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CAMPBELLTON-GRACEVILLE HOSPITAL CORPORATION - Florida Company Profile

Company Details

Entity Name: CAMPBELLTON-GRACEVILLE HOSPITAL CORPORATION
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 19 Mar 2010 (15 years ago)
Date of dissolution: 28 Sep 2018 (7 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 28 Sep 2018 (7 years ago)
Document Number: N10000002896
FEI/EIN Number 596139709

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 5429 COLLEGE DRIVE, GRACEVILLE, FL, 32440, US
Mail Address: P.O. BOX 231, GRACEVILLE, FL, 32440, US
ZIP code: 32440
County: Jackson
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1306143839 2011-02-18 2011-10-03 5429 COLLEGE DRIVE, SUITE B, GRACEVILLE, FL, 324401858, US 5429 COLLEGE DRIVE, SUITE B, GRACEVILLE, FL, 324401858, US

Contacts

Phone +1 850-263-0639
Fax 8502639726

Authorized person

Name MR. JIMMY B RIGSBY
Role ADMINISTRATOR
Phone 8502634431

Taxonomy

Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes
Taxonomy Code 363LF0000X - Family Nurse Practitioner
Is Primary No

Other Provider Identifiers

Issuer MEDICAID
Number 003227500(RHC)
State FL
Issuer MEDICAID
Number 003227501
State FL
Issuer MEDICAID
Number 003227500
State FL

Key Officers & Management

Name Role Address
HICKS HESTON Chairman 1106 1st AVE, GRACEVILLE, FL, 32440
PELHAM PAT Boar 5228 SMOKEY ROAD, GRACEVILLE, FL, 32440
JERNIGAN CHRIS Boar 1141 10th AVE, GRACEVILLE, FL, 32440
JORDAN MICHELLE B Agent 15112 HWY 90, CHIPLEY, FL, 32428

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 - -
REINSTATEMENT 2017-10-23 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2017-09-22 - -
CHANGE OF MAILING ADDRESS 2015-09-08 5429 COLLEGE DRIVE, GRACEVILLE, FL 32440 -
REGISTERED AGENT NAME CHANGED 2015-09-08 JORDAN, MICHELLE BLANKENSHIP -
REGISTERED AGENT ADDRESS CHANGED 2015-09-08 15112 HWY 90, CHIPLEY, FL 32428 -

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J19000582666 ACTIVE 1000000838856 JACKSON 2019-08-26 2029-08-28 $ 70,763.42 STATE OF FLORIDA, DEPARTMENT OF REVENUE, MARIANNA SERVICE CENTER, 4230 LAFAYETTE ST STE D, MARIANNA FL324468231
J16000682835 TERMINATED 1000000724602 LEON 2016-10-17 2026-10-21 $ 7,560.29 STATE OF FLORIDA, DEPARTMENT OF REVENUE, MARIANNA SERVICE CENTER, 4230 LAFAYETTE ST STE D, MARIANNA FL324468231
J16000323992 LAPSED 16000055CAAXMX JACKSON COUNTY CIRCUIT COURT 2015-09-22 2021-05-26 $31,230.76 CANON FINANCIAL SERVICES, INC., 158 GAITHER DRIVE, SUITE 200, MOUNT LAUREL, NJ 08054

Documents

Name Date
REINSTATEMENT 2017-10-23
ANNUAL REPORT 2016-03-08
ANNUAL REPORT 2015-09-08
ANNUAL REPORT 2014-02-11
ANNUAL REPORT 2013-03-22
ANNUAL REPORT 2012-02-09
ANNUAL REPORT 2011-07-05
Domestic Non-Profit 2010-03-19

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
59-6139709 Corporation Unconditional Exemption 5429 COLLEGE DR, GRACEVILLE, FL, 32440-1858 1993-11
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period -
Asset 1,000,000 to 4,999,999
Income 1,000,000 to 4,999,999
Filing Requirement 990 - Not required to file (all other)
PF Filing Requirement No 990-PF return
Accounting Period Sep
Asset Amount -
Income Amount -
Form 990 Revenue Amount -
National Taxonomy of Exempt Entities Health Care: Hospitals and Related Primary Medical Care Facilities
Sort Name -

Publication 78 Data

Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Date of last update: 02 Apr 2025

Sources: Florida Department of State