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Northwest Alabama Mental Health Center

Details

Name: Northwest Alabama Mental Health Center
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 04 Feb 1974 (51 years ago)
Entity Number: 000-070-224
Register Number: 000070224
Place of Formation: Marion County
Principal Address: HAMILTON, AL

Activities ANY LAWFUL ACTIVITY

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
JYDHTSHBFKS8 2025-02-18 1100 7TH AVE, JASPER, AL, 35501, 4377, USA 1100 SEVENTH AVENUE, JASPER, AL, 35501, 4377, USA

Business Information
Congressional District 04
State/Country of Incorporation AL, USA
Activation Date 2024-02-21
Initial Registration Date 2010-04-28
Entity Start Date 1974-02-24
Fiscal Year End Close Date Sep 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name WENDY IVEY
Address 1100 SEVENTH AVENUE, JASPER, AL, 35501, 4377, USA
Title ALTERNATE POC
Name PHILLIP GRACE
Address 1100 SEVENTH AVENUE, JASPER, AL, 35501, 4377, USA
Government Business
Title PRIMARY POC
Name PHILLIP GRACE
Address 1100 SEVENTH AVENUE, JASPER, AL, 35501, 4377, USA
Title ALTERNATE POC
Name WENDY IVEY
Address 1100 SEVENTH AVENUE, JASPER, AL, 35501, 4377, USA
Past Performance Information not Available

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1932485372 2011-10-31 2011-10-31 1100 7TH AVE, JASPER, AL, 355014377, US 141 2ND AVE NW, VERNON, AL, 355920756, US

Contacts
Phone +1 205-302-9000
Phone +1 205-695-9183

Authorized person
Name MR. FLOYD F NEWMAN JR.
Role EXECUTIVE DIRECTION
Phone 2053029000

Taxonomy
Taxonomy Code 251S00000X - Community/Behavioral Health Agency
Is Primary Yes

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
5ZG87 Obsolete Non-Manufacturer 2010-04-28 2024-02-21 No data 2025-02-18

Contact Information
POC PHILLIP GRACE
Phone +1 205-302-9047
Fax +1 205-387-0599
Address 1100 7TH AVE, JASPER, AL, 35501 4377, UNITED STATES

Ownership of Offeror Information
Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LIFE INSURANCE 2016 630524073 2019-05-10 NORTHWEST ALABAMA MENTAL HEALTH CENTER 407
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029000
Plan sponsor’s DBA name NORTHWEST ALABAMA MENTAL HEALTH CENTER
Plan sponsor’s mailing address 1100 7TH AVE, JASPER, AL, 355014377
Plan sponsor’s address 1100 7TH AVE, JASPER, AL, 355014377

Number of participants as of the end of the plan year
Active participants 407

Signature of
Role Plan administrator
Date 2019-05-10
Name of individual signing JUDY STUCKEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-10
Name of individual signing JUDY STUCKEY
Valid signature Filed with authorized/valid electronic signature
LONG TERM DISABILITY 2016 630524073 2019-05-15 NORTHWEST ALABAMA MENTAL HEALTH CENTER 414
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029000
Plan sponsor’s mailing address 1100 7TH AVE, JASPER, AL, 355014377
Plan sponsor’s address 1100 7TH AVE, JASPER, AL, 355014377

Number of participants as of the end of the plan year
Active participants 414

Signature of
Role Plan administrator
Date 2019-05-15
Name of individual signing JUDY STUCKEY
Valid signature Filed with authorized/valid electronic signature
LIFE INSURANCE 2015 630524073 2017-04-28 NORTHWEST ALABAMA MENTAL HEALTH CENTER 463
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029000
Plan sponsor’s mailing address 1100 7TH AVE, JASPER, AL, 355014377
Plan sponsor’s address 1100 7TH AVE, JASPER, AL, 355014377

Number of participants as of the end of the plan year
Active participants 463

Signature of
Role Plan administrator
Date 2017-04-28
Name of individual signing JUDY STUCKEY
Valid signature Filed with authorized/valid electronic signature
LONG TERM DISABILITY 2015 630524073 2017-04-28 NORTHWEST ALABAMA MENTAL HEALTH CENTER 373
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029000
Plan sponsor’s mailing address 1100 7TH AVE, JASPER, AL, 355014377
Plan sponsor’s address 1100 7TH AVE, JASPER, AL, 355014377

Number of participants as of the end of the plan year
Active participants 373

Signature of
Role Plan administrator
Date 2017-04-28
Name of individual signing JUDY STUCKEY
Valid signature Filed with authorized/valid electronic signature
LIFE INSURANCE 2014 630524073 2016-01-21 NORTHWEST ALABAMA MENTAL HEALTH CENTER 420
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029000
Plan sponsor’s DBA name N/A
Plan sponsor’s mailing address 1100 7TH AVENUE, JASPER, AL, 35501
Plan sponsor’s address 1100 7TH AVENUE, JASPER, AL, 35501

Number of participants as of the end of the plan year
Active participants 425

Signature of
Role Plan administrator
Date 2016-01-21
Name of individual signing JENNY ELLIOTT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-01-21
Name of individual signing JENNY ELLIOTT
Valid signature Filed with authorized/valid electronic signature
LONG TERM DISABLILITY 2014 630524073 2016-01-21 NORTHWEST ALABAMA MENTAL HEALTH CENTER 421
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029000
Plan sponsor’s DBA name N/A
Plan sponsor’s mailing address 1100 7TH AVENUE, JASPER, AL, 35501
Plan sponsor’s address 1100 7TH AVENUE, JASPER, AL, 35501

Number of participants as of the end of the plan year
Active participants 425

Signature of
Role Plan administrator
Date 2016-01-21
Name of individual signing JENNY ELLIOTT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-01-21
Name of individual signing JENNY ELLIOTT
Valid signature Filed with authorized/valid electronic signature
LIFE INSURANCE 2013 630524073 2015-04-27 NORTHWEST ALABAMA MENTAL HEALTH CENTER 368
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029019
Plan sponsor’s mailing address 1100 7TH AVENUE, JASPER, AL, 35501
Plan sponsor’s address 1100 7TH AVENUE, JASPER, AL, 35501

Number of participants as of the end of the plan year
Active participants 420

Signature of
Role Plan administrator
Date 2015-04-27
Name of individual signing BONNIE MYERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-27
Name of individual signing BONNIE MYERS
Valid signature Filed with authorized/valid electronic signature
LONG TERM DISABILITY 2013 630524073 2015-04-22 NORTHWEST ALABAMA MENTAL HEALTH CENTER 373
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029019
Plan sponsor’s mailing address 1100 7TH AVENUE, JASPER, AL, 35501
Plan sponsor’s address 1100 7TH AVENUE, JASPER, AL, 35501

Number of participants as of the end of the plan year
Active participants 421

Signature of
Role Plan administrator
Date 2015-04-22
Name of individual signing BONNIE MYERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-22
Name of individual signing BONNIE MYERS
Valid signature Filed with authorized/valid electronic signature
LONG TERM DISABILITY 2011 630524073 2013-03-26 NORTHWEST ALABAMA MENTAL HEALTH CENTER 339
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029047
Plan sponsor’s mailing address 1100 7TH AVENUE, JASPER, AL, 35501
Plan sponsor’s address 1100 7TH AVENUE, JASPER, AL, 35501

Plan administrator’s name and address
Administrator’s EIN 630524073
Plan administrator’s name NORTHWEST ALABAMA MENTAL HEALTH CENTER
Plan administrator’s address 1100 7TH AVENUE, JASPER, AL, 35501
Administrator’s telephone number 2053029047

Number of participants as of the end of the plan year
Active participants 342

Signature of
Role Plan administrator
Date 2013-03-26
Name of individual signing JUDY STUCKEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-03-26
Name of individual signing JUDY STUCKEY
Valid signature Filed with authorized/valid electronic signature
LIFE INSURANCE 2011 630524073 2013-03-26 NORTHWEST ALABAMA MENTAL HEALTH CENTER 339
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1993-10-01
Business code 621420
Sponsor’s telephone number 2053029047
Plan sponsor’s mailing address 1100 7TH AVENUE, JASPER, AL, 35501
Plan sponsor’s address 1100 7TH AVENUE, JASPER, AL, 35501

Plan administrator’s name and address
Administrator’s EIN 630524073
Plan administrator’s name NORTHWEST ALABAMA MENTAL HEALTH CENTER
Plan administrator’s address 1100 7TH AVENUE, JASPER, AL, 35501
Administrator’s telephone number 2053029047

Number of participants as of the end of the plan year
Active participants 342

Signature of
Role Plan administrator
Date 2013-03-26
Name of individual signing JUDY STUCKEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-03-26
Name of individual signing JUDY STUCKEY
Valid signature Filed with authorized/valid electronic signature

Incorporator

Name Role
DAVIS, G S Incorporator
WALKER, E F Incorporator
YERBY, JESSE N Incorporator
MARTIN, NELL Incorporator
SLATTON, JOHN Incorporator

Related by officers

DAVIS, G S

Housing Authority of the Town of Hamilton, Alabama

WALKER, E F

Robert Donnell High School

SLATTON, JOHN

The Industrial Development Board of the City of Haleyville, Alabama Railiner Manufacturing Corporation

Related by address

HAMILTON, AL

Buccaneer Homes Corporation Business Computer Systems, Inc. Dealers Discount, Inc. Hamilton Auto Parts, Incorporated Hamilton Memory Gardens, Inc. Van Lowrey Construction Company, Inc. Marion Mineral Corporation Nailfast, Incorporated Pikeville Country Club Bryant Manufacturing Co., Inc.

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State

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