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  5. ST. AUGUSTINE YOUTH SERVICES, INC.

ST. AUGUSTINE YOUTH SERVICES, INC. - Florida Company Profile

Company Details

Entity Name: ST. AUGUSTINE YOUTH SERVICES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-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: 30 Sep 1988 (37 years ago)
Last Event: AMENDMENT
Event Date Filed: 12 May 1989 (36 years ago)
Document Number: N28637
FEI/EIN Number 592925271

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: C/O Schuyler Siefker, 201 SIMONE WAY, ST. AUGUSTINE, FL, 32086, US
Mail Address: C/O Schuyler Siefker, 201 SIMONE WAY, ST. AUGUSTINE, FL, 32086, US
ZIP code: 32086
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1699816900 2007-02-09 2014-08-27 201 SIMONE WAY, ST. AUGUSTINE, FL, 32086, US 201 SIMONE WAY, ST. AUGUSTINE, FL, 32086, US

Contacts
Phone +1 904-829-1770
Fax 9048250604

Authorized person
Name MRS. SCHUYLER S. SIEFKER
Role EXECUTIVE DIRECTOR
Phone 9048291770

Taxonomy
Taxonomy Code 320800000X - Mental Illness Community Based Residential Treatment Facility
License Number 0206-61-16
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 029585003
State FL
Issuer MEDICAID
Number 029585000
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SAYS 401(K) PLAN 2023 592925271 2025-03-17 ST. AUGUSTINE YOUTH SERVICES, INC 95
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-07-01
Business code 624100
Sponsor’s telephone number 9048291770
Plan sponsor’s address 201 SIMONE WAY, ST. AUGUSTINE, FL, 32086
SAYS 401(K) PLAN 2022 592925271 2023-12-21 ST. AUGUSTINE YOUTH SERVICES, INC 70
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-07-01
Business code 624100
Sponsor’s telephone number 9048291770
Plan sponsor’s address 201 SIMONE WAY, ST. AUGUSTINE, FL, 32086
SAYS 401(K) PLAN 2021 592925271 2023-01-05 ST. AUGUSTINE YOUTH SERVICES, INC 90
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2021-07-01
Business code 624100
Sponsor’s telephone number 9048291770
Plan sponsor’s address 201 SIMONE WAY, ST. AUGUSTINE, FL, 32086
ST AUGUSTINE YOUTH SERVICES 401K PLAN 2013 592925271 2014-06-19 ST AUGUSTINE YOUTH SERVICES 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624100
Sponsor’s telephone number 9048291770
Plan sponsor’s address 201 SIMONE WAY, ST AUGUSTINE, FL, 320867750

Signature of
Role Plan administrator
Date 2014-06-19
Name of individual signing SCHUYLER SIEFKER
Valid signature Filed with authorized/valid electronic signature
ST AUGUSTINE YOUTH SERVICES 401K PLAN 2012 592925271 2013-05-29 ST AUGUSTINE YOUTH SERVICES 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624100
Sponsor’s telephone number 9048291770
Plan sponsor’s address 201 SIMONE WAY, ST AUGUSTINE, FL, 320867750

Signature of
Role Plan administrator
Date 2013-05-29
Name of individual signing SCHUYLER SIEFKER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-29
Name of individual signing SCHUYLER SIEFKER
Valid signature Filed with authorized/valid electronic signature
ST AUGUSTINE YOUTH SERVICES 401K PLAN 2011 592925271 2012-07-23 ST AUGUSTINE YOUTH SERVICES 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624100
Sponsor’s telephone number 9048291770
Plan sponsor’s address 50 SARAGOSSA ST, ST AUGUSTINE, FL, 320843547

Plan administrator’s name and address
Administrator’s EIN 592925271
Plan administrator’s name ST AUGUSTINE YOUTH SERVICES
Plan administrator’s address 50 SARAGOSSA ST, ST AUGUSTINE, FL, 320843547
Administrator’s telephone number 9048291770

Signature of
Role Plan administrator
Date 2012-07-23
Name of individual signing SCHUYLER SIEFKER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-23
Name of individual signing SCHUYLER SIEFKER
Valid signature Filed with authorized/valid electronic signature
ST AUGUSTINE YOUTH SERVICES 401K PLAN 2010 592925271 2011-07-06 ST AUGUSTINE YOUTH SERVICES 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624410
Sponsor’s telephone number 9048291770
Plan sponsor’s address 50 SARAGOSSA ST, ST AUGUSTINE, FL, 320843547

Plan administrator’s name and address
Administrator’s EIN 592925271
Plan administrator’s name ST AUGUSTINE YOUTH SERVICES
Plan administrator’s address 50 SARAGOSSA ST, ST AUGUSTINE, FL, 320843547
Administrator’s telephone number 9048291770

Signature of
Role Plan administrator
Date 2011-07-06
Name of individual signing SCHUYLER SIEFKER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-06
Name of individual signing SCHUYLER SIEFKER
Valid signature Filed with authorized/valid electronic signature
ST AUGUSTINE YOUTH SERVICES 401K PLAN 2009 592925271 2010-07-20 ST AUGUSTINE YOUTH SERVICES 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 111100
Sponsor’s telephone number 9048291770
Plan sponsor’s address 50 SARAGOSSA ST, ST AUGUSTINE, FL, 320843547

Plan administrator’s name and address
Administrator’s EIN 592925271
Plan administrator’s name ST AUGUSTINE YOUTH SERVICES
Plan administrator’s address 50 SARAGOSSA ST, ST AUGUSTINE, FL, 320843547
Administrator’s telephone number 9048291770

Signature of
Role Plan administrator
Date 2010-07-20
Name of individual signing SCHUYLER SIEFKER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-20
Name of individual signing SCHUYLER SIEFKER
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
Burchfield Robin President 237 Segovia Road, St. Augustine, FL, 32086
HOLLISTER MICHELE R Officer 413 TRAVINO AVE, SAINT AUGUSTINE, FL, 32080
SIEFKER SCHUYLER S Chief Executive Officer 704 ALDEN WAY, ST. AUGUSTINE, FL, 32086
Salvato Michael Officer 2137 Oak Street #5, Jacksonville, FL, 32204
Mercurio Teresa Officer 1670 US-1 South, St. Augustine, FL, 32084
Siefker Schuyler S Agent 201 Simone Way, ST. AUGUSTINE, FL, 32086
DION DICKI Officer 137 COASTAL OAK CIRCLE, PONTE VEDRA BEACH, FL, 32082

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2021-04-07 C/O Schuyler Siefker, 201 SIMONE WAY, ST. AUGUSTINE, FL 32086 -
CHANGE OF MAILING ADDRESS 2021-04-07 C/O Schuyler Siefker, 201 SIMONE WAY, ST. AUGUSTINE, FL 32086 -
REGISTERED AGENT NAME CHANGED 2021-04-07 Siefker, Schuyler S. -
REGISTERED AGENT ADDRESS CHANGED 2014-01-16 201 Simone Way, ST. AUGUSTINE, FL 32086 -
AMENDMENT 1989-05-12 - -

Documents

Name Date
ANNUAL REPORT 2024-03-01
ANNUAL REPORT 2023-03-07
ANNUAL REPORT 2022-03-09
ANNUAL REPORT 2021-04-07
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-02-01
ANNUAL REPORT 2018-01-24
ANNUAL REPORT 2017-03-30
ANNUAL REPORT 2016-01-15
ANNUAL REPORT 2015-02-05

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
59-2925271 Corporation Unconditional Exemption 201 SIMONE WAY, ST AUGUSTINE, FL, 32086-7750 1989-06
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Organization that receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2024-06
Asset 5,000,000 to 9,999,999
Income 5,000,000 to 9,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Jun
Asset Amount 6415476
Income Amount 7939271
Form 990 Revenue Amount 7939271
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name ST AUGUSTINE YOUTH SERVICES INC
EIN 59-2925271
Tax Period 202306
Filing Type E
Return Type 990
File View File
Organization Name ST AUGUSTINE YOUTH SERVICES INC
EIN 59-2925271
Tax Period 202206
Filing Type E
Return Type 990
File View File
Organization Name ST AUGUSTINE YOUTH SERVICES INC
EIN 59-2925271
Tax Period 202106
Filing Type E
Return Type 990
File View File
Organization Name ST AUGUSTINE YOUTH SERVICES INC
EIN 59-2925271
Tax Period 202006
Filing Type E
Return Type 990
File View File
Organization Name ST AUGUSTINE YOUTH SERVICES INC
EIN 59-2925271
Tax Period 201906
Filing Type E
Return Type 990
File View File
Organization Name ST AUGUSTINE YOUTH SERVICES INC
EIN 59-2925271
Tax Period 201706
Filing Type P
Return Type 990
File View File
Organization Name ST AUGUSTINE YOUTH SERVICES INC
EIN 59-2925271
Tax Period 201606
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3911307202 2020-04-27 0491 PPP 201 Simone Way, SAINT AUGUSTINE, FL, 32086
Loan Status Date 2021-04-08
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 576500
Loan Approval Amount (current) 576500
Undisbursed Amount 0
Franchise Name -
Lender Location ID 19595
Servicing Lender Name Ameris Bank
Servicing Lender Address 3490 Piedmont Rd NE, Ste 124, ATLANTA, GA, 30305
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address SAINT AUGUSTINE, SAINT JOHNS, FL, 32086-0001
Project Congressional District FL-06
Number of Employees 74
NAICS code 623220
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 19595
Originating Lender Name Ameris Bank
Originating Lender Address ATLANTA, GA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 581222.56
Forgiveness Paid Date 2021-03-09

Companies related by officers

SIEFKER SCHUYLER S

SIMONE & SIMONE LLC - Active
Florida Limited Liability Co. (2004 )

Companies related by address

No other companies in our directory share the same address as ST. AUGUSTINE YOUTH SERVICES, INC.

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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