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  5. FAMILY COUNSELING CENTER OF BREVARD, INC.

FAMILY COUNSELING CENTER OF BREVARD, INC.

Company Details

Entity Name: FAMILY COUNSELING CENTER OF BREVARD, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive
Date Filed: 27 Aug 1964 (60 years ago)
Document Number: 707748
FEI/EIN Number 591059517
Address: 505 BREVARD AVENUE, COCOA, FL, 32922, US
Mail Address: 505 BREVARD AVENUE, COCOA, FL, 32922, US
ZIP code: 32922
County: Brevard
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1912053919 2007-01-25 2008-04-22 840 BREVARD AVE, ROCKLEDGE, FL, 329552149, US 840 BREVARD AVE, ROCKLEDGE, FL, 329552149, US

Contacts
Phone +1 321-632-5792
Fax 3216325796

Authorized person
Name MR. PHILLIP KOLODZIEJ
Role PRESIDENT
Phone 3216325792

Taxonomy
Taxonomy Code 251S00000X - Community/Behavioral Health Agency
License Number SW5110
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 060332500
State FL
Issuer CLINICAL SOCIAL WORKER
Number 275862
State FL
Issuer CLINICAL SOCIAL WORKER
Number 62-40039
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EMPLOYEE BENEFIT PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC. 2016 591059517 2018-01-31 FAMILY COUNSELING CENTER OF BREVARD , INC 32
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-06-01
Business code 621420
Sponsor’s telephone number 3216325792
Plan sponsor’s address 505 BREVARD AVE STE 110, COCOA, FL, 32922

Signature of
Role Plan administrator
Date 2018-01-31
Name of individual signing ERICA PISSANOS
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC 2015 591059517 2016-08-15 FAMILY COUNSELING CENTER OF BREVARD , INC 30
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-06-01
Business code 621420
Sponsor’s telephone number 3216325792
Plan sponsor’s address 505 BREVARD AVE STE 110, COCOA, FL, 32922

Signature of
Role Plan administrator
Date 2016-08-15
Name of individual signing KIM MILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-08-15
Name of individual signing KIM MILLER
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC 2014 591059517 2015-07-30 FAMILY COUNSELING CENTER OF BREVARD , INC 33
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-06-01
Business code 621420
Sponsor’s telephone number 3216325792
Plan sponsor’s address 505 BREVARD AVE STE 110, COCOA, FL, 32922

Signature of
Role Plan administrator
Date 2015-07-30
Name of individual signing KIMBERLY A MILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-30
Name of individual signing KIMBERLY A MILLER
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC 2013 591059517 2014-10-14 FAMILY COUNSELING CENTER OF BREVARD , INC 38
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-06-01
Business code 621420
Sponsor’s telephone number 3216325792
Plan sponsor’s address 840 BREVARD AVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing KIMBERLY MILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-14
Name of individual signing KIMBERLY MILLER
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC 2013 591057517 2015-06-25 FAMILY COUNSELING CENTER OF BREVARD, INC 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-07-01
Business code 621420
Sponsor’s telephone number 3216325792
Plan sponsor’s address 505 BREVARD AVE. STE 106, COCOA, FL, 32922

Signature of
Role Plan administrator
Date 2015-06-25
Name of individual signing KIMBERLY MILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-25
Name of individual signing KIMBERLY MILLER
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC 2012 591059517 2013-07-25 FAMILY COUNSELING CENTER OF BREVARD, INC 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-07-01
Business code 621420
Plan sponsor’s address 840 BREVARD AVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2013-07-25
Name of individual signing KIMBERLY MILLER
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC 2012 591059517 2013-07-25 FAMILY COUNSELING CENTER OF BREVARD , INC 35
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-06-01
Business code 621420
Sponsor’s telephone number 3216325792
Plan sponsor’s address 840 BREVARD AVE, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2013-07-25
Name of individual signing KIMBERLY MILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-25
Name of individual signing KIMBERLY MILLER
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC 2011 591059517 2012-07-26 FAMILY COUNSELING CENTER OF BREVARD , INC 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-07-01
Business code 621420
Sponsor’s telephone number 3216325792
Plan sponsor’s address 840 BREVARD AVE, ROCKLEDGE, FL, 32955

Plan administrator’s name and address
Administrator’s EIN 591059517
Plan administrator’s name FAMILY COUNSELING CENTER OF BREVARD , INC
Plan administrator’s address 840 BREVARD AVE, ROCKLEDGE, FL, 32955
Administrator’s telephone number 3216325792

Signature of
Role Plan administrator
Date 2012-07-26
Name of individual signing KIMBERLY A MILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-26
Name of individual signing KIMBERLY A MILLER
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC 2011 591059517 2012-07-26 FAMILY COUNSELING CENTER OF BREVARD , INC 38
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-06-01
Business code 621420
Sponsor’s telephone number 3216325792
Plan sponsor’s address 840 BREVARD AVE, ROCKLEDGE, FL, 32955

Plan administrator’s name and address
Administrator’s EIN 591059517
Plan administrator’s name FAMILY COUNSELING CENTER OF BREVARD , INC
Plan administrator’s address 840 BREVARD AVE, ROCKLEDGE, FL, 32955
Administrator’s telephone number 3216325792

Signature of
Role Plan administrator
Date 2012-07-26
Name of individual signing KIMBERY A MILLER
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF FAMILY COUNSELING CENTER OF BREVARD, INC 2010 591059517 2011-07-29 FAMILY COUNSELING CENTER OF BREVARD , INC 30
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-06-01
Business code 621420
Sponsor’s telephone number 3216325792
Plan sponsor’s address 840 BREVARD AVE, ROCKLEDGE, FL, 32955

Plan administrator’s name and address
Administrator’s EIN 591059517
Plan administrator’s name FAMILY COUNSELING CENTER OF BREVARD , INC
Plan administrator’s address 840 BREVARD AVE, ROCKLEDGE, FL, 32955
Administrator’s telephone number 3216325792

Signature of
Role Plan administrator
Date 2011-07-29
Name of individual signing PHILLIP KOLODZIEJ
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-29
Name of individual signing PHILLIP KOLODZIEJ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PARSONS LORI L Agent 505 BREVARD AVENUE, COCOA, FL, 32922

Secretary

Name Role Address
VITORIA ROSAMARIA Secretary 505 BREVARD AVENUE, COCOA, FL, 32922

Treasurer

Name Role Address
VITORIA ROSAMARIA Treasurer 505 BREVARD AVENUE, COCOA, FL, 32922

Director

Name Role Address
VITORIA ROSAMARIA Director 505 BREVARD AVENUE, COCOA, FL, 32922
BIERBRUNNER STEVEN Director 505 BREVARD AVENUE, COCOA, FL, 32922
TORRES KIM Director 505 BREVARD AVENUE, COCOA, FL, 32922

Chairman

Name Role Address
BIERBRUNNER STEVEN Chairman 505 BREVARD AVENUE, COCOA, FL, 32922

Vice Chairman

Name Role Address
TORRES KIM Vice Chairman 505 BREVARD AVENUE, COCOA, FL, 32922

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 No data No data
EVENT CONVERTED TO NOTES 1992-01-10 No data No data
NAME CHANGE AMENDMENT 1980-07-28 FAMILY COUNSELING CENTER OF BREVARD, INC. No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J14000613454 TERMINATED 1000000616382 BREVARD 2014-04-24 2024-05-09 $ 9,867.96 STATE OF FLORIDA, DEPARTMENT OF REVENUE, MELBOURNE SERVICE CENTER, 6300 N WICKHAM RD STE 133A, MELBOURNE FL329402029

Related by officers

TORRES KIM

QUALITY TIME TLC, INC

Related by address

No related companies by address

Date of last update: 03 Jan 2025

Sources: Florida Department of State

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