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  5. FAMILY LIFE CARE, INC.

FAMILY LIFE CARE, INC.

Company Details

Entity Name: FAMILY LIFE CARE, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 16 Oct 2000 (24 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 30 Apr 2002 (23 years ago)
Document Number: P00000098156
FEI/EIN Number 593679263
Address: 555 Wells Road, Orange Park, FL, 32073, US
Mail Address: 555 Wells Road, Orange Park, FL, 32073, US
ZIP code: 32073
County: Clay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1851944847 2019-07-19 2020-07-20 555 WELLS RD, ORANGE PARK, FL, 320732923, US 406 OHIO AVE S, LIVE OAK, FL, 320643218, US

Contacts
Phone +1 904-579-1581
Fax 9043751673
Phone +1 386-364-5515
Fax 3863645648

Authorized person
Name DAVID MCMULLEN
Role CEO
Phone 9045791581

Taxonomy
Taxonomy Code 253Z00000X - In Home Supportive Care Agency
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 680609100
State FL
Issuer NURSE REGISTRY LICENSE
Number 30211927
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FAMILY LIFE CARE INC 401(K) PROFIT SHARING PLAN & TRUST 2023 593679263 2024-07-09 FAMILY LIFE CARE INC 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS ROAD, ORANGE PARK, FL, 320730000

Signature of
Role Plan administrator
Date 2024-07-09
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
FAMILY LIFE CARE INC 401(K) PROFIT SHARING PLAN & TRUST 2022 593679263 2023-06-09 FAMILY LIFE CARE INC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS ROAD, ORANGE PARK, FL, 320730000

Signature of
Role Plan administrator
Date 2023-06-09
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
FAMILY LIFE CARE INC 401(K) PROFIT SHARING PLAN & TRUST 2021 593679263 2022-08-12 FAMILY LIFE CARE INC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS ROAD, ORANGE PARK, FL, 320730000

Signature of
Role Plan administrator
Date 2022-08-12
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
FAMILY LIFE CARE INC 401(K) PROFIT SHARING PLAN & TRUST 2020 593679263 2021-04-07 FAMILY LIFE CARE INC 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS ROAD, ORANGE PARK, FL, 320730000

Signature of
Role Plan administrator
Date 2021-04-07
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
FAMILY LIFE CARE INC 401(K) PROFIT SHARING PLAN & TRUST 2019 593679263 2020-04-06 FAMILY LIFE CARE INC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS ROAD, ORANGE PARK, FL, 320730000

Signature of
Role Plan administrator
Date 2020-04-06
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
FAMILY LIFE CARE INC 401 K PROFIT SHARING PLAN TRUST 2018 593679263 2019-10-09 FAMILY LIFE CARE INC 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS ROAD, ORANGE PARK, FL, 320730000

Signature of
Role Plan administrator
Date 2019-10-09
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
FAMILY LIFE CARE INC 401 K PROFIT SHARING PLAN TRUST 2017 593679263 2018-06-26 FAMILY LIFE CARE INC 32
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS ROAD, ORANGE PARK, FL, 320730000

Signature of
Role Plan administrator
Date 2018-06-26
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
FAMILY LIFE CARE INC 401 K PROFIT SHARING PLAN TRUST 2017 593679263 2019-10-13 FAMILY LIFE CARE INC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS ROAD, ORANGE PARK, FL, 320730000

Signature of
Role Plan administrator
Date 2019-10-13
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
FAMILY LIFE CARE INC 401 K PROFIT SHARING PLAN TRUST 2016 593679263 2017-06-20 FAMILY LIFE CARE INC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS ROAD, ORANGE PARK, FL, 320730000

Signature of
Role Plan administrator
Date 2017-06-20
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
FAMILY LIFE CARE INC 401 K PROFIT SHARING PLAN TRUST 2015 593679263 2016-05-17 FAMILY LIFE CARE INC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 812990
Sponsor’s telephone number 9045297072
Plan sponsor’s address 555 WELLS RD, ORANGE PARK, FL, 320732923

Signature of
Role Plan administrator
Date 2016-05-17
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MCMULLEN DAVID B Agent 555 Wells Road, Orange Park, FL, 32073

Chairman

Name Role Address
MCMULLEN DAVID Chairman 1703 SECLUDED WOODS WAY, ORANGE PARK, FL, 32003

Secretary

Name Role Address
MCMULLEN ROBIN Secretary 1703 SECLUDED WOODS WAY, ORANGE PARK, FL, 32003

Treasurer

Name Role Address
MCMULLEN ROBIN Treasurer 1703 SECLUDED WOODS WAY, ORANGE PARK, FL, 32003

Shar

Name Role Address
VALDEZ BRENDA Shar 1115 BLACKBURN AVE, LIVE OAK, FL, 32060

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2014-03-23 555 Wells Road, Orange Park, FL 32073 No data
CHANGE OF MAILING ADDRESS 2014-03-23 555 Wells Road, Orange Park, FL 32073 No data
REGISTERED AGENT ADDRESS CHANGED 2014-03-23 555 Wells Road, Orange Park, FL 32073 No data
REINSTATEMENT 2002-04-30 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2001-09-21 No data No data

Documents

Name Date
ANNUAL REPORT 2024-01-03
ANNUAL REPORT 2023-01-26
ANNUAL REPORT 2022-01-31
ANNUAL REPORT 2021-02-04
ANNUAL REPORT 2020-01-28
ANNUAL REPORT 2019-01-27
ANNUAL REPORT 2018-01-10
ANNUAL REPORT 2017-03-08
ANNUAL REPORT 2016-03-30
ANNUAL REPORT 2015-01-28

Related by officers

MCMULLEN DAVID

SURFING SAMURAI TATTOO LLC

MCMULLEN DAVID B

UNITED DATA IMPRESSIONS, INC.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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