| Entity Name: | SPROUT BEHAVIORAL SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 21 Jul 2016 (9 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 29 Aug 2016 (8 years ago) |
| Document Number: | P16000061241 |
| FEI/EIN Number | 81-3451121 |
| Address: | 11011 SHERIDAN ST., SUITE 210, HOLLYWOOD, FL 33026 |
| Mail Address: | 11011 SHERIDAN ST., SUITE 210, HOLLYWOOD, FL 33026 |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649727090 | 2016-09-01 | 2016-09-01 | 1548 NE 37TH ST, OAKLAND PARK, FL, 333344623, US | 1548 NE 37TH ST, OAKLAND PARK, FL, 333344623, US | |||||||||||||
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| Phone | +1 954-552-6668 |
Authorized person
| Name | KELSEY ELISE BALLEW |
| Role | PRESIDENT |
| Phone | 2562835727 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPROUT BEHAVIORAL SERVICES, INC. 401(K) PLAN | 2023 | 813451121 | 2024-10-01 | SPROUT BEHAVIORAL SERVICES, INC. | 26 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-01 |
| Name of individual signing | MICHAEL VANDERFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621900 |
| Sponsor’s telephone number | 9545526668 |
| Plan sponsor’s address | 11011 SHERIDAN STREET, SUITE 210, COOPER CITY, FL, 33026 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-11 |
| Name of individual signing | MICHAEL VANDERFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621330 |
| Sponsor’s telephone number | 9545526668 |
| Plan sponsor’s address | 11011 SHERIDAN STREET, SUITE 210, COOPER CITY, FL, 33026 |
Signature of
| Role | Plan administrator |
| Date | 2022-08-19 |
| Name of individual signing | JENNA BACHMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 621330 |
| Sponsor’s telephone number | 9545526668 |
| Plan sponsor’s address | 11011 SHERIDAN STREET, SUITE 210, COOPER CITY, FL, 33026 |
Signature of
| Role | Plan administrator |
| Date | 2021-09-23 |
| Name of individual signing | JENNA BACHMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| REPUBLIC REGISTERED AGENT LLC | Agent |
| Name | Role | Address |
|---|---|---|
| Peck, KELSEY Ballew | President | 417 NE 9th Ave., Ft. Lauderdale, FL 33301 |
| BACHMAN, JENNA | President | 1260 SE 1st Avenue, Pompano Beach, FL 33060 |
| Name | Role | Address |
|---|---|---|
| Peck, KELSEY Ballew | Treasurer | 417 NE 9th Ave., Ft. Lauderdale, FL 33301 |
| Name | Role | Address |
|---|---|---|
| Peck, KELSEY Ballew | Secretary | 417 NE 9th Ave., Ft. Lauderdale, FL 33301 |
| BACHMAN, JENNA | Secretary | 1260 SE 1st Avenue, Pompano Beach, FL 33060 |
| Name | Role | Address |
|---|---|---|
| BACHMAN, JENNA | Director | 1260 SE 1st Avenue, Pompano Beach, FL 33060 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000079212 | SPROUT | ACTIVE | 2020-07-07 | 2025-12-31 | No data | 11011 SHERIDAN ST. SUITE 210, HOLLYWOOD, FL, 33026 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-08-17 | REPUBLIC REGISTERED AGENT LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-08-17 | 1150 Nw 72nd Ave Tower I Ste 455, Miami, FL 33126 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-07-16 | 11011 SHERIDAN ST., SUITE 210, HOLLYWOOD, FL 33026 | No data |
| CHANGE OF MAILING ADDRESS | 2018-07-16 | 11011 SHERIDAN ST., SUITE 210, HOLLYWOOD, FL 33026 | No data |
| AMENDMENT | 2016-08-29 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-12 |
| ANNUAL REPORT | 2024-04-15 |
| AMENDED ANNUAL REPORT | 2023-08-17 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-22 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-03-15 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5224777701 | 2020-05-01 | 0455 | PPP | 11011 SHERIDAN ST STE 210, HOLLYWOOD, FL, 33026-1531 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 19 Feb 2025
Sources: Florida Department of State
