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Cahaba Medical Care Foundation

Details

Name: Cahaba Medical Care Foundation
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 05 Oct 2010 (14 years ago) (Companies founded in October 2010)
Entity Number: 000-572-294
Register Number: 000572294
ZIP code: 35042 (Companies in Bibb, 35042)
County: Bibb
Place of Formation: Bibb County
Registered Office Street Address: 405 BELCHER STREETCENTREVILLE, AL 35042

Activities CHARITABLE
RELIGIOUS
EDUCATIONAL
AND SCIENTIFIC PURPOSES

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
PB8JEHXP9TS3 2025-01-29 195 HOSPITAL DR, CENTREVILLE, AL, 35042, 2935, USA CAHABA MEDICAL CARE, 405 BELCHER STREET, CENTREVILLE, AL, 35042, 2946, USA

Business Information
Doing Business As CAHABA MEDICAL CARE
Congressional District 06
State/Country of Incorporation AL, USA
Activation Date 2024-02-01
Initial Registration Date 2010-10-21
Entity Start Date 2010-10-05
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name JOHN B WAITS
Role DR
Address 405 BELCHER STREET, CENTREVILLE, AL, 35042, 2935, USA
Title ALTERNATE POC
Name LACY SMITH
Role DR
Address CAHABA MEDICAL CARE, 195 HOSPITAL DRIVE, CENTREVILLE, AL, 35042, 2935, USA
Government Business
Title PRIMARY POC
Name JOHN B WAITS
Role DR
Address 405 BELCHER STREET, CENTREVILLE, AL, 35042, 2935, USA
Title ALTERNATE POC
Name LACY SMITH
Role DR
Address CAHABA MEDICAL CARE, 195 HOSPITAL DRIVE, CENTREVILLE, AL, 35042, 2935, USA
Past Performance Information not Available

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1104510486 2023-06-08 2023-06-08 405 BELCHER ST, CENTREVILLE, AL, 350422946, US 405 BELCHER ST, CENTREVILLE, AL, 350422946, US

Contacts
Phone +1 205-926-2992

Authorized person
Name KAY COX
Role CCO
Phone 2052772384

Taxonomy
Taxonomy Code 261QF0400X - Federally Qualified Health Center (FQHC)
Is Primary Yes

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
662N9 Obsolete Non-Manufacturer 2010-10-22 2024-02-01 No data 2025-01-29

Contact Information
POC JOHN B. WAITS
Phone +1 205-926-2992
Fax +1 205-316-7675
Address 195 HOSPITAL DR, CENTREVILLE, AL, 35042 2935, 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
CAHABA MEDICAL CARE FOUNDATION 401K PLAN 2017 273605364 2018-07-23 CAHABA MEDICAL CARE FOUNDATION 116
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2059262992
Plan sponsor’s address 405 BELCHER STREET, CENTREVILLE, AL, 35042

Signature of
Role Plan administrator
Date 2018-07-23
Name of individual signing KAY COX
CAHABA MEDICAL CARE FOUNDATION 401K PLAN 2016 273605364 2017-08-07 CAHABA MEDICAL CARE FOUNDATION 83
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2059262992
Plan sponsor’s address 405 BELCHER STREET, CENTREVILLE, AL, 35042

Signature of
Role Plan administrator
Date 2017-08-07
Name of individual signing KAY COX
CAHABA MEDICAL CARE FOUNDATION 401K PLAN 2015 273605364 2016-12-05 CAHABA MEDICAL CARE FOUNDATION 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2059262992
Plan sponsor’s address 405 BELCHER STREET, CENTREVILLE, AL, 35042

Signature of
Role Plan administrator
Date 2016-12-05
Name of individual signing KAY COX
CAHABA MEDICAL CARE FOUNDATION 401K PLAN 2015 273605364 2016-10-20 CAHABA MEDICAL CARE FOUNDATION 43
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2059262992
Plan sponsor’s address 405 BELCHER STREET, CENTREVILLE, AL, 35042

Signature of
Role Plan administrator
Date 2016-10-20
Name of individual signing KAY COX
CAHABA MEDICAL CARE FOUNDATION 401K PLAN 2014 273605364 2015-10-13 CAHABA MEDICAL CARE FOUNDATION 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2059262992
Plan sponsor’s address 405 BELCHER STREET, CENTREVILLE, AL, 35042

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing KAY COX
CAHABA MEDICAL CARE FOUNDATION 401K PLAN 2013 273605364 2014-07-31 CAHABA MEDICAL CARE FOUNDATION 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2059262992
Plan sponsor’s address 195 HOSPITAL DR, CENTREVILLE, AL, 35042

Signature of
Role Plan administrator
Date 2014-07-31
Name of individual signing KAY COX

Agent

Name Role Address
WAITS, JOHN B Agent 195 HOSPITAL DRIVECENTREVILLE, AL 35042

Director

Name Role Address
WAITS, JOHN B Director 195 HOSPITAL DRIVECENTREVILLE, AL 35042
WAITH, RACHEL K Director 232 HUNTER RUNCENTREVILLE, AL 35042
WAITS, JOHN O Director 12765 TOM MONTGOMERY ROADNORTHPORT, AL 35475

Incorporator

Name Role Address
WAITS, JOHN B Incorporator 195 HOSPITAL DRIVECENTREVILLE, AL 35042

Related by officers

WAITS, JOHN B

Cahaba Medical Care of Al., LLC Cahaba Medical Care, Inc. Riverside Medical Billing, LLC The Studio

WAITS, JOHN O

Coker Tomato Farm, LLC J & J Family Properties, LLC Surgical Specialists of Alabama, P.C. JOW, LLC TASC, L.L.C. TASC96, L.L.C. S6 Building Partnership, L.L.C. Freedom Farm, Inc.

Related by address

405 BELCHER STREETCENTREVILLE, AL 35042

Cahaba Medical Care, Inc.

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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