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  5. KIDS HOUSE OF SEMINOLE, INC.

KIDS HOUSE OF SEMINOLE, INC.

Company Details

Entity Name: KIDS HOUSE OF SEMINOLE, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 28 Dec 1995 (29 years ago)
Document Number: N96000000078
FEI/EIN Number 593415005
Address: 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773
Mail Address: 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773
ZIP code: 32773
County: Seminole
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1710414511 2017-05-11 2017-05-11 5467 RONALD REAGAN BLVD, SANFORD, FL, 327736332, US 5467 RONALD REAGAN BLVD, SANFORD, FL, 327736332, US

Contacts
Phone +1 407-324-3036

Authorized person
Name DENISE CONUS
Role MENTAL HEALTH PROGRAM DIRECTOR
Phone 4073243036

Taxonomy
Taxonomy Code 251S00000X - Community/Behavioral Health Agency
License Number IMH15952
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KIDS HOUSE OF SEMINOLE 401K PROFIT SHARING PLAN TRUST 2021 593415005 2022-03-13 KIDS HOUSE OF SEMINOLE INC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 921000
Sponsor’s telephone number 4073243036
Plan sponsor’s address 5467 NORTH RONALD REAGAN BLVD, SANFORD, FL, 327736332

Signature of
Role Plan administrator
Date 2022-03-13
Name of individual signing CAROL BUSH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-03-13
Name of individual signing CAROL BUSH
Valid signature Filed with authorized/valid electronic signature
KIDS HOUSE OF SEMINOLE 401K PROFIT SHARING PLAN TRUST 2019 593415005 2022-03-13 KIDS HOUSE OF SEMINOLE, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 921000
Plan sponsor’s address 5467 NORTH RONALD REAGAN BLVD, SANFORD, FL, 327736332

Signature of
Role Plan administrator
Date 2022-03-13
Name of individual signing CAROL BUSH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-03-13
Name of individual signing CAROL BUSH
Valid signature Filed with authorized/valid electronic signature
KIDS HOUSE OF SEMINOLE INC 401 K PROFIT SHARING PLAN TRUST 2017 593415005 2018-07-26 KIDS HOUSE OF SEMINOLE INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 921000
Sponsor’s telephone number 4073243036
Plan sponsor’s address 5467 N RONALD REGAN BLVD, SANFORD, FL, 327736332

Signature of
Role Plan administrator
Date 2018-07-26
Name of individual signing CAROL BUSH
Valid signature Filed with authorized/valid electronic signature
KIDS HOUSE OF SEMINOLE INC 401 K PROFIT SHARING PLAN TRUST 2016 593415005 2017-05-03 KIDS HOUSE OF SEMINOLE INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 921000
Sponsor’s telephone number 4073243036
Plan sponsor’s address 5467 N RONALD REGAN BLVD, SANFORD, FL, 327736332

Signature of
Role Plan administrator
Date 2017-05-03
Name of individual signing ERNEST HAMILTON
Valid signature Filed with authorized/valid electronic signature
KIDS HOUSE OF SEMINOLE INC 401 K PROFIT SHARING PLAN TRUST 2015 593415005 2016-06-28 KIDS HOUSE OF SEMINOLE INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 921000
Sponsor’s telephone number 4073243036
Plan sponsor’s address 5467 N RONALD REGAN BLVD, SANFORD, FL, 327736332

Signature of
Role Plan administrator
Date 2016-06-28
Name of individual signing ERNEST HAMILTON
Valid signature Filed with authorized/valid electronic signature
KIDS HOUSE OF SEMINOLE INC 401 K PROFIT SHARING PLAN TRUST 2014 593415005 2015-06-02 KIDS HOUSE OF SEMINOLE INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 921000
Sponsor’s telephone number 4073243036
Plan sponsor’s address 5467 N RONALD REGAN BLVD, SANFORD, FL, 327736332

Signature of
Role Plan administrator
Date 2015-06-02
Name of individual signing B WAYNE
Valid signature Filed with authorized/valid electronic signature
KIDS HOUSE OF SEMINOLE INC 401 K PROFIT SHARING PLAN TRUST 2013 593415005 2014-05-16 KIDS HOUSE OF SEMINOLE INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 921000
Sponsor’s telephone number 4073243036
Plan sponsor’s address 5467 N RONALD REGAN BLVD, SANFORD, FL, 327736332

Signature of
Role Plan administrator
Date 2014-05-16
Name of individual signing ERNEST HAMILTON
Valid signature Filed with authorized/valid electronic signature
KIDS HOUSE OF SEMINOLE INC 401 K PROFIT SHARING PLAN TRUST 2012 593415005 2013-05-16 KIDS HOUSE OF SEMINOLE INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 921000
Sponsor’s telephone number 4073243036
Plan sponsor’s address 5467 N RONALD REGAN BLVD, SANFORD, FL, 327736332

Signature of
Role Plan administrator
Date 2013-05-16
Name of individual signing KIDS HOUSE OF SEMINOLE INC
Valid signature Filed with authorized/valid electronic signature
KIDS HOUSE OF SEMINOLE INC 401 K PROFIT SHARING PLAN TRUST 2011 593415005 2013-04-01 KIDS HOUSE OF SEMINOLE INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 912000
Sponsor’s telephone number 4073243036
Plan sponsor’s address 5467 N RONALD REGAN BLVD, SANFORD, FL, 327736332

Plan administrator’s name and address
Administrator’s EIN 593415005
Plan administrator’s name KIDS HOUSE OF SEMINOLE INC
Plan administrator’s address 5467 N RONALD REGAN BLVD, SANFORD, FL, 327736332
Administrator’s telephone number 4073243036

Signature of
Role Plan administrator
Date 2013-04-01
Name of individual signing KIDS HOUSE OF SEMINOLE INC
Valid signature Filed with authorized/valid electronic signature
KIDS HOUSE OF SEMINOLE INC 401 K PROFIT SHARING PLAN TRUST 2010 593415005 2013-03-21 KIDS HOUSE OF SEMINOLE INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 921000
Sponsor’s telephone number 4073243036
Plan sponsor’s address 5467 COUNTY ROAD 427, SANFORD, FL, 32773

Plan administrator’s name and address
Administrator’s EIN 593415005
Plan administrator’s name KIDS HOUSE OF SEMINOLE INC
Plan administrator’s address 5467 COUNTY ROAD 427, SANFORD, FL, 32773
Administrator’s telephone number 4073243036

Signature of
Role Plan administrator
Date 2013-03-21
Name of individual signing KIDS HOUSE OF SEMINOLE INC
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Kong Juliette Agent 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773

Chairman

Name Role Address
Dallari Bob Chairman 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773

Imme

Name Role Address
Davoli Ron Imme 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773

Secretary

Name Role Address
Hodges Jennifer Secretary 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773

Vice President

Name Role Address
Johnson Kent Vice President 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773

Chief Executive Officer

Name Role Address
Kong Juliette o Chief Executive Officer 5467 N Ronald Reagan Blvd, Sanford, FL, 32773

Fina

Name Role Address
Johnson Kent Fina 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2020-04-01 Kong, Juliette No data
CHANGE OF PRINCIPAL ADDRESS 2004-04-12 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL 32773 No data
CHANGE OF MAILING ADDRESS 2004-04-12 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL 32773 No data
REGISTERED AGENT ADDRESS CHANGED 2004-04-12 5467 NORTH RONALD REAGAN BLVD., SANFORD, FL 32773 No data

Documents

Name Date
ANNUAL REPORT 2024-02-02
ANNUAL REPORT 2023-02-15
ANNUAL REPORT 2022-03-09
AMENDED ANNUAL REPORT 2021-10-22
ANNUAL REPORT 2021-02-16
ANNUAL REPORT 2020-04-01
ANNUAL REPORT 2019-02-06
ANNUAL REPORT 2018-01-03
ANNUAL REPORT 2017-04-07
ANNUAL REPORT 2016-05-02

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Related by address

5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773

CARLY EVANS, ARNP-BC LLC

5467 NORTH RONALD REAGAN BLVD., SANFORD, FL, 32773

CARLY EVANS, ARNP-BC LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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