, 32117

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-05-10
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
XINIM CORPORATION 401(K) PLAN 2022 592280609 2023-05-27 XINIM CORPORATION 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 446110
Sponsor’s telephone number 3869312457
Plan sponsor’s address 1702 RIDGEWOOD AVENUE, STE C, HOLLY HILL, FL, 32117

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2023-05-27
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
XINIM CORPORATION 401(K) PLAN 2021 592280609 2022-06-02 XINIM CORPORATION 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 446110
Sponsor’s telephone number 3869312457
Plan sponsor’s address 1702 RIDGEWOOD AVENUE, STE C, HOLLY HILL, FL, 32117

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2022-06-02
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
XINIM CORPORATION 401(K) PLAN 2020 592280609 2021-05-04 XINIM CORPORATION 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 446110
Sponsor’s telephone number 3869312457
Plan sponsor’s address 1702 RIDGEWOOD AVENUE, STE C, HOLLY HILL, FL, 32117

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-05-04
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
HILL THOMAS E Agent % THOMAS E HILL, HOLLY HILL, FL, 32117

Chief Executive Officer

Name Role Address
HILL THOMAS E Chief Executive Officer 346 N 12TH ST, FLAGLER BEACH, FL, 32136

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G19000113484 INTELLICARE RX EXPIRED 2019-10-18 2024-12-31 No data 1702 RIDGEWOOD AVE, STE C, HOLLY HILL, FL, 32117
G17000056035 HOLLY HILL PHARMACY HOME INFUSION SERVICES ACTIVE 2017-05-19 2027-12-31 No data 1702 RIDGEWOOD AVE, STE B, HOLLY HILL, FL, 32117
G92175000083 HOLLY HILL PHARMACY ACTIVE 1992-06-23 2027-12-31 No data 1702 RIDGEWOOD AVE., STE C, HOLLY HILL, FL, 32117

Events

Event Type Filed Date Value Description
AMENDMENT 2019-08-12 No data No data

Related by officers

HILL THOMAS E

1018 JEFFERSON, LLC ESPANOLA P38, LLC SURE FIRE YACHT, LLC SOBE MINE, LLC FHENDETTA, LLC XRAY MD, PLLC MY FRIEND THE GENIUS L.L.C.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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