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  5. SUNCOAST FAMILY MEDICAL ASSOCIATES, INC.

SUNCOAST FAMILY MEDICAL ASSOCIATES, INC.

Company Details

Entity Name: SUNCOAST FAMILY MEDICAL ASSOCIATES, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 31 Dec 1996 (28 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 04 Oct 2016 (8 years ago)
Document Number: P97000001322
FEI/EIN Number 59-3419569
Address: 12020 SEMINOLE BLVD, LARGO, FL 33778
Mail Address: 12020 SEMINOLE BLVD, LARGO, FL 33778
ZIP code: 33778
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1811981178 2005-09-01 2013-01-24 12020 SEMINOLE BLVD, LARGO, FL, 337782805, US 12020 SEMINOLE BLVD, LARGO, FL, 337782805, US

Contacts
Phone +1 727-588-9572
Fax 7275843832

Authorized person
Name JEFFREY S GROVE
Role PRESIDENT
Phone 7275889572

Taxonomy
Taxonomy Code 111N00000X - Chiropractor
License Number CH5247
State FL
Is Primary No
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number OS6098
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS
Number 21242A
State FL
Issuer HUMANA
Number 120374
Issuer MEDICAID
Number 252202100
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SUNCOAST FAMILY MEDICAL ASSOCIATES 401(K) TRUST 2023 593419569 2024-06-24 SUNCOAST FAMILY MEDICAL ASSOCIATES 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 7275889572
Plan sponsor’s address 12020 SEMINOLE BLVD., LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2024-06-24
Name of individual signing MATTHEW WARTICKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-06-24
Name of individual signing MATTHEW WARTICKI
Valid signature Filed with authorized/valid electronic signature
SUNCOAST FAMILY MEDICAL ASSOCIATES 401(K) TRUST 2022 593419569 2023-09-28 SUNCOAST FAMILY MEDICAL ASSOCIATES 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 7275889572
Plan sponsor’s address 12020 SEMINOLE BLVD., LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2023-09-28
Name of individual signing MATTHEW WARTICKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-09-28
Name of individual signing MATTHEW WARTICKI
Valid signature Filed with authorized/valid electronic signature
SUNCOAST FAMILY MEDICAL ASSOCIATES 401(K) TRUST 2021 593419569 2022-10-09 SUNCOAST FAMILY MEDICAL ASSOCIATES 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 7275889572
Plan sponsor’s address 12020 SEMINOLE BLVD., LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2022-10-09
Name of individual signing TERI MEREDITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-09
Name of individual signing TERI MEREDITH
Valid signature Filed with authorized/valid electronic signature
SUNCOAST FAMILY MEDICAL ASSOCIATES 401(K) TRUST 2020 593419569 2021-09-03 SUNCOAST FAMILY MEDICAL ASSOCIATES 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 7275889572
Plan sponsor’s address 12020 SEMINOLE BLVD., LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2021-09-03
Name of individual signing JEFFREY S GROVE D.O.
Valid signature Filed with authorized/valid electronic signature
SUNCOAST FAMILY MEDICAL ASSOCIATES 401(K) TRUST 2019 593419569 2020-07-08 SUNCOAST FAMILY MEDICAL ASSOCIATES 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 7275889572
Plan sponsor’s address 12020 SEMINOLE BLVD., LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2020-07-08
Name of individual signing JEFFREY S GROVE D.O.
Valid signature Filed with authorized/valid electronic signature
SUNCOAST FAMILY MEDICAL ASSOCIATES 401(K) TRUST 2018 593419569 2019-07-24 SUNCOAST FAMILY MEDICAL ASSOCIATES 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 7275889572
Plan sponsor’s address 12020 SEMINOLE BLVD., LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2019-07-24
Name of individual signing JEFFREY S GROVE D.O.
Valid signature Filed with authorized/valid electronic signature
SUNCOAST FAMILY MEDICAL ASSOCIATES 401(K) TRUST 2017 593419569 2018-09-04 SUNCOAST FAMILY MEDICAL ASSOCIATES 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 7275889572
Plan sponsor’s address 12020 SEMINOLE BLVD., LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2018-09-04
Name of individual signing JEFFREY S GROVE D.O.
Valid signature Filed with authorized/valid electronic signature
SUNCOAST FAMILY MEDICAL ASSOCIATES 401(K) TRUST 2016 593419569 2017-07-11 SUNCOAST FAMILY MEDICAL ASSOCIATES 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 7275889572
Plan sponsor’s address 12020 SEMINOLE BLVD., LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2017-07-11
Name of individual signing JEFFREY S GROVE D.O.
Valid signature Filed with authorized/valid electronic signature
SUNCOAST FAMILY MEDICAL ASSOCIATES 401(K) TRUST 2015 593419569 2016-07-13 SUNCOAST FAMILY MEDICAL ASSOCIATES 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 7275889572
Plan sponsor’s address 12020 SEMINOLE BLVD., LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2016-07-13
Name of individual signing JEFFREY S GROVE D.O.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Grove, John Agent 8050 Seminole Blvd, Suite A, Seminole, FL 33772

President

Name Role Address
GROVE, JEFFREY S President 12020 SEMINOLE BLVD, LARGO, FL 33778

Vice President

Name Role Address
TVEDTEN, TY L Vice President 12020 SEMINOLE BLVD, LARGO, FL 33778

Secretary

Name Role Address
TVEDTEN, TY L Secretary 12020 SEMINOLE BLVD, LARGO, FL 33778

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2022-01-27 Grove, John No data
REGISTERED AGENT ADDRESS CHANGED 2022-01-27 8050 Seminole Blvd, Suite A, Seminole, FL 33772 No data
REINSTATEMENT 2016-10-04 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data
CHANGE OF PRINCIPAL ADDRESS 2010-02-26 12020 SEMINOLE BLVD, LARGO, FL 33778 No data
CHANGE OF MAILING ADDRESS 2010-02-26 12020 SEMINOLE BLVD, LARGO, FL 33778 No data

Documents

Name Date
ANNUAL REPORT 2025-01-31
ANNUAL REPORT 2024-01-18
ANNUAL REPORT 2023-01-23
ANNUAL REPORT 2022-01-27
ANNUAL REPORT 2021-03-09
ANNUAL REPORT 2020-05-21
ANNUAL REPORT 2019-04-09
ANNUAL REPORT 2018-02-01
ANNUAL REPORT 2017-01-13
REINSTATEMENT 2016-10-04

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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