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  5. SPACE COAST HEALTH FOUNDATION, INC.

SPACE COAST HEALTH FOUNDATION, INC.

Company Details

Entity Name: SPACE COAST HEALTH FOUNDATION, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 13 Aug 1984 (40 years ago)
Document Number: N04669
FEI/EIN Number 592432318
Address: 1100 ROCKLEDGE BLVD., Suite 100, ROCKLEDGE, FL, 32955, US
Mail Address: 1100 ROCKLEDGE BLVD., Suite 100, ROCKLEDGE, FL, 32955, US
ZIP code: 32955
County: Brevard
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1538406566 2013-01-10 2021-09-15 1100 ROCKLEDGE BLVD STE 100, ROCKLEDGE, FL, 329552818, US 505 BREVARD AVE STE 106, COCOA, FL, 329227973, US

Contacts
Phone +1 321-241-6600
Fax 3216906621
Phone +1 321-632-5792
Fax 3216325796

Authorized person
Name MS. JOHNETTE GINDLING
Role EXECUTIVE DIRECTOR
Phone 3216372606

Taxonomy
Taxonomy Code 251K00000X - Public Health or Welfare Agency
Is Primary No
Taxonomy Code 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary Yes

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
254900GML405PNQJ2780 N04669 US-FL GENERAL ACTIVE 1984-08-13

Addresses
Legal C/O Gindling, Johnette, 1100 Rockledge Blvd., Suite 100, Rockledge, US-FL, US, 32955
Headquarters 1100 Rockledge Blvd., Suite 100, Rockledge, US-FL, US, 32955

Registration details
Registration Date 2019-05-17
Last Update 2024-04-12
Status ISSUED
Next Renewal 2025-04-26
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As N04669

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SPACE COAST HEALTH FOUNDATION, INC. 403(B)(7) 2023 592432318 2024-11-14 SPACE COAST HEALTH FOUNDATION, INC. 81
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-06-30
Business code 813000
Sponsor’s telephone number 3212416600
Plan sponsor’s address 1100 ROCKLEDGE BOULEVARD, SUITE 100, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2024-11-14
Name of individual signing SHANNON RENNEMANN
Valid signature Filed with authorized/valid electronic signature
SPACE COAST HEALTH FOUNDATION, INC. 403(B)(7) 2022 592432318 2023-11-22 SPACE COAST HEALTH FOUNDATION, INC. 91
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-06-30
Business code 813000
Sponsor’s telephone number 3212416600
Plan sponsor’s address 1100 ROCKLEDGE BOULEVARD, SUITE 100, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2023-11-22
Name of individual signing SHANNON RENNEMANN
Valid signature Filed with authorized/valid electronic signature
SPACE COAST HEALTH FOUNDATION, INC. 403(B)(7) 2021 592432318 2023-01-31 SPACE COAST HEALTH FOUNDATION, INC. 88
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-06-30
Business code 813000
Sponsor’s telephone number 3212416600
Plan sponsor’s address 1100 ROCKLEDGE BOULEVARD, SUITE 100, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2023-01-31
Name of individual signing SHANNON
Valid signature Filed with authorized/valid electronic signature
SPACE COAST HEALTH FOUNDATION, INC. 403(B)(7) 2020 592432318 2022-05-10 SPACE COAST HEALTH FOUNDATION, INC. 82
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-06-30
Business code 621900
Sponsor’s telephone number 3212416600
Plan sponsor’s address 1100 ROCKLEDGE BOULEVARD, SUITE 100, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2022-05-10
Name of individual signing SHANNON
Valid signature Filed with authorized/valid electronic signature
SPACE COAST HEALTH FOUNDATION, INC. 403(B)(7) 2019 592432318 2020-05-28 SPACE COAST HEALTH FOUNDATION, INC. 69
Three-digit plan number (PN) 001
Effective date of plan 2019-06-30
Business code 621900
Sponsor’s telephone number 3212416600
Plan sponsor’s address 1100 ROCKLEDGE BOULEVARD, SUITE 100, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2020-05-28
Name of individual signing JOY BLAZEK
Valid signature Filed with authorized/valid electronic signature
SPACE COAST HEALTH FOUNDATION, INC. 403(B)(7) 2019 592432318 2021-07-09 SPACE COAST HEALTH FOUNDATION, INC. 84
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-06-30
Business code 621900
Sponsor’s telephone number 3212416600
Plan sponsor’s address 1100 ROCKLEDGE BOULEVARD, SUITE 100, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2021-07-09
Name of individual signing SHANNON
Valid signature Filed with authorized/valid electronic signature
SPACE COAST HEALTH FOUNDATION, INC. 401(K) PLAN 2019 592432318 2020-09-17 SPACE COAST HEALTH FOUNDATION, INC. 73
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-06-30
Business code 621900
Sponsor’s telephone number 3212416600
Plan sponsor’s address 1100 ROCKLEDGE BOULEVARD, SUITE 100, ROCKLEDGE, FL, 32955

Signature of
Role Plan administrator
Date 2020-09-17
Name of individual signing JOY BLAZEK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GINDLING JOHNETTE Agent 1100 ROCKLEDGE BLVD., ROCKLEDGE, FL, 32955

Boar

Name Role Address
Dwight James Boar 1100 ROCKLEDGE BLVD., ROCKLEDGE, FL, 32955
Dale Linda Boar 1100 ROCKLEDGE BLVD., ROCKLEDGE, FL, 32955
Pilate Patrice Boar 1100 ROCKLEDGE BLVD., ROCKLEDGE, FL, 32955

Treasurer

Name Role Address
Bird Adam Treasurer 1100 ROCKLEDGE BLVD., ROCKLEDGE, FL, 32955

Secretary

Name Role Address
Benton Jane Dr. Secretary 1100 Rockledge Blvd. Suite 100, Rockledge, FL, 32955

Vice President

Name Role Address
Yasin Khalid Vice President 1100 ROCKLEDGE BLVD., ROCKLEDGE, FL, 32955

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G17000098989 LIFETIME COUNSELING CENTER ACTIVE 2017-08-30 2027-12-31 No data 1100 ROCKLEDGE BLVD., ROCKLEDGE, FL, 32955

Events

Event Type Filed Date Value Description
AMENDED AND RESTATEDARTICLES 2024-11-13 No data No data
AMENDED AND RESTATEDARTICLES/NAME CHANGE 2010-09-27 SPACE COAST HEALTH FOUNDATION, INC. No data
AMENDMENT 2001-05-16 No data No data
AMENDMENT 2000-09-18 No data No data
AMENDMENT 1996-10-08 No data No data
AMENDMENT 1994-06-07 No data No data
AMENDMENT 1992-02-21 No data No data
AMENDMENT 1990-04-16 No data No data
REINSTATEMENT 1987-02-24 No data No data
INVOLUNTARILY DISSOLVED 1986-11-14 No data No data

Related by officers

Dwight James

SCHF NOT-FOR-PROFIT WIND-DOWN, INC.

Dale Linda

SCHF NOT-FOR-PROFIT WIND-DOWN, INC.

Pilate Patrice

SCHF NOT-FOR-PROFIT WIND-DOWN, INC.

Bird Adam

SCHF NOT-FOR-PROFIT WIND-DOWN, INC.

GINDLING JOHNETTE

BEHAVIORAL HEALTH BREVARD, LLC SCHF PROGRESSIVE CARE CENTER, INC. SCHF HEALTH SERVICES, INC. SCHF NOT-FOR-PROFIT WIND-DOWN, INC. SCHF MEDICAL CENTER-MELBOURNE, INC. SCHF BREVARD CARDIOLOGY GROUP, INC. SCHF ASSISTED LIVING AT IRCC, INC.

Yasin Khalid

SCHF NOT-FOR-PROFIT WIND-DOWN, INC.

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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