| Entity Name: | ST. ANDREW BAY CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 20 Feb 1978 (47 years ago) |
| Document Number: | 741668 |
| FEI/EIN Number | 590951529 |
| Address: | 1804 CAROLINA AVE., LYNN HAVEN, FL, 32444 |
| Mail Address: | P.O. BOX 1320, LYNN HAVEN, FL, 32444 |
| ZIP code: | 32444 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467679142 | 2007-04-20 | 2012-05-18 | P.O. BOX 1320, LYNN HAVEN, FL, 32444, US | 1804 CAROLINA AVENUE, LYNN HAVEN, FL, 32444, US | |||||||||||||||||||||||||||||
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| Phone | +1 850-265-2951 |
| Fax | 8502482952 |
Authorized person
| Name | MS. CATHY MILLER HOWELL |
| Role | EXECUTIVE DIRECTOR |
| Phone | 8502652951 |
Taxonomy
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 024388498 |
| State | FL |
| Issuer | MEDICAID |
| Number | 024388496 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ST. ANDREW BAY CENTER 401K PLAN | 2023 | 590951529 | 2024-06-05 | ST. ANDREW BAY CENTER | 41 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-05 |
| Name of individual signing | KORI WARNER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 813000 |
| Sponsor’s telephone number | 8502652183 |
| Plan sponsor’s address | PO BOX 1320, LYNN HAVEN, FL, 32444 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-04 |
| Name of individual signing | KORI WARNER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 813000 |
| Sponsor’s telephone number | 8502652183 |
| Plan sponsor’s address | PO BOX 1320, LYNN HAVEN, FL, 32444 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-22 |
| Name of individual signing | KORI WARNER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 813000 |
| Sponsor’s telephone number | 8502652183 |
| Plan sponsor’s address | PO BOX 1320, LYNN HAVEN, FL, 32444 |
Signature of
| Role | Plan administrator |
| Date | 2021-06-02 |
| Name of individual signing | KORI WARNER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 813000 |
| Sponsor’s telephone number | 8502652183 |
| Plan sponsor’s address | PO BOX 1320, LYNN HAVEN, FL, 32444 |
Signature of
| Role | Plan administrator |
| Date | 2020-07-22 |
| Name of individual signing | KORI WARNER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Sharpe Ron | Agent | 1804 CAROLINA AVE., LYNN HAVEN, FL, 32444 |
| Name | Role | Address |
|---|---|---|
| Ramie Ricky | Boar | 1804 CAROLINA AVE., LYNN HAVEN, FL, 32444 |
| Allen Michael D | Boar | 4300 Highway 2300, Panama City, FL, 32409 |
| Lester Erica | Boar | PO BOX 15311, Panama City, FL, 32406 |
| Tunnell Jason | Boar | 205 Hatcher Drive, Panama City, FL, 32409 |
| Ice Ashley | Boar | 1804 CAROLINA AVE., LYNN HAVEN, FL, 32444 |
| Jernigan Jeremy | Boar | 840 W. 11th Street, Panama City, FL, 32401 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000064722 | EMPOWERMENT CAFE | ACTIVE | 2022-05-24 | 2027-12-31 | No data | 1804 CAROLINA AVENUE, LYNN HAVEN, FL, 32444 |
| G22000064723 | INKLUSION COFFEE SHOP | ACTIVE | 2022-05-24 | 2027-12-31 | No data | 1804 CAROLINA AVENUE, LYNN HAVEN, FL, 32444 |
| G17000063677 | THE ARC OF THE BAY | ACTIVE | 2017-06-08 | 2027-12-31 | No data | PC BOX 1320, LYNN HAVEN, FL, 32444 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| RESTATED ARTICLES | 2014-11-21 | No data | No data |
| AMENDMENT | 2013-12-10 | No data | No data |
| RESTATED ARTICLES | 2002-02-06 | No data | No data |
| AMENDMENT | 2000-04-19 | No data | No data |
| AMENDMENT | 1998-06-19 | No data | No data |
| AMENDMENT AND NAME CHANGE | 1995-08-23 | ST. ANDREW BAY CENTER, INC. | No data |
| AMENDMENT | 1992-05-01 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
