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  5. CHIPOLA MEDICAL ASSOCIATES, LLC

CHIPOLA MEDICAL ASSOCIATES, LLC

Company Details

Entity Name: CHIPOLA MEDICAL ASSOCIATES, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 05 May 2017 (8 years ago)
Document Number: L17000100876
FEI/EIN Number 82-1533907
Address: 4215 KELSON AVENUE, MARIANNA, FL, 32446, US
Mail Address: PO BOX 5788, MARIANNA, FL, 32447, US
ZIP code: 32446
County: Jackson
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1346778263 2017-05-24 2019-01-22 4215 - E KELSON AVE, MARIANNA, FL, 32446, US 4215 - E KELSON AVE, MARIANNA, FL, 32446, US

Contacts
Phone +1 850-526-3434
Fax 8505263434

Authorized person
Name JOE H. GAY
Role MANAGING MEMBER
Phone 8505263434

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CHIPOLA MEDICAL ASSOCIATES 401(K) PLAN 2023 821533907 2024-01-22 CHIPOLA MEDICAL ASSOCIATES, LLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8505263434
Plan sponsor’s address 4215 KELSON AVENUE, SUITE E, MARIANNA, FL, 32446

Signature of
Role Plan administrator
Date 2024-01-22
Name of individual signing JOE GAY
Valid signature Filed with authorized/valid electronic signature
CHIPOLA MEDICAL ASSOCIATES 401(K) PLAN 2023 821533907 2024-06-25 CHIPOLA MEDICAL ASSOCIATES, LLC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8505263434
Plan sponsor’s address 4215 KELSON AVENUE, SUITE E, MARIANNA, FL, 32446

Signature of
Role Plan administrator
Date 2024-06-25
Name of individual signing JOE GAY
Valid signature Filed with authorized/valid electronic signature
CHIPOLA MEDICAL ASSOCIATES 401(K) PLAN 2022 821533907 2023-05-30 CHIPOLA MEDICAL ASSOCIATES, LLC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8505263434
Plan sponsor’s address 4215 KELSON AVENUE, SUITE E, MARIANNA, FL, 32446

Signature of
Role Plan administrator
Date 2023-05-30
Name of individual signing JOE GAY
Valid signature Filed with authorized/valid electronic signature
CHIPOLA MEDICAL ASSOCIATES 401(K) PLAN 2021 821533907 2022-03-15 CHIPOLA MEDICAL ASSOCIATES, LLC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8505263434
Plan sponsor’s address 4215 KELSON AVENUE, SUITE E, MARIANNA, FL, 32446

Signature of
Role Plan administrator
Date 2022-03-15
Name of individual signing JOE GAY
Valid signature Filed with authorized/valid electronic signature
CHIPOLA MEDICAL ASSOCIATES 401(K) PLAN 2020 821533907 2021-08-11 CHIPOLA MEDICAL ASSOCIATES, LLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8505263434
Plan sponsor’s address 4215 KELSON AVENUE, SUITE E, MARIANNA, FL, 32446

Signature of
Role Plan administrator
Date 2021-08-11
Name of individual signing JOE GAY
Valid signature Filed with authorized/valid electronic signature
CHIPOLA MEDICAL ASSOCIATES 401(K) PLAN 2019 821533907 2020-05-22 CHIPOLA MEDICAL ASSOCIATES, LLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8505263434
Plan sponsor’s address 4215 KELSON AVENUE, SUITE E, MARIANNA, FL, 32446

Signature of
Role Plan administrator
Date 2020-05-22
Name of individual signing JOE GAY
Valid signature Filed with authorized/valid electronic signature
CHIPOLA MEDICAL ASSOCIATES 401(K) PLAN 2018 821533907 2019-10-10 CHIPOLA MEDICAL ASSOCIATES, LLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8505263434
Plan sponsor’s address 4215 KELSON AVENUE, SUITE E, MARIANNA, FL, 324461939

Signature of
Role Plan administrator
Date 2019-10-10
Name of individual signing JOE GAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-10
Name of individual signing JOE GAY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GAY JOE H Agent 4215 KELSON AVENUE, MARIANNA, FL, 32446

Manager

Name Role Address
GAY JOE H Manager 4215 KELSON AVENUE, MARIANNA, FL, 32446

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2020-01-17 4215 KELSON AVENUE, SUITE E, MARIANNA, FL 32446 No data
CHANGE OF PRINCIPAL ADDRESS 2019-01-31 4215 KELSON AVENUE, SUITE E, MARIANNA, FL 32446 No data

Documents

Name Date
ANNUAL REPORT 2024-01-29
ANNUAL REPORT 2023-03-07
ANNUAL REPORT 2022-04-06
ANNUAL REPORT 2021-04-30
ANNUAL REPORT 2020-01-17
ANNUAL REPORT 2019-04-30
ANNUAL REPORT 2018-04-27
Florida Limited Liability 2017-05-05

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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