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  5. MEDERI OF PALM BEACH COUNTY, INC.

MEDERI OF PALM BEACH COUNTY, INC.

Company Details

Entity Name: MEDERI OF PALM BEACH COUNTY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 23 Feb 1984 (41 years ago)
Document Number: G86042
FEI/EIN Number 592371759
Address: 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306, US
Mail Address: 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306, US
ZIP code: 33306
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1154317204 2005-09-23 2020-08-22 9510 ORMSBY STATION RD, STE 300, LOUISVILLE, KY, 402234081, US 4723 W ATLANTIC AVE, STE A14, DELRAY BEACH, FL, 334453895, US

Contacts
Phone +1 502-891-1000
Fax 5028918067
Phone +1 561-381-1077
Fax 5614960357

Authorized person
Name MR. C. STEVEN GUENTHNER
Role SR VP, CFO
Phone 5028911000

Taxonomy
Taxonomy Code 251E00000X - Home Health Agency
License Number 20693096
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS-BLUE SHIELD
Number H57
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEDERI OF PALM BEACH COUNTY, INC PROFIT SHARING PLAN 2015 592371759 2017-04-18 MEDERI OF PALM BEACH COUNTY, INC. 21
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-07-01
Business code 561300
Plan sponsor’s address PO BOX 330248, MIAMI, FL, 332330248

Signature of
Role Plan administrator
Date 2017-04-18
Name of individual signing DAVID NESSLEIN
Valid signature Filed with authorized/valid electronic signature
MEDERI OF PALM BEACH COUNTY INC PROFIT SHARING PLAN 2013 592371759 2015-04-14 MEDERI OF PALM BEACH COUNTY, INC 21
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-07-01
Business code 561300
Plan sponsor’s address P.O. BOX 330248, MIAMI, FL, 33233

Signature of
Role Plan administrator
Date 2015-04-14
Name of individual signing DAVID NESSLEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-14
Name of individual signing DAVID NESSLEIN
Valid signature Filed with authorized/valid electronic signature
MEDERI OF PALM BEACH COUNTY, INC. PROFIT SHARING PLAN 2012 592371759 2014-04-15 MEDERI OF PALM BEACH COUNTY, INC. 21
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-07-01
Business code 561300
Plan sponsor’s address P.O. BOX 330248, MIAMI, FL, 33233

Signature of
Role Plan administrator
Date 2014-04-15
Name of individual signing DAVID NESSLEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-04-15
Name of individual signing DAVID NESSLEIN
Valid signature Filed with authorized/valid electronic signature
MEDERI OF PALM BEACH COUNTY INC PROFIT SHARING PLAN 2011 592371759 2013-04-16 MEDERI OF PALM BEACH COUNTY INC 21
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-07-01
Business code 561300
Plan sponsor’s address P.O. BOX 330248, MIAMI, FL, 33233

Plan administrator’s name and address
Administrator’s EIN 592371759
Plan administrator’s name MEDERI OF PALM BEACH COUNTY INC
Plan administrator’s address P.O. BOX 330248, MIAMI, FL, 33233

Signature of
Role Plan administrator
Date 2013-04-16
Name of individual signing DAVID NESSLEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-16
Name of individual signing DAVID NESSLEIN
Valid signature Filed with authorized/valid electronic signature
MEDERI OF PALM BEACH COUNTY INC 2010 592371759 2012-04-17 MEDERI OF PALM BEACH COUNTY INC 23
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 561300
Sponsor’s telephone number 3056885315
Plan sponsor’s mailing address P.O BOX 330248, MIAMI, FL, 33233
Plan sponsor’s address P.O BOX 330248, MIAMI, FL, 33233

Plan administrator’s name and address
Administrator’s EIN 592371759
Plan administrator’s name DAVID NESSLEIN
Plan administrator’s address P.O. BOX 330248, MIAMI, FL, 33233
Administrator’s telephone number 3056685315

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 21
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 21
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-04-17
Name of individual signing DAVID NESSLEIN
Valid signature Filed with authorized/valid electronic signature
MEDERI OF PALM BEACH COUNTY INC PROFIT SHARING PLAN 2009 592371759 2011-04-15 MEDERI OF PALM BEACH COUNTY INC 23
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-07-01
Business code 561300
Sponsor’s telephone number 3056685315
Plan sponsor’s mailing address P.O. BOX 330248, MIAMI, FL, 33233
Plan sponsor’s address P.O. BOX 330248, MIAMI, FL, 33233

Plan administrator’s name and address
Administrator’s EIN 592371759
Plan administrator’s name DAVID NESSLEIN
Plan administrator’s address P.O. BOX 330248, MIAMI, FL, 33233
Administrator’s telephone number 3056685315

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 21
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 21
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-04-15
Name of individual signing DAVID NESSLEIN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GALLAGHER JOHN B Agent 2631 EAST OAKLAND PARK BLVD., FORT LAUDERDALE, FL, 33306

Director

Name Role Address
NESSLEIN, DAVID A. Director 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306
DUFAY SANDRA Director 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306

Secretary

Name Role Address
NESSLEIN, DAVID A. Secretary 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306

Treasurer

Name Role Address
NESSLEIN, DAVID A. Treasurer 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306

President

Name Role Address
DUFAY SANDRA President 2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2009-09-25 No data No data

Related by officers

NESSLEIN, DAVID A.

NATIONAL HEALTH CONSULTANTS MEDERI TEMPORARY SERVICES, INC. PHOENIX HOME CARE, INC.

DUFAY SANDRA

MEDERI OF ORANGE COUNTY, INC. MEDERI, INC. LAKESIDE ASSOCIATES OF LAKE COUNTY, L.C.

GALLAGHER JOHN B

JBRA, LLC ARES ON FOWLER, LLC WATER PIPE RESTORATION TECHNOLOGY, LLC RAJB LLC NATIONAL HEALTH CONSULTANTS GALLAGHER INDUSTRIES, INC. DANCO LEASING, INC. MEDERI OF PINELLAS COUNTY, INC. MEDERI OF MANATEE COUNTY, INC. MEDERI OF COLLIER COUNTY, INC.

Related by address

2631 EAST OAKLAND PARK BLVD., SUITE 201, FORT LAUDERDALE, FL, 33306, US

NATIONAL HEALTH CONSULTANTS MEDERI OF MANATEE COUNTY, INC. MEDERI OF ORANGE COUNTY, INC. MEDERI, INC. SANCO LEASING, INC. LAKESIDE ASSOCIATES OF LAKE COUNTY, L.C. MEDERI OF ALACHUA COUNTY, INC.

Date of last update: 01 Jan 2025

Sources: Florida Department of State

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