| Entity Name: | ADVENTHEALTH POLK SOUTH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 15 Apr 2019 (6 years ago) |
| Document Number: | N19000003976 |
| FEI/EIN Number |
834672945
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 900 HOPE WAY, ALTAMONTE SPRINGS, FL, 32714, US |
| Mail Address: | 900 HOPE WAY, ALTAMONTE SPRINGS, FL, 32714, US |
| ZIP code: | 32714 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033770284 | 2019-06-27 | 2022-05-18 | 410 S 11TH ST, LAKE WALES, FL, 338534203, US | 410 S 11TH ST, LAKE WALES, FL, 338534203, US | |||||||||||||||
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| Phone | +1 863-676-1433 |
| Fax | 8632971867 |
Authorized person
| Name | ALAN JUSTIN HENGESBACH |
| Role | CFO |
| Phone | 8634192260 |
Taxonomy
| Taxonomy Code | 273R00000X - Psychiatric Hospital Unit |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Foltz Robert C | Assi | 26300 Siena Dr., Bonita Springs, FL, 34134 |
| Saunders Mike | Assi | 900 Hope Way, Altamonte Springs, FL, 32714 |
| Harcombe Doug | Director | 900 HOPE WAY, ALTAMONTE SPRINGS, FL, 32714 |
| Hilliard Doug | Director | 601 E Rollins St, Orlando, FL, 32803 |
| Schuman Jessica S | Agent | 14055 Riveredge Drive, Suite 250, Tampa, FL, 33637 |
| Addiscott Lynn | Assi | 900 Hope Way, Altamonte Springs, FL, 32714 |
| Graff Jeff | Assi | 900 Hope Way, Altamonte Springs, FL, 32714 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000042945 | ADVENTHEALTH IMAGING LAKE WALES | ACTIVE | 2023-04-04 | 2028-12-31 | - | 410 SOUTH 11TH STREET, LAKE WALES, FL, 33853 |
| G23000017364 | ADVENTHEALTH WOUND CARE CENTER LAKE WALES | ACTIVE | 2023-02-06 | 2028-12-31 | - | 451 SOUTH 11TH STREET, LAKE WALES, FL, 33853 |
| G23000016870 | ADVENTHEALTH WEST FLORIDA DIVISION | ACTIVE | 2023-02-03 | 2028-12-31 | - | 14055 RIVEREDGE DR, SUITE 250, TAMPA, FL, 33637 |
| G19000072327 | ADVENTHEALTH SPORTS MED & REHAB LAKE WALES | ACTIVE | 2019-06-28 | 2029-12-31 | - | 425 SOUTH 11TH STREET, LAKE WALES, FL, 33853 |
| G19000072320 | ADVENTHEALTH LAB | ACTIVE | 2019-06-28 | 2029-12-31 | - | 410 SOUTH 11TH STREET, LAKE WALES, FL, 33853 |
| G19000072321 | ADVENTHEALTH WOUND CARE LAKE WALES | EXPIRED | 2019-06-28 | 2024-12-31 | - | 451 SOUTH 11TH STREET, LAKE WALES, FL, 33853 |
| G19000067921 | ADVENTHEALTH LAKE WALES | ACTIVE | 2019-06-14 | 2029-12-31 | - | 410 S. 11TH STREET, LAKE WALES, FL, 33853-4203 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-09-09 | Schuman, Jessica S | - |
| REGISTERED AGENT ADDRESS CHANGED | 2022-09-09 | 14055 Riveredge Drive, Suite 250, Tampa, FL 33637 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-01-17 |
| AMENDED ANNUAL REPORT | 2022-09-09 |
| AMENDED ANNUAL REPORT | 2022-05-03 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-21 |
| Reg. Agent Change | 2020-12-11 |
| ANNUAL REPORT | 2020-06-23 |
| Domestic Non-Profit | 2019-04-15 |
| EIN | Type of Organization | Exempt Organization Status | Address | Ruling Date | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 83-4672945 | Association | Unconditional Exemption | 410 S 11TH ST, LAKE WALES, FL, 33853-4203 | 1950-01 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Organization Name | ADVENTHEALTH POLK SOUTH INC |
| EIN | 83-4672945 |
| Tax Period | 202012 |
| Filing Type | E |
| Return Type | 990 |
| File | View File |
| Organization Name | ADVENTHEALTH POLK SOUTH INC |
| EIN | 83-4672945 |
| Tax Period | 201912 |
| Filing Type | E |
| Return Type | 990 |
| File | View File |
| Organization Name | ADVENTHEALTH POLK SOUTH INC |
| EIN | 83-4672945 |
| Tax Period | 201912 |
| Filing Type | P |
| Return Type | 990 |
| File | View File |
Date of last update: 02 Mar 2025
Sources: Florida Department of State
