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PENNEY RETIREMENT COMMUNITY, INC. - Florida Company Profile

Company Details

Entity Name: PENNEY RETIREMENT COMMUNITY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
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: 27 Apr 1965 (60 years ago)
Last Event: AMENDED AND RESTATED ARTICLES
Event Date Filed: 10 Sep 2002 (23 years ago)
Document Number: 708863
FEI/EIN Number 590624420

Federal Employer Identification (FEI) Number assigned by the IRS.
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 -

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

Key Officers & Management

Name Role Address
SCOTT TERESA D President 3495 HOFFMAN STREET, PENNEY FARMS, FL, 320790555
DIPATRI RENEE R Secretary 3495 HOFFMAN STREET, PENNEY FARMS, FL, 320790555
PONDER-STANSEL SUSAN Director 4266 Sunbeam Road, Jacksonville, FL, 32257
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
SCOTT TERESA D Agent 3495 HOFFMAN ST., PENNEY FARMS, FL, 32079

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 - P.O. BOX 555, 3465 CAROLINE BLVD., PENNEY FARMS, FL, 32079

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2014-11-10 SCOTT, TERESA D -
AMENDED AND RESTATEDARTICLES 2002-09-10 - -
CHANGE OF PRINCIPAL ADDRESS 2001-01-09 3495 HOFFMAN STREET, PENNEY FARMS, FL 32079-0555 -
RESTATED ARTICLES 1995-11-17 - -
AMENDMENT 1993-07-19 - -
REINSTATEMENT 1986-12-02 - -
INVOLUNTARILY DISSOLVED 1986-11-14 - -
NAME CHANGE AMENDMENT 1972-03-28 PENNEY RETIREMENT COMMUNITY, INC. -

Documents

Name Date
ANNUAL REPORT 2024-04-26
ANNUAL REPORT 2023-04-26
ANNUAL REPORT 2022-04-28
ANNUAL REPORT 2021-04-29
ANNUAL REPORT 2020-04-13
ANNUAL REPORT 2019-04-29
AMENDED ANNUAL REPORT 2018-12-07
ANNUAL REPORT 2018-04-29
ANNUAL REPORT 2017-04-26
ANNUAL REPORT 2016-04-13

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
308431923 0419700 2005-06-24 4560 LEWIS AVENUE, PENNEY FARMS, FL, 32079
Inspection Type Complaint
Scope Partial
Safety/Health Safety
Close Conference 2005-10-19
Emphasis L: LANDSCPE, L: OHPWRLNE
Case Closed 2005-11-07

Related Activity
Type Complaint
Activity Nr 205420524
Safety Yes
Health Yes

Violation Items
Citation ID 01001A
Citaton Type Serious
Standard Cited 19100269 A02 I
Issuance Date 2005-10-28
Abatement Due Date 2005-11-17
Current Penalty 1375.0
Initial Penalty 1375.0
Nr Instances 1
Nr Exposed 1
Related Event Code (REC) Complaint
Gravity 03
Citation ID 01001B
Citaton Type Serious
Standard Cited 19100269 A02 VII
Issuance Date 2005-10-28
Abatement Due Date 2005-11-17
Nr Instances 1
Nr Exposed 1
Gravity 01
Citation ID 01002A
Citaton Type Serious
Standard Cited 19100269 P04 IIIC
Issuance Date 2005-10-28
Abatement Due Date 2005-11-17
Current Penalty 1375.0
Initial Penalty 1375.0
Nr Instances 1
Nr Exposed 2
Related Event Code (REC) Complaint
Gravity 03
Citation ID 01002B
Citaton Type Serious
Standard Cited 19100269 R01 III
Issuance Date 2005-10-28
Abatement Due Date 2005-11-09
Nr Instances 1
Nr Exposed 1
Related Event Code (REC) Complaint
Gravity 03
Citation ID 02001
Citaton Type Other
Standard Cited 19100067 C02 II
Issuance Date 2005-10-28
Abatement Due Date 2005-11-02
Nr Instances 1
Nr Exposed 1
Related Event Code (REC) Complaint
Gravity 01

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
59-0624420 Corporation Unconditional Exemption 3495 HOFFMAN ST, GREEN CV SPGS, FL, 32043-4770 1957-04
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Religious Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Organization that normally receives no more than one-third of its support from gross investment income and unrelated business income and at the same time more than one-third of its support from contributions, fees, and gross receipts related to exempt purposes 509(a)(2)
Tax Period 2024-06
Asset 50,000,000 to greater
Income 10,000,000 to 49,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Jun
Asset Amount 67127533
Income Amount 24119367
Form 990 Revenue Amount 20107371
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name PENNEY RETIREMENT COMMUNITY INC
EIN 59-0624420
Tax Period 202306
Filing Type E
Return Type 990
File View File
Organization Name PENNEY RETIREMENT COMMUNITY INC
EIN 59-0624420
Tax Period 202206
Filing Type E
Return Type 990
File View File
Organization Name PENNEY RETIREMENT COMMUNITY INC
EIN 59-0624420
Tax Period 202106
Filing Type E
Return Type 990
File View File
Organization Name PENNEY RETIREMENT COMMUNITY INC
EIN 59-0624420
Tax Period 202006
Filing Type E
Return Type 990
File View File
Organization Name PENNEY RETIREMENT COMMUNITY INC
EIN 59-0624420
Tax Period 201906
Filing Type E
Return Type 990
File View File
Organization Name PENNEY RETIREMENT COMMUNITY INC
EIN 59-0624420
Tax Period 201706
Filing Type E
Return Type 990
File View File
Organization Name PENNEY RETIREMENT COMMUNITY INC
EIN 59-0624420
Tax Period 201606
Filing Type E
Return Type 990
File View File

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Companies 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 Apr 2025

Sources: Florida Department of State

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