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Lakeside Hospice, Inc.

Details

Name: Lakeside Hospice, Inc.
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 28 Dec 1990 (34 years ago)
Entity Number: 000-068-922
Register Number: 000068922
Historical Names: St. Clair Care, a Hospice, Inc.
County: Saint Clair
Place of Formation: Saint Clair County
Principal Address: PELL CITY, AL
Registered Office Street Address: 4010 MASTERS ROADPELL CITY, AL 35128
Registered Office Street Address ZIP Code: 35128

Activities PHYSICAL PSYCHOLOGICAL & SPIRITUAL COMFORT

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
SL59RM6WXLT5 2021-10-02 4010 MASTERS RD, PELL CITY, AL, 35128, 7550, USA 4010 MASTERS RD, PELL CITY, AL, 35128, 7550, USA

Business Information
URL www.lakesidehospice.org
Congressional District 03
State/Country of Incorporation AL, USA
Activation Date 2020-10-09
Initial Registration Date 2020-10-02
Entity Start Date 1991-01-01
Fiscal Year End Close Date Jun 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name STEPHANIE HONEYCUTT
Role FINANCE DIRECTOR
Address 4010 MASTERS ROAD, TALLADEGA, AL, 35128, USA
Government Business
Title PRIMARY POC
Name PAUL GARING
Role EXECUTIVE DIRECTOR
Address 4010 MASTERS ROAD, PELL CITY, AL, 35128, USA
Past Performance Information not Available

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1023575032 2019-02-26 2019-03-21 4010 MASTERS RD, PELL CITY, AL, 351287550, US 409 E 10TH ST STE 200, ANNISTON, AL, 362074781, US

Contacts
Fax 2058841114
Phone +1 256-541-5696

Authorized person
Name PAUL M GARING
Role EXECUTIVE DIRECTOR
Phone 2058841111

Taxonomy
Taxonomy Code 315D00000X - Inpatient Hospice
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SECTION 403 (B) RETIREMENT PLAN FOR LAKESIDE HOSPICE INC. 2018 631035850 2019-10-10 LAKESIDE HOSPICE INC. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s address 4010 MASTERS RD, PELL CITY, AL, 351287550

Signature of
Role Plan administrator
Date 2019-10-10
Name of individual signing PAUL GARING
SECTION 403 (B) RETIREMENT PLAN FOR LAKESIDE HOSPICE INC. 2017 631035850 2019-07-25 LAKESIDE HOSPICE, INC. 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s address 4010 MASTERS RD, PELL CITY, AL, 351287550

Signature of
Role Plan administrator
Date 2019-07-25
Name of individual signing PAUL GARING
SECTION 403(B) RETIREMENT PLAN FOR LAKESIDE HOSPICE INC 2016 631035850 2018-11-01 LAKESIDE HOSPICE INC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-06-30
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s DBA name LAKESIDE HOSPICE, INC
Plan sponsor’s address 4010 MASTERS RD, PELL CITY, AL, 351287550

Signature of
Role Plan administrator
Date 2018-11-01
Name of individual signing PAUL GARING
Role Employer/plan sponsor
Date 2018-11-01
Name of individual signing PAUL GARING
SECTION 403(B) RETIREMENT PLAN FOR LAKESIDE HOSPICE INC. 2015 631035850 2016-08-24 LAKESIDE HOSPICE, INC. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s address 4010 MASTERS ROAD, PELL CITY, AL, 35128

Signature of
Role Plan administrator
Date 2016-08-24
Name of individual signing PLAN SPONSOR
SECTION 403(B) RETIREMENT PLAN FOR LAKESIDE HOSPICE INC. 2014 631035850 2015-12-23 LAKESIDE HOSPICE, INC. 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s address 4010 MASTERS ROAD, PELL CITY, AL, 35128

Signature of
Role Plan administrator
Date 2015-12-23
Name of individual signing PLAN SPONSOR
SECTION 403 (B) RETIREMENT PLAN FOR LAKESIDE HOSPICE, INC 2013 631035850 2014-12-24 LAKESIDE HOSPICE, INC 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s address P O BOX 544, PELL CITY, AL, 35125

Signature of
Role Plan administrator
Date 2014-12-24
Name of individual signing DAWN MUNCHER
Role Employer/plan sponsor
Date 2014-12-24
Name of individual signing DAWN MUNCHER
SECTION 403(B) RETIREMENT PLAN FOR LAKESIDE HOSPICE INC. 2012 631035850 2014-01-24 LAKESIDE HOSPICE, INC. 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s address P O BOX 544, PELL CITY, AL, 35125

Signature of
Role Plan administrator
Date 2014-01-24
Name of individual signing DAWN MUNCHER
Role Employer/plan sponsor
Date 2014-01-24
Name of individual signing DAWN MUNCHER
SECTION 403(B) RETIREMENT PLAN FOR LAKESIDE HOSPICE, INC 2011 631035850 2013-04-08 LAKESIDE HOSPICE, INC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s address P O BOX 544, PELL CITY, AL, 35125

Plan administrator’s name and address
Administrator’s EIN 631035850
Plan administrator’s name LAKESIDE HOSPICE, INC
Plan administrator’s address P O BOX 544, PELL CITY, AL, 35125
Administrator’s telephone number 2058841111

Signature of
Role Plan administrator
Date 2013-04-08
Name of individual signing DAWN MUNCHER
Role Employer/plan sponsor
Date 2013-04-08
Name of individual signing DAWN MUNCHER
SECTION 403(B) RETIREMENT PLAN FOR LAKESIDE HOSPICE, INC 2010 631035850 2012-01-31 LAKESIDE HOSPICE, INC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s DBA name LAKESIDE HOSPICE, INC
Plan sponsor’s address P O BOX 544, PELL CITY, AL, 35125

Plan administrator’s name and address
Administrator’s EIN 631035850
Plan administrator’s name LAKESIDE HOSPICE, INC
Plan administrator’s address P O BOX 544, PELL CITY, AL, 35125
Administrator’s telephone number 2058841111

Signature of
Role Plan administrator
Date 2012-01-31
Name of individual signing DAWN MUNCHER
SECTION 403(B) RETIREMENT PLAN FOR LAKESIDE HOSPICE, INC. 2009 631035850 2011-03-21 LAKESIDE HOSPICE, INC. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 624100
Sponsor’s telephone number 2058841111
Plan sponsor’s address 4010 MASTERS RD, PELL CITY, AL, 35128

Plan administrator’s name and address
Administrator’s EIN 631035850
Plan administrator’s name LAKESIDE HOSPICE, INC.
Plan administrator’s address 4010 MASTERS RD, PELL CITY, AL, 35128
Administrator’s telephone number 2058841111

Signature of
Role Plan administrator
Date 2011-03-21
Name of individual signing DAWN MUNCHER

Agent

Name Role
STEPHANIE HONEYCUTT Agent

Incorporator

Name Role
MILLER, ALEX C JR MD Incorporator
MILLER RN, JANIS H Incorporator

Events

Event Date Event Type Old Value New Value
1998-09-11 Name Change St. Clair Care, a Hospice, Inc. Lakeside Hospice, Inc.

Related by officers

STEPHANIE HONEYCUTT

Alex C. Miller Community Walking Trail, LLC

Related by address

PELL CITY, AL

Baggett Pontiac - G.M.C., Inc. Blackman's Pell City Cash and Carry, Inc. Bunt Appliance Service Co., Inc. Consolidated Dixie, Inc. DeGaris Drugs, Inc. Twenty Services, Inc. Jolley Air Service, Incorporated Kilgroe Heating & Air Conditioning, Inc. Pell City Dodge, Inc. Pell City Country Club

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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