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  5. XACTFORM USA, INC.

XACTFORM USA, INC. - Florida Company Profile

Company Details

Entity Name: XACTFORM USA, INC.
Jurisdiction: FLORIDA
Filing Type: Foreign 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: 21 Apr 2006 (19 years ago)
Document Number: F06000002492
FEI/EIN Number 20-4551197

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 515 Evergreen Street, Panama City Beach, FL, 32407, US
Mail Address: P.O.Box 20307, Panama City Beach, FL, 32417, US
ZIP code: 32407
County: Bay
Place of Formation: DELAWARE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
XACTFORM USA INC 401(K) PROFIT SHARING PLAN & TRUST 2021 204551197 2022-06-29 XACTFORM USA INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 17704 ASHLEY DRIVE BLDG-C1, SUITE A, PANAMA CITY BEACH, FL, 324130000

Signature of
Role Plan administrator
Date 2022-06-29
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401(K) PROFIT SHARING PLAN & TRUST 2021 204551197 2022-11-17 XACTFORM USA INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 17704 ASHLEY DRIVE BLDG-C1, SUITE A, PANAMA CITY BEACH, FL, 324130000

Signature of
Role Plan administrator
Date 2022-11-17
Name of individual signing REBECCA A DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401(K) PROFIT SHARING PLAN & TRUST 2020 204551197 2021-04-14 XACTFORM USA INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 17704 ASHLEY DRIVE BLDG-C1, SUITE A, PANAMA CITY BEACH, FL, 324130000

Signature of
Role Plan administrator
Date 2021-04-14
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401(K) PROFIT SHARING PLAN & TRUST 2019 204551197 2020-05-07 XACTFORM USA INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 11 MIRACLE STRIP LOOP, SUITE A, PANAMA CITY BEACH, FL, 324070000

Signature of
Role Plan administrator
Date 2020-05-07
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2018 204551197 2019-07-08 XACTFORM USA INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 11 MIRACLE STRIP LOOP, SUITE A, PANAMA CITY BEACH, FL, 324070000

Signature of
Role Plan administrator
Date 2019-07-08
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC. 401 K PROFIT SHARING PLAN TRUST 2017 204551197 2018-05-25 XACTFORM USA INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 515 EVERGREEN, ST STE C, PANAMA CITY BEACH, FL, 324070000

Signature of
Role Plan administrator
Date 2018-05-25
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2016 204551197 2017-07-25 XACTFORM USA INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 515 EVERGREEN STREET, ST STE C, PANAMA CITY BEACH, FL, 324070000

Signature of
Role Plan administrator
Date 2017-07-25
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2015 204551197 2016-07-29 XACTFORM USA INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 515 EVERGREEN ST STE C, PANAMA CITY BEACH, FL, 324078408

Signature of
Role Plan administrator
Date 2016-07-29
Name of individual signing JOE BUTLER
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2014 204551197 2015-06-30 XACTFORM USA INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 11 MIRACLE STRIP LOOP STE A, PANAMA CITY BEACH, FL, 324078408

Signature of
Role Plan administrator
Date 2015-06-30
Name of individual signing JOSEPH W BUTLER II
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2013 204551197 2014-05-12 XACTFORM USA INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 11 MIRACLE STRIP LOOP STE A, PANAMA CITY BEACH, FL, 324078408

Signature of
Role Plan administrator
Date 2014-05-12
Name of individual signing JOSEPH W BUTLER II
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
Chave Pierre-Olivier President 2300 La Chaux-de-Fonds, Boulevard des Eplatures 42
Coray Christian Treasurer 2300 La Chaux-de-Fonds, Boulevard des Eplatures 42
Domiquez Rebecca Secretary P.O.Box 20307, Panama City Beach, FL, 32417
CORPORATION SERVICE COMPANY Agent -

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2025-01-08 515 Evergreen Street, Suite B, Panama City Beach, FL 32407 -
CHANGE OF MAILING ADDRESS 2025-01-08 515 Evergreen Street, Suite B, Panama City Beach, FL 32407 -
CHANGE OF PRINCIPAL ADDRESS 2024-08-05 1519 Ohio Avenue, Unit A, Lynn Haven, FL 32444 -
CHANGE OF MAILING ADDRESS 2019-04-29 1519 Ohio Avenue, Unit A, Lynn Haven, FL 32444 -
REGISTERED AGENT NAME CHANGED 2013-09-10 CORPORATION SERVICE COMPANY -
REGISTERED AGENT ADDRESS CHANGED 2013-09-10 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 -

Documents

Name Date
ANNUAL REPORT 2025-01-08
AMENDED ANNUAL REPORT 2024-08-05
ANNUAL REPORT 2024-01-30
ANNUAL REPORT 2023-04-13
ANNUAL REPORT 2022-04-24
ANNUAL REPORT 2021-04-23
ANNUAL REPORT 2020-02-14
ANNUAL REPORT 2019-04-29
ANNUAL REPORT 2018-01-16
ANNUAL REPORT 2017-03-24

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
1126218408 2021-02-01 0491 PPS 17704 Ashley Dr Unit C1, Panama City Beach, FL, 32413-5249
Loan Status Date 2022-02-18
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 72880
Loan Approval Amount (current) 72880
Undisbursed Amount 0
Franchise Name -
Lender Location ID 188567
Servicing Lender Name Loan Source Incorporated
Servicing Lender Address 353 East 83rd Street Suite 3H, NEW YORK, NY, 10028
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Panama City Beach, BAY, FL, 32413-5249
Project Congressional District FL-02
Number of Employees 5
NAICS code 333515
Borrower Race Unanswered
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 39334
Originating Lender Name Trustmark National Bank
Originating Lender Address JACKSON, MS
Gender Female Owned
Veteran Unanswered
Forgiveness Amount 73496.98
Forgiveness Paid Date 2021-12-16
5901197310 2020-04-30 0491 PPP 515 EVERGREEN ST SUITE B & C, PANAMA CITY BEACH, FL, 32407-3113
Loan Status Date 2021-01-22
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 12655
Loan Approval Amount (current) 60343.92
Undisbursed Amount 0
Franchise Name -
Lender Location ID 39334
Servicing Lender Name Trustmark National Bank
Servicing Lender Address 248 E Capitol St, JACKSON, MS, 39201-2503
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address PANAMA CITY BEACH, BAY, FL, 32407-3113
Project Congressional District FL-02
Number of Employees 6
NAICS code 333515
Borrower Race Unanswered
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 39334
Originating Lender Name Trustmark National Bank
Originating Lender Address JACKSON, MS
Gender Female Owned
Veteran Unanswered
Forgiveness Amount 60709.34
Forgiveness Paid Date 2020-12-10

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No other companies in our directory share the same address as XACTFORM USA, INC.

Date of last update: 01 Apr 2025

Sources: Florida Department of State

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