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  5. BLOOM BEHAVIORAL SOLUTIONS, INC.

BLOOM BEHAVIORAL SOLUTIONS, INC.

Company Details

Entity Name: BLOOM BEHAVIORAL SOLUTIONS, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 26 Jan 2012 (13 years ago)
Document Number: P12000008893
FEI/EIN Number 45-4374714
Address: 997 Atlantic Blvd, Atlantic Beach, FL, 32233, US
Mail Address: 997 Atlantic Blvd, Atlantic Beach, FL, 32233, US
ZIP code: 32233
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1780088609 2014-10-21 2014-10-21 9141 CYPRESS GREEN DR STE 2, JACKSONVILLE, FL, 322562006, US 9141 CYPRESS GREEN DR STE 2, JACKSONVILLE, FL, 322562006, US

Contacts
Phone +1 904-647-1849

Authorized person
Name GENEVIEVE S COVINGTON
Role CEO
Phone 9046471849

Taxonomy
Taxonomy Code 261QR0401X - Comprehensive Outpatient Rehabilitation Facility (CORF)
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLOOM BEHAVIORAL SOLUTIONS INC 401(K) PROFIT SHARING PLAN AND TRUST 2023 454374714 2024-07-16 BLOOM BEHAVIORAL SOLUTIONS INC 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 812990
Sponsor’s telephone number 9046471849
Plan sponsor’s address 997 ATLANTIC BLVD, ATLANTIC BEACH, FL, 32233

Signature of
Role Plan administrator
Date 2024-07-16
Name of individual signing GENEVIEVE COVINGTON
Valid signature Filed with authorized/valid electronic signature
BLOOM BEHAVIORAL SOLUTIONS INC 401(K) PROFIT SHARING PLAN AND TRUST 2022 454374714 2023-08-25 BLOOM BEHAVIORAL SOLUTIONS INC 66
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 812990
Sponsor’s telephone number 9046471849
Plan sponsor’s address 997 ATLANTIC BLVD, ATLANTIC BEACH, FL, 32233

Signature of
Role Plan administrator
Date 2023-08-25
Name of individual signing GENEVIEVE COVINGTON
Valid signature Filed with authorized/valid electronic signature
BLOOM BEHAVIORAL SOLUTIONS INC 401(K) PROFIT SHARING PLAN AND TRUST 2022 454374714 2023-07-21 BLOOM BEHAVIORAL SOLUTIONS INC 66
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 812990
Sponsor’s telephone number 9046471849
Plan sponsor’s address 997 ATLANTIC BLVD, ATLANTIC BEACH, FL, 32233

Signature of
Role Plan administrator
Date 2023-07-21
Name of individual signing GENEVIEVE COVINGTON
Valid signature Filed with authorized/valid electronic signature
BLOOM BEHAVIORAL SOLUTIONS INC 401(K) PROFIT SHARING PLAN AND TRUST 2021 454374714 2022-08-10 BLOOM BEHAVIORAL SOLUTIONS INC 56
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 812990
Sponsor’s telephone number 9046471849
Plan sponsor’s address 997 ATLANTIC BLVD, ATLANTIC BEACH, FL, 32233

Signature of
Role Plan administrator
Date 2022-08-10
Name of individual signing GENEVIEVE COVINGTON
Valid signature Filed with authorized/valid electronic signature
BLOOM BEHAVIORAL SOLUTIONS INC 401(K) PROFIT SHARING PLAN & TRUST 2020 454374714 2021-04-16 BLOOM BEHAVIORAL SOLUTIONS INC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 812990
Sponsor’s telephone number 9046471849
Plan sponsor’s address 997 ATLANTIC BLVD, ATLANTIC BEACH, FL, 322333311

Signature of
Role Plan administrator
Date 2021-04-16
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
BLOOM BEHAVIORAL SOLUTIONS INC 401(K) PROFIT SHARING PLAN & TRUST 2019 454374714 2020-07-09 BLOOM BEHAVIORAL SOLUTIONS INC 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 812990
Sponsor’s telephone number 9046471849
Plan sponsor’s address 9141 CYPRESS GREEN DR - STE 2, JACKSONVILLE, FL, 322562006

Signature of
Role Plan administrator
Date 2020-07-09
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
BLOOM BEHAVIORAL SOLUTIONS INC 401 K PROFIT SHARING PLAN TRUST 2018 454374714 2019-06-10 BLOOM BEHAVIORAL SOLUTIONS INC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 812990
Sponsor’s telephone number 9046471849
Plan sponsor’s address 9141 CYPRESS GREEN DR - STE 2, JACKSONVILLE, FL, 322562006

Plan administrator’s name and address
Administrator’s EIN 264477125
Plan administrator’s name 401K GENERATION
Plan administrator’s address 195 INTERNATIONAL PKWY, S #311, LAKE MARY, FL, 32746
Administrator’s telephone number 8669985879

Signature of
Role Plan administrator
Date 2019-06-10
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
BLOOM BEHAVIORAL SOLUTIONS INC 401 K PROFIT SHARING PLAN TRUST 2017 454374714 2018-03-15 BLOOM BEHAVIORAL SOLUTIONS INC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 812990
Sponsor’s telephone number 9046471849
Plan sponsor’s address 9141 CYPRESS GREEN DR - STE 2, JACKSONVILLE, FL, 322562006

Signature of
Role Plan administrator
Date 2018-03-15
Name of individual signing REBEKAH WOTTON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
COVINGTON GENEVIEVE H Agent 1890 Live Oak Lane, ATLANTIC BEACH, FL, 32233

President

Name Role Address
COVINGTON GENEVIEVE President 1890 Live Oak Lane, ATLANTIC BEACH, FL, 32233

Director

Name Role Address
COVINGTON GENEVIEVE Director 1890 Live Oak Lane, ATLANTIC BEACH, FL, 32233

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G14000035157 BLOOM REHABILITATIVE SERVICES EXPIRED 2014-04-09 2024-12-31 No data 9141 CYPRESS GREEN DRIVE, STE. 2, JACKSONVILLE, FL, 32256

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-01-31 997 Atlantic Blvd, Atlantic Beach, FL 32233 No data
CHANGE OF MAILING ADDRESS 2023-01-31 997 Atlantic Blvd, Atlantic Beach, FL 32233 No data
REGISTERED AGENT ADDRESS CHANGED 2017-02-13 1890 Live Oak Lane, ATLANTIC BEACH, FL 32233 No data
REGISTERED AGENT NAME CHANGED 2013-02-15 COVINGTON, GENEVIEVE H No data

Documents

Name Date
ANNUAL REPORT 2024-04-17
AMENDED ANNUAL REPORT 2023-04-13
ANNUAL REPORT 2023-01-31
ANNUAL REPORT 2022-02-02
ANNUAL REPORT 2021-02-09
ANNUAL REPORT 2020-01-19
ANNUAL REPORT 2019-02-13
ANNUAL REPORT 2018-04-06
ANNUAL REPORT 2017-02-13
ANNUAL REPORT 2016-03-08

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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