| Entity Name: | WEST VOLUSIA FAMILY AND SPORTS MEDICINE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
WEST VOLUSIA FAMILY AND SPORTS MEDICINE, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| 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: | 24 Feb 2010 (15 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 14 Oct 2016 (9 years ago) |
| Document Number: | P10000016803 |
| FEI/EIN Number |
271970908
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1590 S SR 15A, DeLand, FL, 32720, US |
| Mail Address: | 1590 S SR 15A, DeLand, FL, 32720, US |
| ZIP code: | 32720 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548584600 | 2010-03-18 | 2020-08-04 | PO BOX 23764, TAMPA, FL, 336233764, US | 742 N VOLUSIA AVE, ORANGE CITY, FL, 327634857, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 727-823-2188 |
| Fax | 7278280723 |
| Phone | +1 386-774-0016 |
Authorized person
| Name | JOHN HILL |
| Role | OWNER / PROVIDER |
| Phone | 3867740016 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME93242 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002241400 |
| State | FL |
| Issuer | BCBS |
| Number | 000TF |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WEST VOLUSIA 401(K) PLAN | 2023 | 274352136 | 2024-05-17 | WEST VOLUSIA FAMILY AND SPORTS MEDICINE | 38 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-17 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 4074378871 |
| Plan sponsor’s address | 1590 STATE ROAD 15A, DELAND, FL, 32720 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-27 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 4074378871 |
| Plan sponsor’s address | 1590 STATE ROAD 15A, DELAND, FL, 32720 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-02 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| HILL JOHN | President | 1590 S SR 15A, DeLand, FL, 32720 |
| HILL JOHN | Director | 1590 S SR 15A, DeLand, FL, 32720 |
| HILL JOHN | Secretary | 1590 S SR 15A, DeLand, FL, 32720 |
| HILL JOHN | Agent | 1590 S SR 15A, DeLand, FL, 32720 |
| Shinn Steven TDr. | Director | 1590 S SR 15A, DeLand, FL, 32720 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2016-10-14 | - | - |
| REGISTERED AGENT NAME CHANGED | 2016-10-14 | HILL, JOHN | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2013-01-20 | 1590 S SR 15A, DeLand, FL 32720 | - |
| CHANGE OF MAILING ADDRESS | 2013-01-20 | 1590 S SR 15A, DeLand, FL 32720 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2013-01-20 | 1590 S SR 15A, DeLand, FL 32720 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-13 |
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-05-06 |
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-03-19 |
| ANNUAL REPORT | 2017-03-10 |
| REINSTATEMENT | 2016-10-14 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2123907210 | 2020-04-15 | 0491 | PPP | 1590 S STATE ROAD 15A, DELAND, FL, 32720-7817 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 May 2025
Sources: Florida Department of State
