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  5. ST. PETERSBURG FREE CLINIC, INC.

ST. PETERSBURG FREE CLINIC, INC.

Company Details

Entity Name: ST. PETERSBURG FREE CLINIC, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Not For Profit Corporation
Status: Active
Date Filed: 29 Dec 1970 (54 years ago)
Document Number: 719939
FEI/EIN Number 23-7208280
Address: 863 3rd Ave N, St Petersburg, FL 33701
Mail Address: 863 3rd Ave N, St Petersburg, FL 33701
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
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
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 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

Agent

Name Role Address
YEAGLEY, JENNIFER Agent 863 3rd Ave N, St. Petersburg, FL 33701

Director

Name Role Address
Holden, Greg Director 523 23rd Ave N, St Petersburg, FL 33704
Flowers, Gary Director 501 Knights Run Ave., Unit 2319, Tampa, FL 33602
Roodhouse, Erica Director 100 2nd Ave S, St. Petersburg, FL 33701
Diamond, Ben Director 150 2nd Ave N., Suite 570 St. Petersburg, FL 33701

Chair

Name Role Address
Holden, Greg Chair 523 23rd Ave N, St Petersburg, FL 33704

Chief Executive Officer

Name Role Address
Yeagley, Jennifer Chief Executive Officer 863 3rd Ave N, St Petersburg, FL 33701

Treasurer

Name Role Address
Flowers, Gary Treasurer 501 Knights Run Ave., Unit 2319, Tampa, FL 33602

Secretary

Name Role Address
Roodhouse, Erica Secretary 100 2nd Ave S, St. Petersburg, FL 33701

Vice Chair

Name Role Address
Diamond, Ben Vice Chair 150 2nd Ave N., Suite 570 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 No data 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 No data
CHANGE OF MAILING ADDRESS 2021-02-02 863 3rd Ave N, St Petersburg, FL 33701 No data
REGISTERED AGENT ADDRESS CHANGED 2021-02-02 863 3rd Ave N, St. Petersburg, FL 33701 No data
REGISTERED AGENT NAME CHANGED 2020-04-06 YEAGLEY, JENNIFER No data

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

Related by officers

YEAGLEY, JENNIFER

THE SISTER MARGARET FREEMAN FOUNDATION, INC.

Yeagley, Jennifer

BON SECOURS MERCY HEALTH FOUNDATION INC.

Diamond, Ben

ROACH BUSTERS INC.

Related by address

No related companies by address

Date of last update: 06 Feb 2025

Sources: Florida Department of State

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