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  5. FIRST COAST LTC, INC.

FIRST COAST LTC, INC. - Florida Company Profile

Company Details

Entity Name: FIRST COAST LTC, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

FIRST COAST LTC, INC. 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: 25 Mar 1999 (26 years ago)
Document Number: P99000029184
FEI/EIN Number 593567314

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 6555 Chester Ave, Suite 1, Jacksonville, FL, 32217, US
Mail Address: 6555 Chester Ave, Suite 1, Jacksonville, FL, 32217, US
ZIP code: 32217
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1538418868 2012-08-31 2016-03-07 6555 CHESTER AVE STE 1, JACKSONVILLE, FL, 322172279, US 25 STATE ROAD 13, ATT: CLINIC, SAINT JOHNS, FL, 322592842, US

Contacts
Phone +1 904-309-6504
Fax 9045033577

Authorized person
Name DR. DAVID SAMARA
Role PRESIDENT
Phone 9043096504

Taxonomy
Taxonomy Code 208D00000X - General Practice Physician
License Number ME31637
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 371340700
State FL
Issuer RR MEDICARE
Number CG-1814

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FIRST COAST LTC, INC. 401(K) PROFIT SHARING PLAN 2020 593567314 2021-02-01 FIRST COAST LTC, INC. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 9042658209
Plan sponsor’s DBA name 1/1/2016
Plan sponsor’s address 6555 CHESTER AVENUE, SUITE 1, JACKSONVILLE, FL, 322172279

Signature of
Role Plan administrator
Date 2021-02-01
Name of individual signing DAVID SAMARA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-02-01
Name of individual signing DAVID SAMARA
Valid signature Filed with authorized/valid electronic signature
FIRST COAST LTC, INC. 401(K) PROFIT SHARING PLAN 2019 593567314 2020-08-12 FIRST COAST LTC, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 9042658209
Plan sponsor’s address 6555 CHESTER AVENUE, SUITE 1, JACKSONVILLE, FL, 322172279

Signature of
Role Plan administrator
Date 2020-08-12
Name of individual signing DAVID SAMARA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-08-12
Name of individual signing DAVID SAMARA
Valid signature Filed with authorized/valid electronic signature
FIRST COAST LTC, INC. 401(K) PROFIT SHARING PLAN 2018 593567314 2019-05-31 FIRST COAST LTC, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 9042658209
Plan sponsor’s address 6555 CHESTER AVENUE, SUITE 1, JACKSONVILLE, FL, 322172279

Signature of
Role Plan administrator
Date 2019-05-31
Name of individual signing DAVID SAMARA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-31
Name of individual signing DAVID SAMARA
Valid signature Filed with authorized/valid electronic signature
FIRST COAST LTC, INC. 401(K) PROFIT SHARING PLAN 2017 593567314 2018-07-31 FIRST COAST LTC, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 9042658209
Plan sponsor’s address 6555 CHESTER AVENUE, SUITE 1, JACKSONVILLE, FL, 322172279

Signature of
Role Plan administrator
Date 2018-07-31
Name of individual signing DAVID J. SAMARA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-31
Name of individual signing DAVID J. SAMARA
Valid signature Filed with authorized/valid electronic signature
FIRST COAST LTC, INC. 401(K) PROFIT SHARING PLAN 2016 593567314 2017-09-22 FIRST COAST LTC, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 9042658209
Plan sponsor’s address 6555 CHESTER AVENUE, SUITE 1, JACKSONVILLE, FL, 322172279

Signature of
Role Plan administrator
Date 2017-09-22
Name of individual signing DAVID J. SAMARA, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-22
Name of individual signing DAVID J. SAMARA, M.D.
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
SAMARA DAVID J Director 6555 Chester Ave, Jacksonville, FL, 32217
Samara David Agent 6555 Chester Ave, Jacksonville, FL, 32217

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2022-01-26 Samara, David -
REGISTERED AGENT ADDRESS CHANGED 2022-01-26 6555 Chester Ave, Suite 1, Jacksonville, FL 32217 -
CHANGE OF PRINCIPAL ADDRESS 2017-01-08 6555 Chester Ave, Suite 1, Jacksonville, FL 32217 -
CHANGE OF MAILING ADDRESS 2017-01-08 6555 Chester Ave, Suite 1, Jacksonville, FL 32217 -

Documents

Name Date
ANNUAL REPORT 2025-01-05
ANNUAL REPORT 2024-01-09
ANNUAL REPORT 2023-01-10
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-01-16
ANNUAL REPORT 2020-02-11
ANNUAL REPORT 2019-02-17
ANNUAL REPORT 2018-01-30
ANNUAL REPORT 2017-01-08
ANNUAL REPORT 2016-02-06

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
7295378408 2021-02-11 0491 PPP 6555 Chester Ave Ste 1, Jacksonville, FL, 32217-2250
Loan Status Date 2021-12-14
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 262725
Loan Approval Amount (current) 262725
Undisbursed Amount 0
Franchise Name -
Lender Location ID 67422
Servicing Lender Name First Horizon Bank
Servicing Lender Address 165 Madison Ave, MEMPHIS, TN, 38103-2723
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Jacksonville, DUVAL, FL, 32217-2250
Project Congressional District FL-05
Number of Employees 21
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 67422
Originating Lender Name First Horizon Bank
Originating Lender Address MEMPHIS, TN
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 264644.35
Forgiveness Paid Date 2021-11-10

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Samara David

DSMD, LLC - Active
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Companies related by address

No other companies in our directory share the same address as FIRST COAST LTC, INC.

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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