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  5. FIRST COAST MENTAL HEALTH P.A.

FIRST COAST MENTAL HEALTH P.A. - Florida Company Profile

Company Details

Entity Name: FIRST COAST MENTAL HEALTH P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

FIRST COAST MENTAL HEALTH P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act.
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: 26 Mar 2008 (17 years ago)
Document Number: P08000031811
FEI/EIN Number 223977578

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 1409 KINGSLEY AVE., SUITE 8, ORANGE PARK, FL, 32073, US
Mail Address: 1409 KINGSLEY AVE., SUITE 8, 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
1285884650 2008-09-23 2022-10-19 1409 KINGSLEY AVE STE 8, ORANGE PARK, FL, 320734553, US 1409 KINGSLEY AVE STE 8, ORANGE PARK, FL, 320734553, US

Contacts
Phone +1 904-269-7200
Fax 9042690070

Authorized person
Name MELODY D TAYLOR
Role OFFICE MANAGER
Phone 9042697200

Taxonomy
Taxonomy Code 2084P0800X - Psychiatry Physician
License Number ME100502
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2023 223977578 2024-07-30 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9044343899
Plan sponsor’s address 1409 KINGSLEY AVE STE 8, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2024-07-30
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2022 223977578 2023-07-26 FIRST COAST MENTAL HEALTH P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2021 223977578 2022-07-19 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2022-07-19
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2020 223977578 2021-07-21 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2021-07-21
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401(K) PROFIT SHARING PLAN & TRUST 2019 223977578 2020-07-20 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2020-07-20
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2018 223977578 2019-07-31 FIRST COAST MENTAL HEALTH P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2019-07-31
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2017 223977578 2018-07-10 FIRST COAST MENTAL HEALTH P A 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9042697208
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2018-07-10
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2016 223977578 2017-07-28 FIRST COAST MENTAL HEALTH P A 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2017-07-28
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2015 223977578 2016-07-27 FIRST COAST MENTAL HEALTH P A 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2016-07-27
Name of individual signing KATHLEEN GRISSETT
Valid signature Filed with authorized/valid electronic signature
FIRST COAST MENTAL HEALTH P A 401 K PROFIT SHARING PLAN TRUST 2014 223977578 2015-07-22 FIRST COAST MENTAL HEALTH P A 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 9043496221
Plan sponsor’s address 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 320734583

Signature of
Role Plan administrator
Date 2015-07-22
Name of individual signing MELODY TAYLOR
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
GRISSETT KATHLEEN B President 1543 kingsley ave, ORANGE PARK, FL, 32073
GRISSETT KATHLEEN B Vice President 1543 kingsley ave, ORANGE PARK, FL, 32073
GRISSETT KATHLEEN B Secretary 1543 kingsley ave, ORANGE PARK, FL, 32073
GRISSETT KATHLEEN B Treasurer 1543 kingsley ave, ORANGE PARK, FL, 32073
GRISSETT KATHLEEN B Director 1543 Kingsley ave, ORANGE PARK, FL, 32073
WILLIAM G HAEBERLE Agent 1440 PEACHTREE ST, JAX, FL, 32207

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-04-20 1409 KINGSLEY AVE., SUITE 8, ORANGE PARK, FL 32073 -
CHANGE OF MAILING ADDRESS 2023-04-20 1409 KINGSLEY AVE., SUITE 8, ORANGE PARK, FL 32073 -
REGISTERED AGENT NAME CHANGED 2012-04-23 WILLIAM G HAEBERLE -
REGISTERED AGENT ADDRESS CHANGED 2012-04-23 1440 PEACHTREE ST, JAX, FL 32207 -

Documents

Name Date
ANNUAL REPORT 2024-04-29
ANNUAL REPORT 2023-04-20
ANNUAL REPORT 2022-04-26
ANNUAL REPORT 2021-04-07
ANNUAL REPORT 2020-04-29
ANNUAL REPORT 2019-04-24
ANNUAL REPORT 2018-04-26
ANNUAL REPORT 2017-04-18
ANNUAL REPORT 2016-04-12
ANNUAL REPORT 2015-04-29

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
7064257708 2020-05-01 0491 PPP 1543 KINGSLEY AVE STE 6, ORANGE PARK, FL, 32073-4583
Loan Status Date 2021-01-21
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 51360
Loan Approval Amount (current) 51360
Undisbursed Amount 0
Franchise Name -
Lender Location ID 9551
Servicing Lender Name Bank of America, National Association
Servicing Lender Address 100 N Tryon St, Ste 170, CHARLOTTE, NC, 28202-4024
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description New Business or 2 years or less
Project Address ORANGE PARK, CLAY, FL, 32073-4583
Project Congressional District FL-04
Number of Employees 5
NAICS code 621999
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Professional Association
Originating Lender ID 9551
Originating Lender Name Bank of America, National Association
Originating Lender Address CHARLOTTE, NC
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 51676.6
Forgiveness Paid Date 2020-12-16

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Companies related by address

No other companies in our directory share the same address as FIRST COAST MENTAL HEALTH P.A.

Date of last update: 01 Apr 2025

Sources: Florida Department of State

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