Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. St. Johns
    4. ›
  4. 32086
    5. ›
  5. ST. AUGUSTINE YOUTH SERVICES, INC.

ST. AUGUSTINE YOUTH SERVICES, INC.

Company Details

Entity Name: ST. AUGUSTINE YOUTH SERVICES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 30 Sep 1988 (36 years ago)
Document Number: N28637
FEI/EIN Number 592925271
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 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

Agent

Name Role Address
Siefker Schuyler S Agent 201 Simone Way, ST. AUGUSTINE, FL, 32086

President

Name Role Address
Burchfield Robin President 237 Segovia Road, St. Augustine, FL, 32086

Officer

Name Role Address
HOLLISTER MICHELE R Officer 413 TRAVINO AVE, SAINT AUGUSTINE, FL, 32080
DION DICKI Officer 137 COASTAL OAK CIRCLE, PONTE VEDRA BEACH, FL, 32082
Salvato Michael Officer 2137 Oak Street #5, Jacksonville, FL, 32204
Mercurio Teresa Officer 1670 US-1 South, St. Augustine, FL, 32084

Chief Executive Officer

Name Role Address
SIEFKER SCHUYLER S Chief Executive Officer 704 ALDEN WAY, ST. AUGUSTINE, FL, 32086

Events

Event Type Filed Date Value Description
AMENDMENT 1989-05-12 No data No data

Related by officers

SIEFKER SCHUYLER S

SIMONE & SIMONE LLC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 flprofile.com, Part of Big Data Integrated