| Entity Name: | MAR-J MEDICAL SUPPLY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 11 Sep 2000 (24 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 14 Nov 2002 (22 years ago) |
| Document Number: | P00000085822 |
| FEI/EIN Number | 651038279 |
| Address: | 801 MEADOWS ROAD, SUITE 101, BOCA RATON, FL, 33486, US |
| Mail Address: | 801 MEADOWS ROAD, SUITE 101, BOCA RATON, FL, 33486, US |
| ZIP code: | 33486 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568465185 | 2005-05-27 | 2020-01-27 | 801 MEADOWS RD, SUITE 101, BOCA RATON, FL, 334862346, US | 801 MEADOWS RD, STE 101, BOCA RATON, FL, 334862346, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-347-7997 |
| Fax | 5614175588 |
Authorized person
| Name | JASON HOUSENBOLD |
| Role | PRESIDENT |
| Phone | 5613477997 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 1338 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022811700 |
| State | FL |
| Issuer | BCBS |
| Number | R9245 |
| State | FL |
| Issuer | AMERIGROUP |
| Number | 241622 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MAR-J MEDICAL SUPPLY, INC. 401(K) PROFIT SHARING PLAN & TRU | 2023 | 651038279 | 2024-07-16 | MAR-J MEDICAL SUPPLY, INC. | 13 | |||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-16 |
| Name of individual signing | SHIRLEY HORNER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 9548031321 |
| Plan sponsor’s address | 801 MEADOWS ROAD SUITE 101, BOCA RATON, FL, 33486 |
Signature of
| Role | Plan administrator |
| Date | 2023-04-03 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 9548031321 |
| Plan sponsor’s address | 801 MEADOWS ROAD SUITE 101, BOCA RATON, FL, 33486 |
Signature of
| Role | Plan administrator |
| Date | 2022-04-18 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 9548031321 |
| Plan sponsor’s address | 801 MEADOWS ROAD SUITE 101, BOCA RATON, FL, 33486 |
Signature of
| Role | Plan administrator |
| Date | 2021-04-21 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 9548031321 |
| Plan sponsor’s address | 801 MEADOWS ROAD SUITE 101, BOCA RATON, FL, 33486 |
Signature of
| Role | Plan administrator |
| Date | 2020-04-08 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 9548031321 |
| Plan sponsor’s address | 801 MEADOWS ROAD SUITE 101, BOCA RATON, FL, 33486 |
Plan administrator’s name and address
| Administrator’s EIN | 264477125 |
| Plan administrator’s name | 401K GENERATION |
| Plan administrator’s address | 195 INTERNATIONAL PKWY, S #311, LAKE MARY, FL, 32746 |
| Administrator’s telephone number | 8669985879 |
Signature of
| Role | Plan administrator |
| Date | 2019-06-04 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| HOUSENBOLD JASON P | Agent | 801 MEADOWS ROAD, BOCA RATON, FL, 33486 |
| Name | Role | Address |
|---|---|---|
| HOUSENBOLD JASON | President | 801 MEADOWS ROAD, SUITE 101, BOCA RATON, FL, 33486 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2010-01-06 | HOUSENBOLD, JASON PRES | No data |
| CHANGE OF MAILING ADDRESS | 2005-01-12 | 801 MEADOWS ROAD, SUITE 101, BOCA RATON, FL 33486 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-01-12 | 801 MEADOWS ROAD, SUITE 101, BOCA RATON, FL 33486 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-04-30 | 801 MEADOWS ROAD, SUITE 101, BOCA RATON, FL 33486 | No data |
| AMENDMENT | 2002-11-14 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J09001095974 | TERMINATED | 1000000091879 | 22864 1358 | 2008-09-18 | 2029-04-08 | $ 20.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J09000138833 | TERMINATED | 1000000091879 | 22864 1358 | 2008-09-18 | 2029-01-22 | $ 317.07 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J09000375179 | ACTIVE | 1000000091879 | 22864 1358 | 2008-09-18 | 2029-01-28 | $ 317.07 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J09000502905 | TERMINATED | 1000000091879 | 22864 1358 | 2008-09-18 | 2029-02-04 | $ 20.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J09000577618 | TERMINATED | 1000000091879 | 22864 1358 | 2008-09-18 | 2029-02-11 | $ 20.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J09000654094 | TERMINATED | 1000000091879 | 22864 1358 | 2008-09-18 | 2029-02-18 | $ 20.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J09000730167 | TERMINATED | 1000000091879 | 22864 1358 | 2008-09-18 | 2014-02-25 | $ 20.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J09000788561 | TERMINATED | 1000000091879 | 22864 1358 | 2008-09-18 | 2029-03-05 | $ 20.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J09000848480 | TERMINATED | 1000000091879 | 22864 1358 | 2008-09-18 | 2029-03-11 | $ 20.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| J09000906015 | TERMINATED | 1000000091879 | 22864 1358 | 2008-09-18 | 2029-03-18 | $ 20.03 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-06-28 |
| ANNUAL REPORT | 2019-03-08 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-03-02 |
| ANNUAL REPORT | 2015-02-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
