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  5. NORTHWEST BEHAVIORAL HEALTH SERVICES, INC.

NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. - Florida Company Profile

Company Details

Entity Name: NORTHWEST BEHAVIORAL HEALTH 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: 24 Jun 1992 (33 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 08 Jan 1996 (29 years ago)
Document Number: N49538
FEI/EIN Number 593128476

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 2392 N. EDGEWOOD AVENUE, JACKSONVILLE, FL, 32254, US
Mail Address: 2392 N Edgewood Ave, JACKSONVILLE, FL, 32254, US
ZIP code: 32254
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1568636181 2008-04-15 2008-04-15 2392 EDGEWOOD AVE N, JACKSONVILLE, FL, 322541725, US 2392 EDGEWOOD AVE N, JACKSONVILLE, FL, 322541725, US

Contacts
Phone +1 904-781-7797
Fax 9048540506

Authorized person
Name MS. VERONICA GRIFFIN
Role CASE MANAGER
Phone 9047817797

Taxonomy
Taxonomy Code 251B00000X - Case Management Agency
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 2020 593128476 2021-04-13 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 624310
Sponsor’s telephone number 9047817797
Plan sponsor’s address 2392 N EDGEWOOD AVE, JACKSONVILLE, FL, 322541725

Signature of
Role Plan administrator
Date 2021-04-13
Name of individual signing M ELLEN BARNES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-13
Name of individual signing M ELLEN BARNES
Valid signature Filed with authorized/valid electronic signature
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. EMPLOYEES SAVINGS 2020 593128476 2021-04-13 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 624310
Sponsor’s telephone number 9047817797
Plan sponsor’s address 2392 N EDGEWOOD AVE, JACKSONVILLE, FL, 322541725

Signature of
Role Plan administrator
Date 2021-04-13
Name of individual signing M ELLEN BARNES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-13
Name of individual signing M ELLEN BARNES
Valid signature Filed with authorized/valid electronic signature
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. EMPLOYEES SAVINGS 2019 593128476 2020-08-14 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 624310
Sponsor’s telephone number 9047817797
Plan sponsor’s address 2392 N EDGEWOOD AVE, JACKSONVILLE, FL, 322541725

Signature of
Role Plan administrator
Date 2020-08-14
Name of individual signing M ELLEN BARNES
Valid signature Filed with authorized/valid electronic signature
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. EMPLOYEES SAVINGS 2018 593128476 2019-10-02 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 624310
Sponsor’s telephone number 9047817797
Plan sponsor’s address 2392 N EDGEWOOD AVE, JACKSONVILLE, FL, 322541725

Signature of
Role Plan administrator
Date 2019-10-02
Name of individual signing M ELLEN BARNES
Valid signature Filed with authorized/valid electronic signature
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. EMPLOYEES SAVINGS TRUST 2017 593128476 2018-10-02 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 624310
Sponsor’s telephone number 9047817797
Plan sponsor’s address 2392 N EDGEWOOD AVE, JACKSONVILLE, FL, 322541725

Signature of
Role Plan administrator
Date 2018-10-02
Name of individual signing M. ELLEN BARNES
Valid signature Filed with authorized/valid electronic signature
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. EMPLOYEES SAVINGS TRUST 2016 593128476 2017-04-28 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 54
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 624310
Sponsor’s telephone number 9047817797
Plan sponsor’s address 2392 N EDGEWOOD AVE, JACKSONVILLE, FL, 32254

Signature of
Role Plan administrator
Date 2017-04-28
Name of individual signing M. ELLEN BARNES
Valid signature Filed with authorized/valid electronic signature
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. EMPLOYEES SAVINGS TRUST 2015 593128476 2016-07-12 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 54
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 624310
Sponsor’s telephone number 9047817797
Plan sponsor’s address 2392 N EDGEWOOD AVE, JACKSONVILLE, FL, 32254

Signature of
Role Plan administrator
Date 2016-07-12
Name of individual signing PATRICIA SAMPSON
Valid signature Filed with authorized/valid electronic signature
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. EMPLOYEES SAVINGS TRUST 2014 593128476 2015-04-21 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 54
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 624310
Sponsor’s telephone number 9047817797
Plan sponsor’s address 2392 N EDGEWOOD AVE, JACKSONVILLE, FL, 32254

Signature of
Role Plan administrator
Date 2015-04-21
Name of individual signing PATRICIA SAMPSON
Valid signature Filed with authorized/valid electronic signature
NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. EMPLOYEES SAVINGS TRUST 2013 593128476 2014-07-24 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. 53
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 624310
Sponsor’s telephone number 9047817797
Plan sponsor’s address 2392 N EDGEWOOD AVE, JACKSONVILLE, FL, 32254

Signature of
Role Plan administrator
Date 2014-07-24
Name of individual signing PATRICIA SAMPSON
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
GLOVER TERRI D Chief Executive Officer 11 E FORSYTH ST, Jacksonville, FL, 32226
PARKER-BELL BERNICE Vice President 10887 CHADRON DRIVE, Jacksonville, FL, 32218
HOPKINS MELANIE President 303 N LIBERTY STREET, Jacksonville, FL, 32202
THOMAS ODEAN Treasurer 8000 RAMSGATE RD, JACKSONVILLE, FL, 32208
MAZEKE KENTISHA Secretary 3908 VICTORIA LAKE DR, JACKSONVILLE, FL, 32226
ESTELL REGINALD J Agent 303 N. Liberty Street, JACKSONVILLE, FL, 32202

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2021-04-01 303 N. Liberty Street, JACKSONVILLE, FL 32202 -
CHANGE OF MAILING ADDRESS 2020-04-10 2392 N. EDGEWOOD AVENUE, JACKSONVILLE, FL 32254 -
REGISTERED AGENT NAME CHANGED 2018-04-23 ESTELL, REGINALD J. -
NAME CHANGE AMENDMENT 1996-01-08 NORTHWEST BEHAVIORAL HEALTH SERVICES, INC. -
CHANGE OF PRINCIPAL ADDRESS 1995-04-26 2392 N. EDGEWOOD AVENUE, JACKSONVILLE, FL 32254 -

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J18000144774 LAPSED 16-2017-CC-010383-X DUVAL COUNTY COURT 2018-01-25 2023-04-12 $10,988.97 ADVANCED MD, INC., A DELAWARE CORPORATION, C/O SPRECHMAN & FISHER, P.A., 2775 SUNNY ISLES BLVD 100, NORTH MIAMI BEACH, FL 33160

Documents

Name Date
ANNUAL REPORT 2024-04-22
AMENDED ANNUAL REPORT 2023-10-13
AMENDED ANNUAL REPORT 2023-07-18
ANNUAL REPORT 2023-02-13
ANNUAL REPORT 2022-03-22
ANNUAL REPORT 2021-04-01
ANNUAL REPORT 2020-04-10
ANNUAL REPORT 2019-03-15
ANNUAL REPORT 2018-04-23
ANNUAL REPORT 2017-04-25

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
345451868 0419700 2021-07-29 2392 NORTH EDGEWOOD AVE, JACKSONVILLE, FL, 32254
Inspection Type Monitoring
Scope Partial
Safety/Health Safety
Close Conference 2021-07-29
Case Closed 2021-08-03

Related Activity
Type Complaint
Activity Nr 1734844
Safety Yes
Health Yes

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
59-3128476 Corporation Unconditional Exemption 2392 EDGEWOOD AVE N, JACKSONVILLE, FL, 32254-1725 2021-10
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 500,000 to 999,999
Income 1,000,000 to 4,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Jun
Asset Amount 815788
Income Amount 2811505
Form 990 Revenue Amount 2811505
National Taxonomy of Exempt Entities Mental Health & Crisis Intervention: Community Mental Health Center
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)

Auto-Revocation List
Description Organizations whose federal tax exempt status was automatically revoked for not filing a Form 990-series return or notice for three consecutive years. Important note: Just because an organization appears on this list, it does not mean the organization is currently revoked, as they may have been reinstated.
Exemption Type 501(c)(3): Religious, educational, charitable, scientific, literary, testing for public safety, fostering national or international amateur sports competition, or prevention of cruelty to children or animals organizations
Revocation Date 2019-11-15
Revocation Posting Date 2020-03-09
Exemption Reinstatement Date 2019-11-15

Determination Letter
Final Letter(s) FinalLetter_59-3128476_NORTHWESTBEHAVIORALHEALTHSERVICESINC_05202021_00.tif

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name NORTHWEST BEHAVIORAL HEALTH SERVICES INC
EIN 59-3128476
Tax Period 202306
Filing Type E
Return Type 990
File View File
Organization Name NORTHWEST BEHAVIORAL HEALTH SERVICES INC
EIN 59-3128476
Tax Period 202206
Filing Type E
Return Type 990
File View File
Organization Name NORTHWEST BEHAVIORAL HEALTH SERVICES INC
EIN 59-3128476
Tax Period 202106
Filing Type E
Return Type 990
File View File
Organization Name NORTHWEST BEHAVIORAL HEALTH SERVICES INC
EIN 59-3128476
Tax Period 202006
Filing Type P
Return Type 990
File View File
Organization Name NORTHWEST BEHAVIORAL HEALTH SERVICES INC
EIN 59-3128476
Tax Period 201906
Filing Type P
Return Type 990
File View File
Organization Name NORTHWEST BEHAVIORAL HEALTH SERVICES INC
EIN 59-3128476
Tax Period 201606
Filing Type E
Return Type 990
File View File
Organization Name NORTHWEST BEHAVIORAL HEALTH SERVICES INC
EIN 59-3128476
Tax Period 201606
Filing Type P
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
1427838704 2021-03-27 0491 PPS 2392 Edgewood Ave N, Jacksonville, FL, 32254-1725
Loan Status Date 2022-01-13
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 310893.25
Loan Approval Amount (current) 310893.25
Undisbursed Amount 0
Franchise Name -
Lender Location ID 44449
Servicing Lender Name PNC Bank, National Association
Servicing Lender Address 222 Delaware Ave, WILMINGTON, DE, 19801-1621
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Jacksonville, DUVAL, FL, 32254-1725
Project Congressional District FL-04
Number of Employees 32
NAICS code 621112
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 760
Originating Lender Name First Source Federal Credit Union
Originating Lender Address Rome, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 312965.62
Forgiveness Paid Date 2021-11-26
3204857302 2020-04-29 0491 PPP 11 E FORSYTH ST, JACKSONVILLE, FL, 32202
Loan Status Date 2021-09-24
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 280913
Loan Approval Amount (current) 280913
Undisbursed Amount 0
Franchise Name -
Lender Location ID 44449
Servicing Lender Name PNC Bank, National Association
Servicing Lender Address 222 Delaware Ave, WILMINGTON, DE, 19801-1621
Rural or Urban Indicator U
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address JACKSONVILLE, DUVAL, FL, 32202-3300
Project Congressional District FL-04
Number of Employees 57
NAICS code 623210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 760
Originating Lender Name First Source Federal Credit Union
Originating Lender Address Rome, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 284627.29
Forgiveness Paid Date 2021-08-26

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Companies related by address

No other companies in our directory share the same address as NORTHWEST BEHAVIORAL HEALTH SERVICES, INC.

Date of last update: 03 Apr 2025

Sources: Florida Department of State

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