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  5. BAYCARE ALLIANT HOSPITAL, INC.

BAYCARE ALLIANT HOSPITAL, INC.

Company Details

Entity Name: BAYCARE ALLIANT HOSPITAL, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Not For Profit Corporation
Status: Active
Date Filed: 09 Feb 2004 (21 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 08 Oct 2013 (11 years ago)
Document Number: N04000001310
FEI/EIN Number 05-0615150
Address: 601 MAIN STREET, MS #402, DUNEDIN, FL 34698
Mail Address: 601 MAIN STREET, MS #402, DUNEDIN, FL 34698
ZIP code: 34698
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1174716955 2007-08-24 2019-11-21 601 MAIN ST, MAILSTOP 402, DUNEDIN, FL, 346985848, US 601 MAIN ST, MAILSTOP 402, DUNEDIN, FL, 346985848, US

Contacts
Phone +1 727-281-9479
Fax 7277346486
Phone +1 727-734-6302

Authorized person
Name MS. ANITA RUSSELL
Role EXECUTIVE DIRECTOR
Phone 7277346302

Taxonomy
Taxonomy Code 282E00000X - Long Term Care Hospital
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BAYCARE ALLIANT RETIREMENT PLAN 2013 050615150 2014-04-08 BAYCARE ALLIANT HOSPITAL, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 7277346302
Plan sponsor’s mailing address 601 MAIN STREET, DUNEDIN, FL, 34698
Plan sponsor’s address 601 MAIN STREET, DUNEDIN, FL, 34698

Plan administrator’s name and address
Administrator’s EIN 050615150
Plan administrator’s name BAYCARE ALLIANT HOSPITAL, INC.
Plan administrator’s address 601 MAIN STREET, DUNEDIN, FL, 34698
Administrator’s telephone number 7277346302

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 0
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 0
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 2014-04-08
Name of individual signing DARLENE SHELTON
Valid signature Filed with authorized/valid electronic signature
BAYCARE ALLIANT RETIREMENT PLAN 2012 050615150 2013-04-29 BAYCARE ALLIANT HOSPITAL, INC. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 7277346302
Plan sponsor’s mailing address 601 MAIN STREET, DUNEDIN, FL, 34698
Plan sponsor’s address 601 MAIN STREET, DUNEDIN, FL, 34698

Plan administrator’s name and address
Administrator’s EIN 050615150
Plan administrator’s name BAYCARE ALLIANT HOSPITAL, INC.
Plan administrator’s address 601 MAIN STREET, DUNEDIN, FL, 34698
Administrator’s telephone number 7277346302

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
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 0
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 2013-04-29
Name of individual signing DARLENE SHELTON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-29
Name of individual signing DARLENE SHELTON
Valid signature Filed with authorized/valid electronic signature
BAYCARE ALLIANT RETIREMENT PLAN 2011 050615150 2012-05-04 BAYCARE ALLIANT HOSPITAL, INC. 103
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 7277346782
Plan sponsor’s mailing address 601 MAIN STREET, DUNEDIN, FL, 34698
Plan sponsor’s address 601 MAIN STREET, DUNEDIN, FL, 34698

Plan administrator’s name and address
Administrator’s EIN 050615150
Plan administrator’s name BAYCARE ALLIANT HOSPITAL, INC.
Plan administrator’s address 601 MAIN STREET, DUNEDIN, FL, 34698
Administrator’s telephone number 7277346782

Number of participants as of the end of the plan year
Active participants 7
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 132
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 132
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 2012-05-04
Name of individual signing DARLENE SHELTON
Valid signature Filed with authorized/valid electronic signature
BAYCARE ALLIANT RETIREMENT PLAN 2010 050615150 2011-04-08 BAYCARE ALLIANT HOSPITAL, INC. 88
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 7277346302
Plan sponsor’s mailing address 601 MAIN STREET, DUNEDIN, FL, 34698
Plan sponsor’s address 601 MAIN STREET, DUNEDIN, FL, 34698

Plan administrator’s name and address
Administrator’s EIN 050615150
Plan administrator’s name BAYCARE ALLIANT HOSPITAL, INC.
Plan administrator’s address 601 MAIN STREET, DUNEDIN, FL, 34698
Administrator’s telephone number 7277346302

Number of participants as of the end of the plan year
Active participants 80
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 23
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 102
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 22

Signature of
Role Plan administrator
Date 2011-04-08
Name of individual signing DARLENE SHELTON
Valid signature Filed with authorized/valid electronic signature
BAYCARE ALLIANT RETIREMENT PLAN 2009 050615150 2010-04-12 BAYCARE ALLIANT HOSPITAL, INC. 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 7277346302
Plan sponsor’s mailing address 601 MAIN STREET, DUNEDIN, FL, 34698
Plan sponsor’s address 601 MAIN STREET, DUNEDIN, FL, 34698

Plan administrator’s name and address
Administrator’s EIN 050615150
Plan administrator’s name BAYCARE ALLIANT HOSPITAL, INC.
Plan administrator’s address 601 MAIN STREET, DUNEDIN, FL, 34698
Administrator’s telephone number 7277346302

Number of participants as of the end of the plan year
Active participants 73
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 15
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 83
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 15

Signature of
Role Plan administrator
Date 2010-04-12
Name of individual signing DARLENE SHELTON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Perez, Maya Agent 601 MAIN STREET, MS #402, DUNEDIN, FL 34698

Director

Name Role Address
Brethauer, Jon Director 611 Druid Road East, 105 CLEARWATER, FL 33756
HAMILTON, KEN Director 10 BAY ESPLANADE, CLEARWATER, FL 34630
Soriano, Su Director 2851 Tampa Road, Palm Harbor, FL 34684
May, Brandon Director 6600 Madison Street, New Port Richey, FL 34652
Beamon, Ron Director 2985 Drew Street, Clearwater, FL 33759

Chairman

Name Role Address
HOLDERITH, ALAN Chairman 620 DREW STREET, CLEARWATER, FL 33755

Secretary

Name Role Address
Robinson, Charles Secretary 901 Chestnut Street, C Clearwater, FL 33756

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2024-04-01 Perez, Maya No data
REINSTATEMENT 2013-10-08 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2013-09-27 No data No data
CHANGE OF PRINCIPAL ADDRESS 2008-04-16 601 MAIN STREET, MS #402, DUNEDIN, FL 34698 No data
CHANGE OF MAILING ADDRESS 2008-04-16 601 MAIN STREET, MS #402, DUNEDIN, FL 34698 No data
REGISTERED AGENT ADDRESS CHANGED 2008-04-16 601 MAIN STREET, MS #402, DUNEDIN, FL 34698 No data
AMENDMENT AND NAME CHANGE 2007-08-16 BAYCARE ALLIANT HOSPITAL, INC. No data

Documents

Name Date
ANNUAL REPORT 2024-04-01
ANNUAL REPORT 2023-03-07
AMENDED ANNUAL REPORT 2022-04-25
ANNUAL REPORT 2022-03-25
ANNUAL REPORT 2021-01-20
ANNUAL REPORT 2020-06-17
ANNUAL REPORT 2019-04-26
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-02-06
ANNUAL REPORT 2016-03-01

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Related by address

No related companies by address

Date of last update: 05 Jan 2025

Sources: Florida Department of State

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