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  5. LIGHTHOUSE OF PINELLAS, INC.

LIGHTHOUSE OF PINELLAS, INC.

Company Details

Entity Name: LIGHTHOUSE OF PINELLAS, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 15 May 1967 (58 years ago)
Document Number: 712735
FEI/EIN Number 237042938
Address: 6925 112 CIRCLE N, SUITE 103, LARGO, FL, 33773, US
Mail Address: 6925 112 CIRCLE N, SUITE 103, LARGO, FL, 33773, US
ZIP code: 33773
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801858071 2006-04-04 2016-06-09 6925 112TH CIR N, LARGO, FL, 337735520, US 6925 112TH CIR, LARGO, FL, 337735200, US

Contacts
Phone +1 727-544-4433
Fax 7275445511

Authorized person
Name MR. DANIEL T MANN
Role PRESIDENT/CEO
Phone 7275444433

Taxonomy
Taxonomy Code 152WL0500X - Low Vision Rehabilitation Optometrist
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 880145200
State FL
Issuer MEDICAID
Number 880147900
State FL
Issuer MEDICAID
Number 882356100
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2022 237042938 2024-07-15 LIGHTHOUSE OF PINELLAS, INC. 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773

Signature of
Role Plan administrator
Date 2024-07-15
Name of individual signing KIM CHURCH
Valid signature Filed with authorized/valid electronic signature
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2021 237042938 2023-07-11 LIGHTHOUSE OF PINELLAS, INC. 55
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2020 237042938 2022-07-15 LIGHTHOUSE OF PINELLAS, INC. 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2019 237042938 2022-07-15 LIGHTHOUSE OF PINELLAS, INC. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2018 237042938 2020-07-09 LIGHTHOUSE OF PINELLAS, INC. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2018 237042938 2020-07-09 LIGHTHOUSE OF PINELLAS, INC. 42
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2017 237042938 2018-02-12 LIGHTHOUSE OF PINELLAS, INC. 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2017 237042938 2019-06-12 LIGHTHOUSE OF PINELLAS, INC. 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2017 237042938 2018-02-12 LIGHTHOUSE OF PINELLAS, INC. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773
LIGHTHOUSE OF PINELLAS, INC. TAX SHELTERED ANNUITY RETIREMENT PLAN 2017 237042938 2018-02-12 LIGHTHOUSE OF PINELLAS, INC. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-03-31
Business code 813000
Sponsor’s telephone number 7275444433
Plan sponsor’s address 6925 112TH CIRCLE NORTH, SUITE 103, LARGO, FL, 33773

Agent

Name Role Address
CHURCH KIMBERLY Agent 6925 112 CIRCLE N, LARGO, FL, 33773

Director

Name Role Address
Cothran Nora Director 6925 112 CIRCLE N, LARGO, FL, 33773
Kula Jeff Director 6925 112 CIRCLE N, LARGO, FL, 33773
Neilson Jamie Director 6925 112 CIRCLE N, LARGO, FL, 33773

President

Name Role Address
CHURCH KIMBERLY President 6925 112 CIRCLE N, LARGO, FL, 33773

Chairman

Name Role Address
MANDEVILLE DONALD R Chairman 6925 112 CIRCLE N, LARGO, FL, 33773

Treasurer

Name Role Address
Bouchard Ricky Treasurer 6925 112 CIRCLE N, LARGO, FL, 33773

Events

Event Type Filed Date Value Description
MERGER 2019-10-17 No data CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 300000196993
NAME CHANGE AMENDMENT 2005-08-30 LIGHTHOUSE OF PINELLAS, INC. No data
NAME CHANGE AMENDMENT 2003-01-09 WATSON CENTER FOR THE BLIND AND VISUALLY IMPAIRED, INC. No data
NAME CHANGE AMENDMENT 2000-08-24 WATSON CENTER, INC. No data
REINSTATEMENT 1986-11-26 No data No data
INVOLUNTARILY DISSOLVED 1986-11-14 No data No data
NAME CHANGE AMENDMENT 1984-10-31 PINELLAS CENTER FOR THE VISUALLY IMPAIRED, INC. No data
NAME CHANGE AMENDMENT 1984-03-19 CHANNEL MARKERS - COMMUNITY CENTERS FOR THE VISUALLY IMPAIRED, INC. No data
NAME CHANGE AMENDMENT 1969-06-18 CHANNEL MARKERS FOR THE BLIND, INC. No data

Related by officers

CHURCH KIMBERLY

GREATER BAY BALLET COMPANY, INC. LIGHTHOUSE OF PINELLAS FOUNDATION, INC. SERTOMA HEALTH PROFESSIONALS OF TAMPA, INC.

Related by address

6925 112 CIRCLE N, SUITE 103, LARGO, FL, 33773, US

LIGHTHOUSE OF PINELLAS FOUNDATION, INC.

6925 112 CIRCLE N, SUITE 103, LARGO, FL, 33773, US

LIGHTHOUSE OF PINELLAS FOUNDATION, INC.

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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