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HOSPICE OF ST. FRANCIS, INC.

Company Details

Entity Name: HOSPICE OF ST. FRANCIS, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 28 Nov 1977 (47 years ago)
Document Number: 740892
FEI/EIN Number 591795440
Address: 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 32780-7927, US
Mail Address: 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 32780-7927, US
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1598815839 2007-01-11 2022-03-25 1250 GRUMMAN PL STE B, TITUSVILLE, FL, 327807927, US 1250 GRUMMAN PL STE B, TITUSVILLE, FL, 327807927, US

Contacts
Phone +1 321-269-4240
Fax 3212695428

Authorized person
Name MR. KAMEN JENKINS
Role MANAGE CARE/SYSTEMS SPECIALIST
Phone 3215228612

Taxonomy
Taxonomy Code 251G00000X - Community Based Hospice Care Agency
License Number 5029096
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 087255500
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HOSPICE OF ST. FRANCIS 403B RETIREMENT PLAN 2012 591795440 2013-10-09 HOSPICE OF ST. FRANCIS 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-02-01
Business code 621610
Sponsor’s telephone number 3212694240
Plan sponsor’s address 1250 GRUMMAN PLACE SUITE B, TITUSVILLE, FL, 32780

Signature of
Role Plan administrator
Date 2013-10-09
Name of individual signing BRUCE WOLTERS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF ST. FRANCIS 403B RETIREMENT PLAN 2011 591795440 2012-10-10 HOSPICE OF ST. FRANCIS 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-02-01
Business code 621610
Sponsor’s telephone number 3212694240
Plan sponsor’s address 1250 GRUMMAN PLACE SUITE B, TITUSVILLE, FL, 32780

Plan administrator’s name and address
Administrator’s EIN 591795440
Plan administrator’s name HOSPICE OF ST. FRANCIS
Plan administrator’s address 1250 GRUMMAN PLACE SUITE B, TITUSVILLE, FL, 32780
Administrator’s telephone number 3212694240

Signature of
Role Plan administrator
Date 2012-10-10
Name of individual signing BRUCE WOLTERS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF ST. FRANCIS 403B RETIREMENT PLAN 2010 591795440 2011-10-13 HOSPICE OF ST. FRANCIS 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-02-01
Business code 621610
Sponsor’s telephone number 3212694240
Plan sponsor’s address 1250 GRUMMAN PLACE SUITE B, TITUSVILLE, FL, 32780

Plan administrator’s name and address
Administrator’s EIN 591795440
Plan administrator’s name HOSPICE OF ST. FRANCIS
Plan administrator’s address 1250 GRUMMAN PLACE SUITE B, TITUSVILLE, FL, 32780
Administrator’s telephone number 3212694240

Signature of
Role Plan administrator
Date 2011-10-13
Name of individual signing BRUCE WOLTERS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF ST. FRANCIS 403B RETIREMENT PLAN 2009 591795440 2010-10-14 HOSPICE OF ST. FRANCIS 60
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-02-01
Business code 621610
Sponsor’s telephone number 3212694240
Plan sponsor’s address 1250 GRUMMAN PLACE SUITE B, TITUSVILLE, FL, 32780

Plan administrator’s name and address
Administrator’s EIN 591795440
Plan administrator’s name HOSPICE OF ST. FRANCIS
Plan administrator’s address 1250 GRUMMAN PLACE SUITE B, TITUSVILLE, FL, 32780
Administrator’s telephone number 3212694240

Signature of
Role Plan administrator
Date 2010-10-13
Name of individual signing BRUCE WOLTERS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Killian Joseph Agent 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 327807927

Director

Name Role Address
MCALPINE CHRISTOPHER Director 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 327807927
Allender Jerry Director 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 327807927

Member

Name Role Address
Ferguson David Member 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 327807927

Chief Executive Officer

Name Role Address
Killian Joseph S Chief Executive Officer 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 327807927

Past

Name Role Address
Alderman Mary Ann Past 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 327807927

Vice President

Name Role Address
Hurt Tony Vice President 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 327807927

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G20000134412 ST. FRANCIS REFLECTIONS HOSPICE ACTIVE 2020-10-16 2025-12-31 No data 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 32780
G20000133658 ST. FRANCIS REFLECTIONS CHILD GRIEF PROGRAM ACTIVE 2020-10-15 2025-12-31 No data 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 32780
G20000119812 ST. FRANCIS REFLECTIONS CHILD GRIEF PROGRAM ACTIVE 2020-09-15 2025-12-31 No data 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 32780
G20000119815 ST. FRANCIS REFLECTIONS PET PLEDGE ACTIVE 2020-09-15 2025-12-31 No data 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 32780
G20000119814 ST. FRANCIS REFLECTIONS GRIEF SUPPORT ACTIVE 2020-09-15 2025-12-31 No data 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 32780
G20000119808 ST. FRANCIS REFLECTIONS PEDIATRIC PALLIATIVE CARE ACTIVE 2020-09-15 2025-12-31 No data 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 32780
G20000101724 ST. FRANCIS REFLECTIONS LIFESTAGE CARE ACTIVE 2020-08-11 2025-12-31 No data 1250-B GRUMMAN PLACE, TITUSVILLE, FL, 32780

Events

Event Type Filed Date Value Description
RESTATED ARTICLES 2024-10-01 No data No data
AMENDMENT 2022-08-16 No data No data
RESTATED ARTICLES 2019-10-04 No data No data
AMENDMENT 2013-06-05 No data No data
NAME CHANGE AMENDMENT 1991-05-01 HOSPICE OF ST. FRANCIS, INC. No data
NAME CHANGE AMENDMENT 1988-03-23 NORTH BREVARD HOSPICE, INC. No data

Related by officers

MCALPINE CHRISTOPHER

CENTURY MEDICAL PLAZA ASSOCIATION, INC. COASTAL HEALTH SYSTEMS OF BREVARD, INC. DIALYSIS AND KIDNEY CENTER OF NORTH BREVARD, INC. TITUSVILLE FAMILY PRACTICE CENTER, P.A.

Ferguson David

FL GOODS & SUPPLIES LLC BANYAN HOUSE CONDOMINIUM, INC. FIRST BAPTIST CHURCH CITRUS PARK, INC.

Killian Joseph

SYNTHASE, INC. MEADOWRIDGE/SOUTH ASSOCIATION, INC.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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