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PENNEY RETIREMENT COMMUNITY, INC.

Company Details

Entity Name: PENNEY RETIREMENT COMMUNITY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 27 Apr 1965 (60 years ago)
Document Number: 708863
FEI/EIN Number 590624420
Address: 3495 HOFFMAN STREET, PENNEY FARMS, FL, 32079-0555
Mail Address: P.O. BOX 555, PENNEY FARMS, FL, 32079-0555
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1285991265 2012-04-16 2012-04-16 PO BOX 555, PENNEY FARMS, FL, 320790555, US 1 PAVILION PLACE, PENNEY FARMS, FL, 320790555, US

Contacts
Phone +1 904-284-8582
Fax 9042846259

Authorized person
Name MS. BARBARA MARIE ENGELKES
Role ADMINISTRATOR
Phone 9042848582

Taxonomy
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number SNF1325096
State FL
Is Primary Yes

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
549300KM2799PJZFJB26 708863 US-FL GENERAL ACTIVE No data

Addresses
Legal C/O SCOTT, TERESA D, 3495 HOFFMAN ST., PENNEY FARMS, US-FL, US, 32079
Headquarters 3495 Hoffman Street, Penney Farms, US-FL, US, 32079

Registration details
Registration Date 2017-11-22
Last Update 2023-08-04
Status LAPSED
Next Renewal 2018-11-21
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 708863

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PENNEY RETIREMENT COMMUNITY, INC. 2023 590624420 2024-10-22 PENNEY RETIREMENT COMMUNITY, INC. 100
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2023-04-01
Business code 623000
Sponsor’s telephone number 9045317062
Plan sponsor’s mailing address PO BOX 555, PENNEY FARMS, FL, 320790555
Plan sponsor’s address 3495 HOFFMAN ST, PENNEY FARMS, FL, 32079

Number of participants as of the end of the plan year
Active participants 102

Signature of
Role Plan administrator
Date 2024-10-22
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
PENNEY RETIREMENT COMMUNITY, INC. 2022 590624420 2023-10-25 PENNEY RETIREMENT COMMUNITY, INC. 98
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2022-04-01
Business code 623000
Sponsor’s telephone number 9045317062
Plan sponsor’s mailing address PO BOX 555, PENNEY FARMS, FL, 320790555
Plan sponsor’s address 3495 HOFFMAN ST, PENNEY FARMS, FL, 32043

Number of participants as of the end of the plan year
Active participants 100

Signature of
Role Plan administrator
Date 2023-10-25
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
PENNEY RETIREMENT COMMUNITY, INC. 2021 590624420 2022-10-31 PENNEY RETIREMENT COMMUNITY, INC. 100
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2021-04-01
Business code 623000
Sponsor’s telephone number 9045317062
Plan sponsor’s mailing address PO BOX 555, PENNEY FARMS, FL, 320790555
Plan sponsor’s address 3495 HOFFMAN ST, PENNEY FARMS, FL, 32079

Number of participants as of the end of the plan year
Active participants 98

Signature of
Role Plan administrator
Date 2022-10-31
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
PENNEY RETIREMENT COMMUNITY, INC 2020 590624420 2021-10-11 PENNEY RETIREMENT COMMUNITY, INC 111
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2013-04-01
Business code 623000
Sponsor’s telephone number 9045317062
Plan sponsor’s mailing address PO BOX 555, PENENY FARMS, FL, 32079
Plan sponsor’s address 3495 HOFFMAN ST, PENNEY FARMS, FL, 32079

Number of participants as of the end of the plan year
Active participants 106

Signature of
Role Plan administrator
Date 2021-10-11
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-11
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
PENNEY RETIREMENT COMMUNITY, INC. 2020 590624420 2021-10-11 PENNEY RETIREMENT COMMUNITY, INC. 107
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2015-04-01
Business code 623000
Sponsor’s telephone number 9042848200
Plan sponsor’s mailing address PO BOX 555, PENNEY FARMS, FL, 320790555
Plan sponsor’s address 3495 HOFFMAN ST, PENNEY FARMS, FL, 32079

Number of participants as of the end of the plan year
Active participants 104

Signature of
Role Plan administrator
Date 2021-10-11
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-11
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
PENNEY RETIREMENT COMMUNITY, INC. 2020 590624420 2021-10-12 PENNEY RETIREMENT COMMUNITY, INC. 107
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2018-04-01
Business code 623000
Sponsor’s telephone number 9042848200
Plan sponsor’s mailing address PO BOX 555, PENNEY FARMS, FL, 320790555
Plan sponsor’s address 3495 HOFFMAN ST, PENNEY FARMS, FL, 32079

Number of participants as of the end of the plan year
Active participants 107

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
PENNEY RETIREMENT COMMUNITY, INC. 2020 590624420 2021-10-12 PENNEY RETIREMENT COMMUNITY, INC. 104
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2016-04-01
Business code 623000
Sponsor’s telephone number 9042848200
Plan sponsor’s mailing address PO BOX 555, PENNEY FARMS, FL, 320790555
Plan sponsor’s address 3495 HOFFMAN ST, PENNEY FARMS, FL, 32079

Number of participants as of the end of the plan year
Active participants 110

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
PENNEY RETIREMENT COMMUNITY, INC. 2020 590624420 2021-10-12 PENNEY RETIREMENT COMMUNITY.INC. 110
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2017-04-01
Business code 623000
Sponsor’s telephone number 9042848200
Plan sponsor’s mailing address PO BOX 555, PENNEY FARMS, FL, 320790555
Plan sponsor’s address 3495 HOFFMAN ST, PENNEY FARMS, FL, 32079

Number of participants as of the end of the plan year
Active participants 107

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
PENNEY RETIREMENT COMMUNITY, INC 2020 590624420 2021-10-12 PENNEY RETIREMENT COMMUNITY, INC 111
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-04-01
Business code 623000
Sponsor’s telephone number 9045317062
Plan sponsor’s mailing address PO BOX 555, PENNEY FARMS, FL, 320790555
Plan sponsor’s address 3495 HOFFMAN ST, PENNEY FARMS, FL, 32079

Number of participants as of the end of the plan year
Active participants 114

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
PENNEY RETIREMENT COMMUNITY, INC. 2019 590624420 2021-10-12 PENNEY RETIREMENT COMMUNITY, INC. 107
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-04-01
Business code 623000
Sponsor’s telephone number 9042848200
Plan sponsor’s mailing address 3495 HOFFMAN ST, PO BOX 555, PENNEY FARMS, FL, 320790555
Plan sponsor’s address PO BOX 555, PENNEY FARMS, FL, 32079

Number of participants as of the end of the plan year
Active participants 111

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-12
Name of individual signing LISA CLARK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SCOTT TERESA D Agent 3495 HOFFMAN ST., PENNEY FARMS, FL, 32079

Director

Name Role Address
COURTNEY WILLIAM Director 50 N. Laura Street, Jacksonville, FL, 32202
HILLMAN EVELYN Director P.O. Box 1005, Penney Farms, FL, 32079
ROYAL Bert D Director 3616 Magnolia Point Blvd., Green Cove Springs, FL, 32043
PONDER-STANSEL SUSAN Director 4266 Sunbeam Road, Jacksonville, FL, 32257

Secretary

Name Role Address
DIPATRI RENEE R Secretary 3495 HOFFMAN STREET, PENNEY FARMS, FL, 320790555

President

Name Role Address
SCOTT TERESA D President 3495 HOFFMAN STREET, PENNEY FARMS, FL, 320790555

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G12000078794 THE PAVILION FOR HEALTH CARE ACTIVE 2012-08-09 2027-12-31 No data P.O. BOX 555, 3465 CAROLINE BLVD., PENNEY FARMS, FL, 32079

Events

Event Type Filed Date Value Description
AMENDED AND RESTATEDARTICLES 2002-09-10 No data No data
RESTATED ARTICLES 1995-11-17 No data No data
AMENDMENT 1993-07-19 No data No data
REINSTATEMENT 1986-12-02 No data No data
INVOLUNTARILY DISSOLVED 1986-11-14 No data No data
NAME CHANGE AMENDMENT 1972-03-28 PENNEY RETIREMENT COMMUNITY, INC. No data

Related by officers

COURTNEY WILLIAM

COURTNEY-AIKEN INVESTMENTS, LLC CLEAN RUN LLC ALL IN ONE RENTAL LLC KYLE COURTNEY PROPERTY LLC FLORIDA LINE LOGISTICS LLC BC PIPE AND WELDING LLC CLARKWESTERN BUILDING SYSTEMS, INC. FAT BOYS HUNTING CLUB, INC. B & K LAUNDRY, INC. FERBER AND OSTEEN ROOFING AND SHEET METAL CONTRACTORS, INC.

PONDER-STANSEL SUSAN

COMMUNITY MANAGEMENT COMPANY OF NORTHEAST FLORIDA, INC. PACE PARTNERS OF NORTHEAST FLORIDA, INC. ST. JOHNS VOLUNTEERS!, INC. CARENET INC. ALIVIA CARE, INC. ALIVIA CARE SOLUTIONS, INC. COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION FOR CARING, INC. SAN MARCO ANTIQUE MALL, INC.

Related by address

3495 HOFFMAN STREET, PENNEY FARMS, FL, 32079-0555

THE ASSOCIATION OF PENNEY RETIREMENT COMMUNITY RESIDENTS, LLC RESIDENTS' AID FUND OF PENNEY RETIREMENT COMMUNITY, LLC

P.O. BOX 555, PENNEY FARMS, FL, 32079-0555

THE ASSOCIATION OF PENNEY RETIREMENT COMMUNITY RESIDENTS, LLC RESIDENTS' AID FUND OF PENNEY RETIREMENT COMMUNITY, LLC

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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