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  5. TREASURE COAST COMMUNITY HEALTH, INC.

TREASURE COAST COMMUNITY HEALTH, INC.

Company Details

Entity Name: TREASURE COAST COMMUNITY HEALTH, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 08 Oct 1993 (31 years ago)
Document Number: N93000004631
FEI/EIN Number 593219191
Address: 12196 CR 512, FELLSMERE, FL, 32948, US
Mail Address: 1555 INDIAN RIVER BLVD, SUITE B210, VERO BEACH, FL, 32960, US
ZIP code: 32948
County: Indian River
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1730931379 2024-04-05 2024-06-12 1545 9TH ST SW, VERO BEACH, FL, 329624312, US 1545 9TH ST SW, MEDICAL MOBILE UNIT, VERO BEACH, FL, 329624312, US

Contacts
Phone +1 772-257-8224

Authorized person
Name VICKI SOULE
Role CEO
Phone 7722578224

Taxonomy
Taxonomy Code 261QF0400X - Federally Qualified Health Center (FQHC)
Is Primary Yes

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
549300M73VNPK31TH354 N93000004631 US-FL GENERAL ACTIVE No data

Addresses
Legal C/O SOULE, VICKI, 1555 INDIAN RIVER BLVD, SUITE B210, VERO BEACH, US-FL, US, 32960
Headquarters 1555 Indian River Blvd, Ste B21, VERO BEACH, US-FL, US, 32960

Registration details
Registration Date 2021-02-15
Last Update 2023-08-04
Status LAPSED
Next Renewal 2022-02-13
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As N93000004631

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TREASURE COAST COMMUNITY HEALTH, INC. 403(B) PLAN 2011 593219191 2012-10-15 TREASURE COAST COMMUNITY HEALTH, INC. 112
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-01-01
Business code 622000
Sponsor’s telephone number 7725718828
Plan sponsor’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948

Plan administrator’s name and address
Administrator’s EIN 593219191
Plan administrator’s name TREASURE COAST COMMUNITY HEALTH, INC.
Plan administrator’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948
Administrator’s telephone number 7725718828

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing VICKI SOULE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-15
Name of individual signing VICKI SOULE
Valid signature Filed with authorized/valid electronic signature
TREASURE COAST COMMUNITY HEALTH, INC. 403(B) PLAN 2010 593219191 2011-10-14 TREASURE COAST COMMUNITY HEALTH, INC. 93
Three-digit plan number (PN) 002
Effective date of plan 2007-01-01
Business code 622000
Sponsor’s telephone number 7725718828
Plan sponsor’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948

Plan administrator’s name and address
Administrator’s EIN 593219191
Plan administrator’s name TREASURE COAST COMMUNITY HEALTH, INC.
Plan administrator’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948
Administrator’s telephone number 7725718828

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing LINDA COSTA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-14
Name of individual signing LINDA COSTA
Valid signature Filed with authorized/valid electronic signature
TREASURE COAST COMMUNITY HEALTH, INC. 403(B) PLAN 2010 593219191 2011-12-23 TREASURE COAST COMMUNITY HEALTH, INC. 89
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-01-01
Business code 622000
Sponsor’s telephone number 7725718828
Plan sponsor’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948

Plan administrator’s name and address
Administrator’s EIN 593219191
Plan administrator’s name TREASURE COAST COMMUNITY HEALTH, INC.
Plan administrator’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948
Administrator’s telephone number 7725718828

Signature of
Role Plan administrator
Date 2011-12-22
Name of individual signing LINDA COSTA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-12-22
Name of individual signing LINDA COSTA
Valid signature Filed with authorized/valid electronic signature
TREASURE COAST COMMUNITY HEALTH, INC. 403(B) PLAN 2009 593219191 2011-12-23 TREASURE COAST COMMUNITY HEALTH, INC. 48
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-01-01
Business code 622000
Sponsor’s telephone number 7725718828
Plan sponsor’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948

Plan administrator’s name and address
Administrator’s EIN 593219191
Plan administrator’s name TREASURE COAST COMMUNITY HEALTH, INC.
Plan administrator’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948
Administrator’s telephone number 7725718828

Signature of
Role Plan administrator
Date 2011-12-22
Name of individual signing LINDA COSTA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-12-22
Name of individual signing LINDA COSTA
Valid signature Filed with authorized/valid electronic signature
TREASURE COAST COMMUNITY HEALTH, INC. 403(B) PLAN 2009 593219191 2010-10-15 TREASURE COAST COMMUNITY HEALTH, INC. 48
Three-digit plan number (PN) 002
Effective date of plan 2007-01-01
Business code 622000
Sponsor’s telephone number 7725718828
Plan sponsor’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948

Plan administrator’s name and address
Administrator’s EIN 593219191
Plan administrator’s name TREASURE COAST COMMUNITY HEALTH, INC.
Plan administrator’s address 12196 COUNTY ROAD 512, FELLSMERE, FL, 32948
Administrator’s telephone number 7725718828

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing LINDA COSTA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-15
Name of individual signing LINDA COSTA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SOULE VICKI Agent 1555 INDIAN RIVER BLVD, VERO BEACH, FL, 32960

Chief Executive Officer

Name Role Address
Soule Vicki Chief Executive Officer 1555 INDIAN RIVER BLVD, VERO BEACH, FL, 32960

Chief Financial Officer

Name Role Address
Fedock Andrea Chief Financial Officer 1555 INDIAN RIVER BLVD, VERO BEACH, FL, 32960

Chairman

Name Role Address
MILLER JUDI Chairman 1555 INDIAN RIVER BLVD, VERO BEACH, FL, 32960

Events

Event Type Filed Date Value Description
NAME CHANGE AMENDMENT 2005-01-12 TREASURE COAST COMMUNITY HEALTH, INC. No data
AMENDMENT 1994-11-21 No data No data

Related by officers

Soule Vicki

ROTARY CLUB OF VERO BEACH OCEANSIDE, INC. 1545 9TH STREET SW HOLDINGS, LLC SENIOR COLLABORATIVE OF INDIAN RIVER COUNTY, INC. THE FLORIDA ASSOCIATION OF COMMUNITY HEALTH CENTERS, INC.

Fedock Andrea

TREASURE COAST COMMUNITY HEALTH FOUNDATION, INC. 1545 9TH STREET SW HOLDINGS, LLC

SOULE VICKI

TREASURE COAST COMMUNITY HEALTH FOUNDATION, INC. 1545 9TH STREET SW HOLDINGS, LLC 12196 CR 512 HOLDINGS, LLC TREASURE COAST ROTARY CLUB OF VERO BEACH FOUNDATION, INC. TCCH BUILDING HEALTHY FUTURES CORP.

MILLER JUDI

TREASURE COAST COMMUNITY HEALTH FOUNDATION, INC. GOLD COAST CHARTER CHAPTER OF AMERICAN BUSINESS WOMEN'S ASSOCIATION INC. 12196 CR 512 HOLDINGS, LLC SANDPIPER DESIGN LLC INDIAN RIVER LITTLE HOUSE ASSOCIATION, INC.

Related by address

1555 INDIAN RIVER BLVD, SUITE B210, VERO BEACH, FL, 32960, US

TREASURE COAST COMMUNITY HEALTH FOUNDATION, INC. 1545 9TH STREET SW HOLDINGS, LLC

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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