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  5. WASHINGTON COUNTY COUNCIL ON AGING, INC

WASHINGTON COUNTY COUNCIL ON AGING, INC

Company Details

Entity Name: WASHINGTON COUNTY COUNCIL ON AGING, INC
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 06 Apr 1973 (52 years ago)
Document Number: 726022
FEI/EIN Number 591485912
Address: 1348 SOUTH BLVD., CHIPLEY, FL, 32428, US
Mail Address: 1348 SOUTH BLVD., CHIPLEY, FL, 32428, US
ZIP code: 32428
County: Washington
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1629274659 2007-06-26 2023-04-28 1348 SOUTH BLVD, CHIPLEY, FL, 324281846, US 1348 SOUTH BLVD, CHIPLEY, FL, 324281846, US

Contacts
Phone +1 850-638-6217
Fax 8506386363

Authorized person
Name TRACEY LONG
Role EXECUTIVE DIRECTOR
Phone 8506386217

Taxonomy
Taxonomy Code 251B00000X - Case Management Agency
Is Primary No
Taxonomy Code 253Z00000X - In Home Supportive Care Agency
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 024869000
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING, INC. 2021 591485912 2022-08-15 WASHINGTON COUNTY COUNCIL ON AGING, INC. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624200
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 324281846

Signature of
Role Plan administrator
Date 2022-08-15
Name of individual signing TRACEY LONG
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING, INC. 2020 591485912 2021-07-30 WASHINGTON COUNTY COUNCIL ON AGING, INC. 19
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624200
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 324281846

Signature of
Role Plan administrator
Date 2021-07-30
Name of individual signing TAYLER AMERSON
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING, INC. 2019 591485912 2020-09-03 WASHINGTON COUNTY COUNCIL ON AGING, INC. 15
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624200
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 324281846

Signature of
Role Plan administrator
Date 2020-09-03
Name of individual signing ANITA CLARKE
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING, INC. 2018 591485912 2020-09-03 WASHINGTON COUNTY COUNCIL ON AGING, INC. 19
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624200
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 324281846

Signature of
Role Plan administrator
Date 2020-09-03
Name of individual signing ANITA CLARKE
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING INC 2017 591485912 2018-06-29 WASHINGTON COUNTY COUNCIL ON AGING INC 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624100
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 324281846

Signature of
Role Plan administrator
Date 2018-06-29
Name of individual signing ANITA CLARKE
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING, INC. 2016 591485912 2017-07-19 WASHINGTON COUNTY COUNCIL ON AGING, INC. 19
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624100
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 32428

Signature of
Role Plan administrator
Date 2017-07-19
Name of individual signing ANITA INGERSOLL
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING, INC. 2015 591485912 2016-07-26 WASHINGTON COUNTY COUNCIL ON AGING, INC. 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624100
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 32428

Signature of
Role Plan administrator
Date 2016-07-26
Name of individual signing ANITA INGERSOLL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-26
Name of individual signing ANITA INGERSOLL
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING, INC. 2014 591485912 2015-07-06 WASHINGTON COUNTY COUNCIL ON AGING, INC. 19
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624100
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 32428

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing ANITA INGERSOLL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-06
Name of individual signing ANITA INGERSOLL
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING, INC. 2013 591485912 2014-07-02 WASHINGTON COUNTY COUNCIL ON AGING, INC. 20
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624100
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 32428

Signature of
Role Plan administrator
Date 2014-07-02
Name of individual signing ANITA INGERSOLL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-02
Name of individual signing ANITA INGERSOLL
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF WASHINGTON COUNTY COUNCIL ON AGING, INC. 2012 591485912 2013-07-31 WASHINGTON COUNTY COUNCIL ON AGING, INC. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-07-01
Business code 624100
Sponsor’s telephone number 8506386216
Plan sponsor’s address 1348 SOUTH BLVD, CHIPLEY, FL, 32428

Signature of
Role Plan administrator
Date 2013-07-31
Name of individual signing ANITA INGERSOLL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-31
Name of individual signing ANITA INGERSOLL
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Willis Patricia Agent 1348 SOUTH BLVD., CHIPLEY, FL, 32428

Officer

Name Role Address
BROWN MILTON Officer 3399 MALLORY ROAD, VERNON, FL, 32462
RAY MARLENE Officer 819 3RD STREET, CHIPLEY, FL, 32428

President

Name Role Address
LEWIS JAMES President 925 HURST COURT, PANAMA CITY, FL, 32404

Director

Name Role Address
Willis Patricia Director 1348 SOUTH BLVD., CHIPLEY, FL, 32428

Events

Event Type Filed Date Value Description
REINSTATEMENT 2024-04-26 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2023-09-22 No data No data
AMENDMENT 1992-01-22 No data No data

Related by officers

BROWN MILTON

PIONEER DEVELOPMENT SERVICES, LLC PIONEER DEVELOPMENT SERVICES 1, LLC KJMC GROUP LLC PIONEER MEDICAL GROUP CLINIC FOUNDATION, INC. PIONEER DEVELOPMENT SERVICES 2, LLC PIONEER DEVELOPMENT SERVICES FLETCHER, LLC NATIVE CERAMICS INC. ANNIE'S SAND & SOIL, INC. BETHEL GOSPEL TABERNACLE, INC. GATEWAY CABLING SERVICES, INC.

LEWIS JAMES

SOUTH FLORIDA SALVAGE & DISPOSAL II, LLC JA JD ENTERPRISES,INC LEWIS DELIVERY INC THE TINES GROUP, INC. JAMES LEWIS PAINTING, INC. SANITIZING SOLUTIONS, INC. REMEDY HEALTHCARE SOLUTIONS LLC ENCOUNTERS OF THE REAL, UNREAL AND BEYOND, LLC TRANSCENDENT PROPERTIES, LLC REMEDY HEALTHCARE SOLUTIONS, INC.

Willis Patricia

LAKE MAYAN APARTMENTS INC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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