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  5. IMPACT FOR DEVELOPMENTAL EDUCATION, INC.

IMPACT FOR DEVELOPMENTAL EDUCATION, INC.

Company Details

Entity Name: IMPACT FOR DEVELOPMENTAL EDUCATION, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 26 Jun 1979 (46 years ago)
Document Number: 747821
FEI/EIN Number 591935415
Address: 1650 MEDICAL LANE, #4, FORT MYERS, FL, 33907, US
Mail Address: P.O. BOX 51319, FORT MYERS, FL, 33994, US
ZIP code: 33907
County: Lee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1386368801 2022-09-28 2023-03-07 P.O. BOX 51319, FORT MYERS, FL, 339941119, US 1650 MEDICAL LANE SUITE 4, FORT MYERS, FL, 339071116, US

Contacts
Phone +1 239-334-6160
Fax 2393341339

Authorized person
Name MRS. KATHY S BEELER
Role EXECUTIVE DIRECTOR
Phone 2393346160

Taxonomy
Taxonomy Code 261Q00000X - Clinic/Center
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 105037500
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 2021 591935415 2023-03-08 IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2393346160
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 339941319

Signature of
Role Plan administrator
Date 2023-03-08
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 2020 591935415 2021-03-22 IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2393346160
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 339941319

Signature of
Role Plan administrator
Date 2021-03-22
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 2019 591935415 2020-06-26 IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2393346160
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 339941319

Signature of
Role Plan administrator
Date 2020-06-26
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 2018 591935415 2019-09-17 IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2393346160
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 339941319

Signature of
Role Plan administrator
Date 2019-09-17
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION INC 2017 591935415 2018-06-13 IMPACT FOR DEVELOPMENTAL EDUCATION INC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2393346160
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 339941319

Signature of
Role Plan administrator
Date 2018-06-13
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-13
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 2016 591935415 2017-05-04 IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2398511574
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 33994

Signature of
Role Plan administrator
Date 2017-05-04
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-04
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 2015 591935415 2016-04-12 IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2398511574
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 33994

Signature of
Role Plan administrator
Date 2016-04-12
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-04-12
Name of individual signing MADELINE BRAVO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 2014 591935415 2015-07-06 IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2398511574
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 33994

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing CHERYL GENTRY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-06
Name of individual signing CHERYL GENTRY
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 2013 591935415 2014-06-16 IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2393346160
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 33994

Signature of
Role Plan administrator
Date 2014-06-16
Name of individual signing CHERYL L GENTRY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-16
Name of individual signing CHERYL L GENTRY
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 2012 591935415 2013-04-29 IMPACT FOR DEVELOPMENTAL EDUCATION, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-12-01
Business code 624100
Sponsor’s telephone number 2393346160
Plan sponsor’s address PO BOX 51319, FORT MYERS, FL, 33994

Signature of
Role Plan administrator
Date 2013-04-29
Name of individual signing CHERYL L GENTRY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-29
Name of individual signing CHERYL L GENTRY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BEEHLER KATHY S Agent 1597 WINSTON RD, FORT MYERS, FL, 33917

President

Name Role Address
EDENFIELD RONALD M President 7381 MONARCH LANE, FORT MYERS, FL, 33912

Chief Executive Officer

Name Role Address
BEEHLER KATHY S Chief Executive Officer 1597 WINSTON RD, NORTH FORT MYERS, FL, 33917

Director

Name Role Address
JOHNSON BRANDON Director 2285 CAPE HEATHER CIRCLE, CAPE CORAL, FL, 33991
ROHRBACHER MICHAEL Director 1650 MEDICAL LANE, FORT MYERS, FL, 33907
WAGNER PAM M Director 2855 COLONIAL BLVD, FORT MYERS, FL, 33966
HORNER CHERIE Director 1650 MEDICAL LANE, FORT MYERS, FL, 33907

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G16000117137 IMPACT FOR EARLY CHILDHOOD EDUCATION ACTIVE 2016-10-31 2026-12-31 No data 12011 WEDGE DRIVE, FORT MYERS, FL, 33913

Events

Event Type Filed Date Value Description
AMENDMENT 1995-06-13 No data No data

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Related by address

No related companies by address

Date of last update: 01 Jan 2025

Sources: Florida Department of State

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