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HEALTHMARK OF WALTON RURAL HEALTH CLINIC, INC. - Florida Company Profile

Company Details

Entity Name: HEALTHMARK OF WALTON RURAL HEALTH CLINIC, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

HEALTHMARK OF WALTON RURAL HEALTH CLINIC, 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: 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: 18 Dec 1992 (32 years ago)
Date of dissolution: 22 Sep 2023 (a year ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 22 Sep 2023 (a year ago)
Document Number: P92000012940
FEI/EIN Number 593156240

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

Address: 4415 HWY 331 SOUTH, DEFUNIAK SPRINGS, FL, 32435, US
Mail Address: 4415 HWY 331 SOUTH, DEFUNIAK SPRINGS, FL, 32435, US
ZIP code: 32435
County: Walton
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1013908201 2005-11-04 2021-09-27 4415 US HIGHWAY 331 S, DEFUNIAK SPRINGS, FL, 324356307, US 4415 US HIGHWAY 331 S, DEFUNIAK SPRINGS, FL, 324356307, US

Contacts

Phone +1 850-951-4640
Fax 8508927079

Authorized person

Name MS. LISA SHIRLEY HOLLEY
Role COO
Phone 8509514507

Taxonomy

Taxonomy Code 261QR1300X - Rural Health Clinic/Center
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 372384401
State FL

Key Officers & Management

Name Role Address
THOMPSON JAMES H Director 4413 HWY 331 SOUTH, DEFUNIAK SPRINGS, FL, 32435
Holley Lisa Director 4413 HWY 331 SOUTH, DEFUNIAK SPRINGS, FL, 32435
Jenkins Terri L Director 4413 US Hwy 331 South, DeFuniak Springs, FL, 32435
THOMPSON JAMES HPhd Agent 4413 HWY 331- SOUTH, DEFUNIAK SPRINGS, FL, 32435

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000086531 331 MEDICAL CENTER ACTIVE 2022-07-21 2027-12-31 - 4415 HWY 331 SOUTH, DEFUNIAK SPRINGS, FL, 32435
G12000069726 HEALTHMARK CLINIC ACTIVE 2012-07-12 2027-12-31 - 4415 HWY 331 SOUTH, DEFUNIAK SPRINGS, FL, 32435

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2023-09-22 - -
REGISTERED AGENT NAME CHANGED 2013-03-26 THOMPSON, JAMES H, Phd -
CHANGE OF PRINCIPAL ADDRESS 2007-04-02 4415 HWY 331 SOUTH, DEFUNIAK SPRINGS, FL 32435 -
CHANGE OF MAILING ADDRESS 2007-04-02 4415 HWY 331 SOUTH, DEFUNIAK SPRINGS, FL 32435 -
REGISTERED AGENT ADDRESS CHANGED 2001-04-19 4413 HWY 331- SOUTH, DEFUNIAK SPRINGS, FL 32435 -

Documents

Name Date
ANNUAL REPORT 2022-02-23
ANNUAL REPORT 2021-07-29
ANNUAL REPORT 2020-02-05
ANNUAL REPORT 2019-05-15
ANNUAL REPORT 2018-03-28
ANNUAL REPORT 2017-04-06
ANNUAL REPORT 2016-01-22
ANNUAL REPORT 2015-03-23
ANNUAL REPORT 2014-03-03
ANNUAL REPORT 2013-03-26

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2090077300 2020-04-29 0491 PPP 4415 US Hwy 331 S, DEFUNIAK SPRINGS, FL, 32435-6307
Loan Status Date 2021-12-14
Loan Status Charged Off
Loan Maturity in Months 3
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 115121.52
Loan Approval Amount (current) 115121.52
Undisbursed Amount 0
Franchise Name -
Lender Location ID 437056
Servicing Lender Name SouthPoint Bank
Servicing Lender Address 3501 Grandview Pkwy, BIRMINGHAM, AL, 35243-1930
Rural or Urban Indicator R
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address DEFUNIAK SPRINGS, WALTON, FL, 32435-6307
Project Congressional District FL-02
Number of Employees 7
NAICS code 621112
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 437056
Originating Lender Name SouthPoint Bank
Originating Lender Address BIRMINGHAM, AL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 77828.49
Forgiveness Paid Date 2021-03-05

Date of last update: 01 Mar 2025

Sources: Florida Department of State