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  5. ST. PETERSBURG FREE CLINIC, INC.

ST. PETERSBURG FREE CLINIC, INC. - Florida Company Profile

Company Details

Entity Name: ST. PETERSBURG FREE CLINIC, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 29 Dec 1970 (54 years ago)
Document Number: 719939
FEI/EIN Number 237208280

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 863 3rd Ave N, St Petersburg, FL, 33701, US
Mail Address: 863 3rd Ave N, St Petersburg, FL, 33701, US
ZIP code: 33701
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1366945099 2018-03-08 2018-03-08 5501 - 4TH STREET NORTH, ST. PETERSBURG, FL, 33703, US 5501 - 4TH STREET NORTH, ST. PETERSBURG, FL, 33703, US

Contacts
Phone +1 727-327-0333
Fax 7273216412

Authorized person
Name MS. BETH ANNE HOUGHTON
Role EXECUTIVE DIRECTOR
Phone 7278237866

Taxonomy
Taxonomy Code 208D00000X - General Practice Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ST. PETERSBURG FREE CLINIC, INC. 401(K) RETIREMENT PLAN 2022 237208280 2024-07-10 ST. PETERSBURG FREE CLINIC, INC 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 3RD AVENUE NORTH, ST. PETERSBURG, FL, 33701

Signature of
Role Plan administrator
Date 2024-07-10
Name of individual signing NIK SHARXHI
Valid signature Filed with authorized/valid electronic signature
ST. PETERSBURG FREE CLINIC, INC. 401(K) RETIREMENT PLAN 2021 237208280 2023-07-17 ST. PETERSBURG FREE CLINIC, INC 54
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 3RD AVENUE NORTH, ST. PETERSBURG, FL, 33701

Signature of
Role Plan administrator
Date 2023-07-17
Name of individual signing NIK SHARXHI
Valid signature Filed with authorized/valid electronic signature
ST. PETERSBURG FREE CLINIC 401(K) RETIREMENT PLAN 2020 237208280 2022-07-15 ST. PETERSBURG FREE CLINIC 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 3RD AVENUE NORTH, ST. PETERSBURG, FL, 33701
ST. PETERSBURG FREE CLINIC 401(K) RETIREMENT PLAN 2020 237208280 2022-07-15 ST. PETERSBURG FREE CLINIC 59
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 3RD AVENUE NORTH, ST. PETERSBURG, FL, 33701
ST. PETERSBURG FREE CLINIC 401(K) RETIREMENT PLAN 2019 237208280 2021-06-23 ST. PETERSBURG FREE CLINIC 54
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 3RD AVENUE NORTH, ST. PETERSBURG, FL, 33701

Signature of
Role Plan administrator
Date 2021-06-23
Name of individual signing CRAIG CHAMBERLIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-23
Name of individual signing CRAIG CHAMBERLIN
Valid signature Filed with authorized/valid electronic signature
ST. PETERSBURG FREE CLINIC 401(K) RETIREMENT PLAN 2018 237208280 2020-07-14 ST. PETERSBURG FREE CLINIC, INC. 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 THIRD AVE N, ST. PETERSBURG, FL, 33701
ST. PETERSBURG FREE CLINIC 401(K) RETIREMENT PLAN 2017 237208280 2019-07-15 ST. PETERSBURG FREE CLINIC, INC. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 THIRD AVE N, ST. PETERSBURG, FL, 33701
ST. PETERSBURG FREE CLINIC 401(K) RETIREMENT PLAN 2016 237208280 2018-07-12 ST. PETERSBURG FREE CLINIC, INC. 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 THIRD AVE N, ST. PETERSBURG, FL, 33701
ST. PETERSBURG FREE CLINIC 401(K) RETIREMENT PLAN 2015 237208280 2017-04-12 ST. PETERSBURG FREE CLINIC, INC. 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 THIRD AVE N, ST. PETERSBURG, FL, 33701
ST. PETERSBURG FREE CLINIC 401(K) RETIREMENT PLAN 2014 237208280 2016-03-30 ST. PETERSBURG FREE CLINIC, INC. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-10-01
Business code 621498
Sponsor’s telephone number 7278211200
Plan sponsor’s address 863 THIRD AVE N, ST. PETERSBURG, FL, 33701

Key Officers & Management

Name Role Address
Holden Greg Director 523 23rd Ave N, St Petersburg, FL, 33704
Yeagley Jennifer Chief Executive Officer 863 3rd Ave N, St Petersburg, FL, 33701
Flowers Gary Director 501 Knights Run Ave., Unit 2319, Tampa, FL, 33602
Diamond Ben Director 150 2nd Ave N., St. Petersburg, FL, 33701
YEAGLEY JENNIFER Agent 863 3rd Ave N, St. Petersburg, FL, 33701
Roodhouse Erica Director 100 2nd Ave S, St. Petersburg, FL, 33701

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G17000119513 VIRGINIA AND DAVID BALDWIN WOMEN'S RESIDENCE ACTIVE 2017-10-30 2027-12-31 - 814 4TH AVE N, ST PETERSBURG, FL, 33701

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2021-02-02 863 3rd Ave N, St Petersburg, FL 33701 -
CHANGE OF MAILING ADDRESS 2021-02-02 863 3rd Ave N, St Petersburg, FL 33701 -
REGISTERED AGENT ADDRESS CHANGED 2021-02-02 863 3rd Ave N, St. Petersburg, FL 33701 -
REGISTERED AGENT NAME CHANGED 2020-04-06 YEAGLEY, JENNIFER -

Documents

Name Date
ANNUAL REPORT 2024-03-20
ANNUAL REPORT 2023-03-02
ANNUAL REPORT 2022-01-31
ANNUAL REPORT 2021-02-02
ANNUAL REPORT 2020-04-06
ANNUAL REPORT 2019-04-01
ANNUAL REPORT 2018-01-17
ANNUAL REPORT 2017-01-18
ANNUAL REPORT 2016-01-22
ANNUAL REPORT 2015-01-06

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
23-7208280 Corporation Unconditional Exemption 863 3RD N AVE, SAINT PETERSBURG, FL, 33701-0000 1975-09
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Educational Organization, Local Association of Employees, Agricultural Organization, Horticultural Organization, Board of Trade, Business League, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Voluntary Employees' Beneficiary Association (Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Mutual Ditch or Irrigation Co., Burial Association, Cemetery Company, Credit Union, Other Mutual Corp. or Assoc., Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2023-09
Asset 10,000,000 to 49,999,999
Income 10,000,000 to 49,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Sep
Asset Amount 30414854
Income Amount 37423876
Form 990 Revenue Amount 34885587
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name ST PETERSBURG FREE CLINIC INC
EIN 23-7208280
Tax Period 201909
Filing Type E
Return Type 990
File View File
Organization Name ST PETERSBURG FREE CLINIC INC
EIN 23-7208280
Tax Period 201809
Filing Type E
Return Type 990
File View File
Organization Name ST PETERSBURG FREE CLINIC INC
EIN 23-7208280
Tax Period 201709
Filing Type E
Return Type 990
File View File
Organization Name ST PETERSBURG FREE CLINIC INC
EIN 23-7208280
Tax Period 201609
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
7278958403 2021-02-11 0455 PPS 863 3rd Ave N, St Petersburg, FL, 33701-2703
Loan Status Date 2022-01-19
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 569635
Loan Approval Amount (current) 569635
Undisbursed Amount 0
Franchise Name -
Lender Location ID 19248
Servicing Lender Name Synovus Bank
Servicing Lender Address 1148 Broadway, COLUMBUS, GA, 31901-2429
Rural or Urban Indicator U
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address St Petersburg, PINELLAS, FL, 33701-2703
Project Congressional District FL-14
Number of Employees 59
NAICS code 624221
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 19248
Originating Lender Name Synovus Bank
Originating Lender Address COLUMBUS, GA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 574348.14
Forgiveness Paid Date 2021-12-16
5201887108 2020-04-13 0455 PPP 863 3RD AVE North, SAINT PETERSBURG, FL, 33701-2703
Loan Status Date 2021-05-15
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 486650
Loan Approval Amount (current) 486650
Undisbursed Amount 0
Franchise Name -
Lender Location ID 19248
Servicing Lender Name Synovus Bank
Servicing Lender Address 1148 Broadway, COLUMBUS, GA, 31901-2429
Rural or Urban Indicator U
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address SAINT PETERSBURG, PINELLAS, FL, 33701-2703
Project Congressional District FL-14
Number of Employees 59
NAICS code 624221
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 19248
Originating Lender Name Synovus Bank
Originating Lender Address COLUMBUS, GA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 491436.5
Forgiveness Paid Date 2021-04-12

Motor Carrier Census

USDOT Number Carrier Operation MCS-150 Form Date MCS-150 Mileage MCS-150 Year Power Units Drivers Operation Classification
3302063 Intrastate Non-Hazmat 2024-04-10 58000 2023 4 7 Private(Property)
Legal Name ST PETERSBURG FREE CLINIC
DBA Name -
Physical Address 863 3RD AVE N, ST PETERSBURG, FL, 33701-2703, US
Mailing Address 863 3RD AVE N, ST PETERSBURG, FL, 33701-2703, US
Phone (727) 821-1200
Fax (727) 821-9263
E-mail SHAINA.BENT@STPETERSBURGFREECLINIC.ORG

Safety Measurement System - All Transportation
Total Number of Inspections for the measurement period (24 months) 1
Driver Fitness BASIC Serious Violation Indicator No
Vehicle Maintenance BASIC Acute/Critical Indicator No
Unsafe Driving BASIC Acute/Critical Indicator No
Driver Fitness BASIC Roadside Performance measure value 0
Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value 0
Total Number of Driver Inspections for the measurment period 1
Vehicle Maintenance BASIC Roadside Performance measure value 0
Total Number of Vehicle Inspections for the measurement period 0
Controlled Substances and Alcohol BASIC Roadside Performance measure value 0
Unsafe Driving BASIC Roadside Performance Measure Value 0
Number of inspections with at least one Driver Fitness BASIC violation 0
Number of inspections with at least one Hours-of-Service BASIC violation 0
Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation 0
Number of inspections with at least one Vehicle Maintenance BASIC violation 0
Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation 0
Number of inspections with at least one Controlled Substances and Alcohol BASIC violation 0
Number of inspections with at least one Unsafe Driving BASIC violation 0

Inspections
Unique report number of the inspection 3572005775
State abbreviation that indicates the state the inspector is from FL
The date of the inspection 2023-10-06
ID that indicates the level of inspection Driver-Only
State abbreviation that indicates where the inspection occurred FL
Time weight of the inspection 1
Number of Out-Of-Service violations related to Driver 0
Number of Out-Of-Service violations related to vehicle 0
Number of violations related to Hazardous Materials 0
Total number of Out-Of-Service violations 0
Total number of Out-Of-Service violations related to Hazardous Materials 0
Description of the type of the main unit STRAIGHT TRUCK
Description of the make of the main unit INTL
License plate of the main unit X0071E
License state of the main unit FL
Vehicle Identification Number of the main unit 1HTMMMMN8KH562898
Unsafe Driving BASIC inspection Y
Hours-of-Service Compliance BASIC inspection Y
Driver Fitness BASIC inspection Y
Controlled Substances/Alcohol BASIC inspection Y
Total number of BASIC violations 0
Number of Unsafe Driving BASIC violations 0
Number of Hours-of-Service Compliance BASIC violations 0
Number of Driver Fitness BASIC violations 0
Number of Controlled Substances/Alcohol BASIC violations 0
Number of Vehicle Maintenance BASIC violations 0
Number of Hazardous Materials Compliance BASIC violations 0
1238344 Intrastate Non-Hazmat 2014-02-19 10000 2013 1 2 Private(Property), FOOD BANK
Legal Name ST PETERSBURG FREE CLINIC INC
DBA Name -
Physical Address 863 3RD AVE NO, ST PETERSBURG, FL, 33701, US
Mailing Address 863 3RD AVE NO, ST PETERSBURG, FL, 33701, US
Phone (727) 821-1200
Fax (727) 821-9263
E-mail -

Safety Measurement System - All Transportation
Total Number of Inspections for the measurement period (24 months) 0
Driver Fitness BASIC Serious Violation Indicator No
Vehicle Maintenance BASIC Acute/Critical Indicator No
Unsafe Driving BASIC Acute/Critical Indicator No
Driver Fitness BASIC Roadside Performance measure value 0
Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value 0
Total Number of Driver Inspections for the measurment period 0
Vehicle Maintenance BASIC Roadside Performance measure value 0
Total Number of Vehicle Inspections for the measurement period 0
Controlled Substances and Alcohol BASIC Roadside Performance measure value 0
Unsafe Driving BASIC Roadside Performance Measure Value 0
Number of inspections with at least one Driver Fitness BASIC violation 0
Number of inspections with at least one Hours-of-Service BASIC violation 0
Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation 0
Number of inspections with at least one Vehicle Maintenance BASIC violation 0
Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation 0
Number of inspections with at least one Controlled Substances and Alcohol BASIC violation 0
Number of inspections with at least one Unsafe Driving BASIC violation 0

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Companies related by address

No other companies in our directory share the same address as ST. PETERSBURG FREE CLINIC, INC.

Date of last update: 03 Apr 2025

Sources: Florida Department of State

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