| Entity Name: | HARMONY HILLS BEHAVIORAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Apr 2020 (5 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 21 Oct 2022 (2 years ago) |
| Document Number: | L20000100388 |
| FEI/EIN Number | 85-0696391 |
| Address: | 18121 BOYS RANCH ROAD, ALTOONA, FL 32702 |
| Mail Address: | P.O. BOX 6703, DELRAY BEACH, FL 33482 |
| ZIP code: | 32702 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700403730 | 2020-06-25 | 2020-11-25 | PO BOX 6703, DELRAY BEACH, FL, 334826703, US | 18307 BOYS RANCH RD, ALTOONA, FL, 327029093, US | |||||||||||||||||||||||||
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| Phone | +1 352-707-1773 |
Authorized person
| Name | MICHAEL ANTHONY CAMPI |
| Role | AUTHORIZED OFFICIAL |
| Phone | 3527071773 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 320800000X - Mental Illness Community Based Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 323P00000X - Psychiatric Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 324500000X - Substance Abuse Rehabilitation Facility |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HARMONY HILLS 401K | 2023 | 850696391 | 2024-07-11 | HARMONY HILLS BEHAVIORAL HEALTH | 71 | |||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-11 |
| Name of individual signing | SHELIA ELLIOTT |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-09-01 |
| Business code | 621420 |
| Sponsor’s telephone number | 7542178127 |
| Plan sponsor’s address | 18121 BOYS RANCH ROAD, ALTOONA, FL, 32702 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-27 |
| Name of individual signing | TARA EVANS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-09-01 |
| Business code | 621420 |
| Sponsor’s telephone number | 9548617260 |
| Plan sponsor’s address | 18121 BOYS RANCH ROAD, ALTOONA, FL, 32702 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | TAG RESOURCES LLC |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-27 |
| Name of individual signing | TARA EVANS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-09-01 |
| Business code | 621420 |
| Sponsor’s telephone number | 9548617260 |
| Plan sponsor’s address | 18121 BOYS RANCH ROAD, ALTOONA, FL, 32702 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | TAG RESOURCES LLC |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2021-09-18 |
| Name of individual signing | SHELIA ELLIOTT |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| GSF GROUP LLC | Agent |
| Name | Role | Address |
|---|---|---|
| WINIKOFF, BENJAMIN | Chief Executive Officer | 18121 BOYS RANCH ROAD, ALTOONA, FL 32702 |
| Name | Role | Address |
|---|---|---|
| THATCHER, EDWARD | Chief Financial Officer | 18121 BOYS RANCH ROAD, ALTOONA, FL 32702 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2022-10-21 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-10-21 | GSF GROUP, LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-10-21 | 433 PLAZA REAL, SUITE 302, STE 351, BOCA RATON, FL 33432 | No data |
| LC STMNT OF RA/RO CHG | 2021-12-06 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2021-07-26 | 18121 BOYS RANCH ROAD, ALTOONA, FL 32702 | No data |
| LC AMENDMENT | 2020-06-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-01-27 |
| CORLCRACHG | 2022-10-21 |
| ANNUAL REPORT | 2022-02-15 |
| CORLCRACHG | 2021-12-06 |
| ANNUAL REPORT | 2021-07-26 |
| LC Amendment | 2020-06-24 |
| Florida Limited Liability | 2020-04-09 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
