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Pickens County Medical Center, Inc.

Details

Name: Pickens County Medical Center, Inc.
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 18 Nov 1985 (39 years ago)
Entity Number: 000-818-928
Register Number: 000818928
County: Pickens
Place of Formation: Pickens County
Principal Address: CARROLLTON, AL
Registered Office Street Address: #1 R K WILSON DRIVECARROLTON, AL 35447
Registered Office Street Address ZIP Code: 35447

Activities MAINTAIN/OPERATE A PUBLIC HOSPITAL

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1891102323 2014-07-16 2014-07-16 PO BOX 347, CARROLLTON, AL, 354470347, US 289 WILLIAM E HILL DR STE C, CARROLLTON, AL, 354473247, US

Contacts
Phone +1 205-367-8197
Fax 2053678198

Authorized person
Name SHARON HAMLIN
Role ADMINISTRATOR
Phone 2053678111

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

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PICKENS COUNTY MEDICAL CENTER INC ANNUITY PLAN 2013 630920915 2014-10-15 PICKENS COUNTY MEDICAL CENTER INC 339
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 622000
Sponsor’s telephone number 2053678111
Plan sponsor’s mailing address PO BOX 478, CARROLLTON, AL, 354470478
Plan sponsor’s address HIGHWAY 17 NORTH, CARROLLTON, AL, 354470478

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2014-10-15
Name of individual signing H WAYNE MCELROY
Valid signature Filed with authorized/valid electronic signature
PICKENS COUNTY MEDICAL CENTER INC ANNUITY PLAN 2012 630920915 2013-10-15 PICKENS COUNTY MEDICAL CENTER INC 358
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 622000
Sponsor’s telephone number 2053678111
Plan sponsor’s mailing address PO BOX 478, CARROLLTON, AL, 354470478
Plan sponsor’s address HIGHWAY 17 NORTH, CARROLLTON, AL, 354470478

Number of participants as of the end of the plan year
Active participants 270
Retired or separated participants receiving benefits 86
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 201
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 4

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing H WAYNE MCELROY
Valid signature Filed with authorized/valid electronic signature
PICKENS COUNTY MEDICAL CENTER INC CAFETERIA PLAN 2012 630920915 2013-07-30 PICKENS COUNTY MEDICAL CENTER INC 197
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-10-25
Business code 622000
Sponsor’s telephone number 2053678111
Plan sponsor’s mailing address PO BOX 478, CARROLLTON, AL, 35447
Plan sponsor’s address 241 ROBERT K WILSON DR., CARROLLTON, AL, 35447

Plan administrator’s name and address
Administrator’s EIN 630920915
Plan administrator’s name PICKENS COUNTY MEDICAL CENTER INC
Plan administrator’s address PO BOX 478, CARROLLTON, AL, 35447
Administrator’s telephone number 2053678111

Number of participants as of the end of the plan year
Active participants 186
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2013-07-30
Name of individual signing WAYNE MCELROY
Valid signature Filed with authorized/valid electronic signature
PICKENS COUNTY MEDICAL CENTER INC ANNUITY PLAN 2011 630920915 2012-10-13 PICKENS COUNTY MEDICAL CENTER INC 334
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 622000
Sponsor’s telephone number 2053678111
Plan sponsor’s mailing address PO BOX 478, CARROLLTON, AL, 354470478
Plan sponsor’s address HIGHWAY 17 NORTH, CARROLLTON, AL, 354470478

Plan administrator’s name and address
Administrator’s EIN 630920915
Plan administrator’s name PICKENS COUNTY MEDICAL CENTER INC
Plan administrator’s address PO BOX 478, CARROLLTON, AL, 354470478
Administrator’s telephone number 2053678111

Number of participants as of the end of the plan year
Active participants 278
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 74
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 201
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 15

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing H WAYNE MCELROY
Valid signature Filed with authorized/valid electronic signature
PICKENS COUNTY MEDICAL CENTER INC CAFETERIA PLAN 2011 630920915 2012-10-12 PICKENS COUNTY MEDICAL CENTER INC 184
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-10-25
Business code 622000
Sponsor’s telephone number 2053678111
Plan sponsor’s mailing address PO BOX 478, CARROLLTON, AL, 35447
Plan sponsor’s address 241 ROBERT K WILSON DR., CARROLLTON, AL, 35447

Plan administrator’s name and address
Administrator’s EIN 630920915
Plan administrator’s name PICKENS COUNTY MEDICAL CENTER INC
Plan administrator’s address PO BOX 478, CARROLLTON, AL, 35447
Administrator’s telephone number 2053678111

Number of participants as of the end of the plan year
Active participants 185
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing WAYNE MCELROY
Valid signature Filed with authorized/valid electronic signature
PICKENS COUNTY MEDICAL CENTER INC ANNUITY PLAN 2010 630920915 2011-10-14 PICKENS COUNTY MEDICAL CENTER INC 351
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 622000
Sponsor’s telephone number 2053678111
Plan sponsor’s mailing address PO BOX 478, CARROLLTON, AL, 354470478
Plan sponsor’s address HIGHWAY 17 NORTH, CARROLLTON, AL, 354470478

Plan administrator’s name and address
Administrator’s EIN 630920915
Plan administrator’s name PICKENS COUNTY MEDICAL CENTER INC
Plan administrator’s address PO BOX 478, CARROLLTON, AL, 354470478
Administrator’s telephone number 2053678111

Number of participants as of the end of the plan year
Active participants 280
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 67
Number of participants with account balances as of the end of the plan year 204
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing H WAYNE MCELROY
Valid signature Filed with authorized/valid electronic signature
PICKENS COUNTY MEDICAL CENTER INC CAFETERIA PLAN 2010 630920915 2011-10-07 PICKENS COUNTY MEDICAL CENTER INC 180
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-10-25
Business code 622000
Sponsor’s telephone number 2053678111
Plan sponsor’s mailing address PO BOX 478, CARROLLTON, AL, 35447
Plan sponsor’s address 241 ROBERT K WILSON DR., CARROLLTON, AL, 35447

Plan administrator’s name and address
Administrator’s EIN 630920915
Plan administrator’s name PICKENS COUNTY MEDICAL CENTER INC
Plan administrator’s address PO BOX 478, CARROLLTON, AL, 35447
Administrator’s telephone number 2053678111

Number of participants as of the end of the plan year
Active participants 184
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2011-10-07
Name of individual signing WAYNE MCELROY
Valid signature Filed with authorized/valid electronic signature
PICKENS COUNTY MEDICAL CENTER INC RETIREMENT ANNUITY PLAN 2009 630920915 2010-10-14 PICKENS COUNTY MEDICAL CENTER INC 344
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 622000
Sponsor’s telephone number 2053678111
Plan sponsor’s mailing address PO BOX 478, CARROLLTON, AL, 354470478
Plan sponsor’s address HIGHWAY 17 NORTH, CARROLLTON, AL, 354470478

Plan administrator’s name and address
Administrator’s EIN 630920915
Plan administrator’s name PICKENS COUNTY MEDICAL CENTER INC
Plan administrator’s address PO BOX 478, CARROLLTON, AL, 354470478
Administrator’s telephone number 2053678111

Number of participants as of the end of the plan year
Active participants 287
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 23
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 190
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing H WAYNE MCELROY
Valid signature Filed with authorized/valid electronic signature
PICKENS COUNTY MEDICAL CENTER INC CAFETERIA PLAN 2009 630920915 2010-10-12 PICKENS COUNTY MEDICAL CENTER INC 187
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-10-25
Business code 622000
Sponsor’s telephone number 2053678111
Plan sponsor’s mailing address PO BOX 478, CARROLLTON, AL, 35447
Plan sponsor’s address 241 ROBERT K WILSON DR., CARROLLTON, AL, 35447

Plan administrator’s name and address
Administrator’s EIN 630920915
Plan administrator’s name PICKENS COUNTY MEDICAL CENTER INC
Plan administrator’s address PO BOX 478, CARROLLTON, AL, 35447
Administrator’s telephone number 2053678111

Number of participants as of the end of the plan year
Active participants 180
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2010-10-12
Name of individual signing WAYNE MCELROY
Valid signature Filed with authorized/valid electronic signature

Incorporator

Name Role
BRANDON, JOHN E Incorporator
BROOKE, WILLIAM R Incorporator
CROWDER, BENNETT L II Incorporator
CURRY, WILLIAM A Incorporator
GENTRY, JAMES H SR Incorporator
HILL, WILLIAM E Incorporator
KAMALAPURKAR, BALU G Incorporator
LAMMERS, J EUGENE Incorporator
SHEPPARD, A ROBERT Incorporator
WHITAKER, WILLIAM Incorporator

Agent

Name Role
SHEPPARD, A ROBERT Agent

Awards

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
PO AWARD DJBALILVM420033 2012-07-31 2012-09-30 2012-09-30
Unique Award Key CONT_AWD_DJBALILVM420033_1540_-NONE-_-NONE-
Awarding Agency Department of Justice
Link View Page

Description
Title "IGF::OT::IGF" PRE-EMPLOYMENT PHYSICAL EXAMINATIONS
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q403: MEDICAL- EVALUATION/SCREENING

Recipient Details
Recipient PICKENS COUNTY MEDICAL CENTER, INC.
UEI M3XLSEAQ5LM3
Legacy DUNS 001977966
Recipient Address UNITED STATES, 241 R K WILSON DR, CARROLLTON, 354473247

Related by officers

BRANDON, JOHN E

Pickens County Family Practice Center, Inc.

BROOKE, WILLIAM R

Pickens County Family Practice Center, Inc.

CURRY, WILLIAM A

Rural Alabama Health Alliance

SHEPPARD, A ROBERT

Pickens County Family Practice Center, Inc.

GENTRY, JAMES H SR

Aliceville Rural Health Clinic, P.C.

HILL, WILLIAM E

Beaver Pond Hunting Club W. E. Hill & Associates, Inc. The Nursing Home of Boaz, Inc. Employee Estate Agency, Inc. Huntsville Geriatric Center, Inc. Hill and Hill Realty Company, Inc. Mid-South Mortgage Company of Huntsville, Inc.

Related by address

CARROLLTON, AL

Carrollton Woodyard, Inc. Farm Bureau Service Center of Pickens, Inc. First State Bank of Carrollton Pate Lumber Company Pickens County Broadcasting Company, Inc. Pine Crest Farm Windle Construction Company, Inc. Alabama Hardwood Corporation Mike Junkin Ford, Inc. Pickens County Cooperative, Inc.

Date of last update: 16 Aug 2024

Sources: Alabama Secretary of State

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