Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. Calhoun
    4. ›
  4. 32424
    5. ›
  5. CALHOUN-LIBERTY HOSPITAL ASSOCIATION, INC.

CALHOUN-LIBERTY HOSPITAL ASSOCIATION, INC. - Florida Company Profile

Company Details

Entity Name: CALHOUN-LIBERTY HOSPITAL ASSOCIATION, 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: 21 Feb 1991 (34 years ago)
Last Event: CANCEL ADM DISS/REV
Event Date Filed: 20 Dec 2005 (19 years ago)
Document Number: N42167
FEI/EIN Number 593051173

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 20370 NE BURNS AVENUE, BLOUNTSTOWN, FL, 32424, US
Mail Address: 20370 NE BURNS AVENUE, BLOUNTSTOWN, FL, 32424, US
ZIP code: 32424
County: Calhoun
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1588944334 2011-08-25 2024-10-18 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045, US 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045, US

Contacts
Phone +1 850-674-5411
Fax 8506743550

Authorized person
Name EMILY MARLO BROWN
Role CHIEF EXECUTIVE OFFICER
Phone 8506745411

Taxonomy
Taxonomy Code 261QP2300X - Primary Care Clinic/Center
License Number HCC680
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CALHOUN LIBERTY HOSPITAL HUMANA LIFE INSURANCE 2018 539051173 2019-05-13 CALHOUN LIBERTY HOSPITAL ASSOCIATION 92
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2018-02-01
Business code 622000
Sponsor’s telephone number 8506745411
Plan sponsor’s DBA name CALHOUN LIBERTY HOSPITAL
Plan sponsor’s mailing address 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045
Plan sponsor’s address 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045

Number of participants as of the end of the plan year
Active participants 92

Signature of
Role Plan administrator
Date 2019-05-13
Name of individual signing CHARLES STEWARD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-13
Name of individual signing CHARLES STEWARD
Valid signature Filed with authorized/valid electronic signature
CALHOUN LIBERTY HOSPITAL HUMANA LIFE INSURANCE 2017 593051173 2019-05-13 CALHOUN LIBERTY HOSPITAL ASSOCIATION INC 109
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2017-02-01
Business code 622000
Sponsor’s telephone number 8506745411
Plan sponsor’s DBA name CALHOUN LIBERTY HOSPITAL
Plan sponsor’s mailing address 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045
Plan sponsor’s address 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045

Number of participants as of the end of the plan year
Active participants 109

Signature of
Role Plan administrator
Date 2019-05-13
Name of individual signing CHARLES STEWARD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-13
Name of individual signing CHARLES STEWARD
Valid signature Filed with authorized/valid electronic signature
CALHOUN LIBERTY HOSPITAL HUMANA LIFE INSURANCE 2017 593051173 2019-05-13 CALHOUN LIBERTY HOSPITAL ASSOCIATION INC 109
Three-digit plan number (PN) 503
Effective date of plan 2017-02-01
Business code 622000
Sponsor’s telephone number 8506745411
Plan sponsor’s DBA name CALHOUN LIBERTY HOSPITAL
Plan sponsor’s mailing address 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045
Plan sponsor’s address 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045

Number of participants as of the end of the plan year
Active participants 109

Signature of
Role Plan administrator
Date 2019-05-13
Name of individual signing CHARLES STEWARD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-13
Name of individual signing CHARLES STEWARD
Valid signature Filed with authorized/valid electronic signature
CALHOUN LIBERTY HOSPITAL HUMANA LIFE INSURANCE 2016 593051173 2019-05-13 CALHOUN LIBERTY HOSPITAL ASSOCIATION INC 107
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2016-02-01
Business code 622000
Sponsor’s telephone number 8506745411
Plan sponsor’s DBA name CALHOUN LIBERTY HOSPITAL
Plan sponsor’s mailing address 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045
Plan sponsor’s address 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 324241045

Number of participants as of the end of the plan year
Active participants 109
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2019-05-13
Name of individual signing CHARLES STEWARD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-13
Name of individual signing CHARLES STEWARD
Valid signature Filed with authorized/valid electronic signature
CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC. 401(K) PLAN 2010 593051173 2011-07-20 CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC. 80
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-11-01
Business code 622000
Sponsor’s telephone number 8506745411
Plan sponsor’s address 20370 NORTHEAST BURNS AVE, BOX 419, BLOUNTSTOWN, FL, 32424

Plan administrator’s name and address
Administrator’s EIN 593051173
Plan administrator’s name CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 20370 NORTHEAST BURNS AVE, BOX 419, BLOUNTSTOWN, FL, 32424
Administrator’s telephone number 8506745411

Signature of
Role Plan administrator
Date 2011-07-20
Name of individual signing NATHAN EBERSOLE
Valid signature Filed with authorized/valid electronic signature
CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC. 401(K) PLAN 2009 593051173 2011-01-03 CALHOUN-LIBERTY HOSPITAL ASSOCIATION, INC. 98
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-11-01
Business code 622000
Sponsor’s telephone number 8506745411
Plan sponsor’s address 20370 NORTHEAST BURNS AVE. BOX 419, BLOUNTSTOWN, FL, 32424

Plan administrator’s name and address
Administrator’s EIN 593051173
Plan administrator’s name CALHOUN-LIBERTY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 20370 NORTHEAST BURNS AVE. BOX 419, BLOUNTSTOWN, FL, 32424
Administrator’s telephone number 8506745411

Signature of
Role Plan administrator
Date 2011-01-03
Name of individual signing NATHAN EBERSOLE
Valid signature Filed with authorized/valid electronic signature
CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC. 401(K) PLAN 2009 593051173 2010-12-29 CALHOUN-LIBERTY HOSPITAL ASSOCIATION, INC. 98
Three-digit plan number (PN) 001
Effective date of plan 2007-11-01
Business code 622000
Sponsor’s telephone number 8506745411
Plan sponsor’s address 20370 NORTHEAST BURNS AVE. BOX 419, BLOUNTSTOWN, FL, 32424

Plan administrator’s name and address
Administrator’s EIN 593051173
Plan administrator’s name CALHOUN-LIBERTY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 20370 NORTHEAST BURNS AVE. BOX 419, BLOUNTSTOWN, FL, 32424
Administrator’s telephone number 8506745411
CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC. 2009 593051173 2010-09-24 CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC. 7
Three-digit plan number (PN) 001
Effective date of plan 2007-11-01
Business code 940733
Sponsor’s telephone number 8506745411
Plan sponsor’s DBA name CALHOUN - LIBERTY HOSPITAL
Plan sponsor’s address 20370 NORTHEAST BURNS AVE., P.O. BOX 419, BLOUNTSTOWN, FL, 32424

Plan administrator’s name and address
Administrator’s EIN 593051173
Plan administrator’s name CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 20370 NORTHEAST BURNS AVE., P.O. BOX 419, BLOUNTSTOWN, FL, 32424
Administrator’s telephone number 8506745411

Signature of
Role Plan administrator
Date 2010-09-24
Name of individual signing NATHAN EBERSOLE
Valid signature Filed with authorized/valid electronic signature
CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC. 2009 593051173 2010-09-27 CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-11-01
Business code 622000
Sponsor’s telephone number 8506745411
Plan sponsor’s DBA name CALHOUN - LIBERTY HOSPITAL
Plan sponsor’s address 20370 NORTHEAST BURNS AVE., P.O. BOX 419, BLOUNTSTOWN, FL, 32424

Plan administrator’s name and address
Administrator’s EIN 593051173
Plan administrator’s name CALHOUN - LIBERTY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 20370 NORTHEAST BURNS AVE., P.O. BOX 419, BLOUNTSTOWN, FL, 32424
Administrator’s telephone number 8506745411

Signature of
Role Plan administrator
Date 2010-09-27
Name of individual signing NATHAN EBERSOLE
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
WILLIAMS LADDIE Director 17371 NW 5TH STREET, BLOUNTSTOWN, FL, 32424
RUSSELL MARILYN Secretary 19306 NE JOHN G. BRYANT RD, BLOUNTSTOWN, FL, 32424
BONTRAGER LABAN D Director 12799 NW PEA RIDGE RD, BRISTOL, FL, 32321
PLUMMER MARK Chairman 16059 NW LAKESIDE LANE, BRISTOL, FL, 32321
TOMLINSON JOHN J Treasurer 20007 NE HENTZ AVE., BLOUNTSTOWN, FL, 32424
Revell Tim Vice Chairman 17444 NW CR 379-A, Bristol, FL, 32321
Brown Emily Agent 20370 NE BURNS AVENUE, BLOUNTSTOWN, FL, 32424

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G12000032276 CALHOUN - LIBERTY PRIMARY CARE CLINIC ACTIVE 2012-04-03 2027-12-31 - 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 32424
G07037900214 CALHOUN-LIBERTY HOSPITAL ACTIVE 2007-02-06 2027-12-31 - 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 32424

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-07-02 20370 NE BURNS AVENUE, BLOUNTSTOWN, FL 32424 -
REGISTERED AGENT NAME CHANGED 2024-07-02 Brown, Emily -
REGISTERED AGENT ADDRESS CHANGED 2011-07-21 20370 NE BURNS AVENUE, BLOUNTSTOWN, FL 32424 -
CANCEL ADM DISS/REV 2005-12-20 - -
CHANGE OF PRINCIPAL ADDRESS 2005-12-20 20370 NE BURNS AVENUE, BLOUNTSTOWN, FL 32424 -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2004-10-01 - -
REINSTATEMENT 2002-03-15 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2001-09-21 - -
REINSTATEMENT 1998-11-25 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 1998-10-16 - -

Documents

Name Date
AMENDED ANNUAL REPORT 2024-10-04
AMENDED ANNUAL REPORT 2024-07-02
AMENDED ANNUAL REPORT 2024-03-08
ANNUAL REPORT 2024-01-30
ANNUAL REPORT 2023-01-23
ANNUAL REPORT 2022-02-18
ANNUAL REPORT 2021-03-24
ANNUAL REPORT 2020-07-01
ANNUAL REPORT 2019-01-31
ANNUAL REPORT 2018-03-13

USAspending Awards. Financial Assistance

FAIN Awarding Agency Assistance Listings Start Date End Date Description
8045913430153881 Department of Agriculture 10.766 - COMMUNITY FACILITIES LOANS AND GRANTS 2008-06-05 2008-06-05 COMMUNITY FACILITY GRANTS
Recipient CALHOUN-LIBERTY HOSPITAL ASSOCIATION, INC.
Recipient Name Raw CALHOUN LIBERTY HOSPITAL ASSOCIATION,INC
Recipient UEI MVVFA4FW3CL4
Recipient DUNS 616390014
Recipient Address 20370 NE BURNS AVENUE, BLOUNTSTOWN, CALHOUN, FLORIDA, 32424-1045, UNITED STATES
Obligated Amount 22000.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page
8178425634153881 Department of Agriculture 10.766 - COMMUNITY FACILITIES LOANS AND GRANTS 2008-06-05 2008-06-05 COMMUNITY FACILITY GRANTS
Recipient CALHOUN-LIBERTY HOSPITAL ASSOCIATION, INC.
Recipient Name Raw CALHOUN LIBERTY HOSPITAL ASSOCIATION,INC
Recipient UEI MVVFA4FW3CL4
Recipient DUNS 616390014
Recipient Address 20370 NE BURNS AVENUE, BLOUNTSTOWN, CALHOUN, FLORIDA, 32424-1045
Obligated Amount 90000.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
59-3051173 Corporation Unconditional Exemption 20370 NE BURNS AVE, BLOUNTSTOWN, FL, 32424-1045 1992-04
In Care of Name % MR LADDIE WILLIAMS CHAIRMAN
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 2023-12
Asset 10,000,000 to 49,999,999
Income 10,000,000 to 49,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 15868679
Income Amount 15019817
Form 990 Revenue Amount 15019817
National Taxonomy of Exempt Entities -
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)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC
EIN 59-3051173
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name CALHOUN-LIBERTY HOSPITAL ASSOCIATION INC
EIN 59-3051173
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name CALHOUN LIBERTY HOSPITAL ASSOC INC
EIN 59-3051173
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name CALHOUN LIBERTY HOSPITAL ASSOC INC
EIN 59-3051173
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name CALHOUN LIBERTY HOSPITAL ASSOC INC
EIN 59-3051173
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name CALHOUN LIBERTY HOSPITAL ASSOC INC
EIN 59-3051173
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name CALHOUN LIBERTY HOSPITAL ASSOC INC
EIN 59-3051173
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name CALHOUN LIBERTY HOSPITAL ASSOC INC
EIN 59-3051173
Tax Period 201612
Filing Type E
Return Type 990
File View File
Organization Name CALHOUN LIBERTY HOSPITAL ASSOCIATIONINC
EIN 59-3051173
Tax Period 201512
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
9489767005 2020-04-09 0491 PPP 20370 NE BURNS AVENUE, BLOUNTSTOWN, FL, 32424-1045
Loan Status Date 2021-07-14
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 1149389.9
Loan Approval Amount (current) 1149389.9
Undisbursed Amount 0
Franchise Name -
Lender Location ID 4392
Servicing Lender Name Centennial Bank
Servicing Lender Address 620 Chestnut St, CONWAY, AR, 72032-5404
Rural or Urban Indicator R
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address BLOUNTSTOWN, CALHOUN, FL, 32424-1045
Project Congressional District FL-02
Number of Employees 114
NAICS code 622110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 4392
Originating Lender Name Centennial Bank
Originating Lender Address CONWAY, AR
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 1162080.42
Forgiveness Paid Date 2021-06-01

Companies related by officers

WILLIAMS LADDIE

RIVERTOWN MOTORS, INC. - Inactive
Domestic Profit (2008 - 2009)
NATIONWIDE HOME RELIEF PROCESSING, LLC - Inactive
Florida Limited Liability Co. (2008 - 2009)

RUSSELL MARILYN

MARILYN ASHLEY DESIGN ASSOCIATES, INC - Inactive
Domestic Profit (2015 - 2017)
CALHOUN COUNTY SENIOR CITIZENS ASSOCIATION, INC. - Active
Domestic Non-Profit (1977 )
CAPTURE IT ALL, INC. - Inactive
Domestic Profit (2005 - 2006)
CAPTURE IT ALL, INC. - Inactive
Domestic Profit (2005 - 2006)
CAPTURE IT ALL, INC. - Inactive
Domestic Profit (2005 - 2006)
CAPTURE IT ALL, INC. - Inactive
Domestic Profit (2005 - 2006)
RUSSELL FAMILY PROPERTIES, LLC - Inactive
Florida Limited Liability Co. (2004 - 2005)
RUSSELL FAMILY PROPERTIES, LLC - Inactive
Florida Limited Liability Co. (2004 - 2005)
DESIGN MAGNIFIQUE INC - Inactive
Domestic Profit (2011 - 2015)
CALHOUN COUNTY SENIOR CITIZENS ASSOCIATION, INC. - Active
Domestic Non-Profit (1977 )

PLUMMER MARK

AIS ENERGY, LLC - Inactive
Florida Limited Liability Co. (2021 - 2023)
MNM GOLF INC - Active
Foreign Profit (2020 )
MNM GOLF INC - Active
Foreign Profit (2020 )
BIG BEND HEALTH ALLIANCE, LLC - Active
Florida Limited Liability Co. (2022 )

Brown Emily

ENESCO PROPERTIES, LLC - Inactive
Foreign Limited Liability Co. (2019 - 2023)
BIG BEND HEALTH ALLIANCE, LLC - Active
Florida Limited Liability Co. (2022 )
EMTIM TRAINING & CONSULTING SERVICES, INC. - Active
Domestic Non-Profit (2016 )
CITRUS TOWER COMMERCIAL CENTER ASSOCIATION, INC. - Active
Domestic Non-Profit (2003 )
ORLANDO CORPORATE CENTRE ASSOCIATION, INC. - Active
Domestic Non-Profit (1991 )
BREAKTHROUGHS ON A MISSION, INC. - Active
Domestic Non-Profit (2019 )
BUFFALO ROCK COMPANY - Active
Foreign Profit (1986 )
BALDWIN PARK NO. 7 CONDOMINIUM ASSOCIATION, INC. - Active
Domestic Non-Profit (2006 )
NEUROBEHAVIORAL CONSULTING LLC - Active
Florida Limited Liability Co. (2013 )
ENESCO, LLC - Active
Foreign Limited Liability Co. (2007 )

Companies related by address

20370 NE BURNS AVENUE, BLOUNTSTOWN, FL, 32424, US

BIG BEND HEALTH ALLIANCE, LLC CLH QALICB, INC.

20370 NE BURNS AVENUE, BLOUNTSTOWN, FL, 32424, US

BIG BEND HEALTH ALLIANCE, LLC CLH QALICB, INC.

Date of last update: 02 Apr 2025

Sources: Florida Department of State

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 flprofile.com, Part of Big Data Integrated