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CLAY COUNTY COUNCIL ON AGING, INC. - Florida Company Profile

Company Details

Entity Name: CLAY COUNTY COUNCIL ON AGING, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 02 May 1974 (51 years ago)
Date of dissolution: 08 Feb 2021 (4 years ago)
Last Event: VOLUNTARY DISS W/ NOTICE
Event Date Filed: 08 Feb 2021 (4 years ago)
Document Number: 729535
FEI/EIN Number 591557913

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

Address: 3530 Enterprise Way, GREEN COVE SPRINGS, FL, 32043, US
Mail Address: P. O. Box 655, GREEN COVE SPRINGS, FL, 32043, US
ZIP code: 32043
County: Clay
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Clary Tina President P. O. Box 655, GREEN COVE SPRINGS, FL, 32043
Peeples Eliabeth Vice President 5038 Springbank Road, Green Cove Springs, FL, 32043
Powers John Treasurer P. O. Box 655, GREEN COVE SPRINGS, FL, 32043
Elliott Lynn Secretary P. O. Box 655, GREEN COVE SPRINGS, FL, 32043
Bowles John Past P. O. Box 655, GREEN COVE SPRINGS, FL, 32043
Coleman Ronald Director P. O. Box 655, GREEN COVE SPRINGS, FL, 32043
Bowles John Agent 611 Custer Circle, Orange Park, FL, 32073

National Provider Identifier

NPI Number:
1679730824

Authorized Person:

Name:
MR. ANDREW DECANDIS
Role:
EXECUTIVE DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
302R00000X - Health Maintenance Organization
Is Primary:
No
Selected Taxonomy:
302R00000X - Health Maintenance Organization
Is Primary:
Yes

Contacts:

Fax:
9042840296

Form 5500 Series

Employer Identification Number (EIN):
591557913
Plan Year:
2016
Number Of Participants:
116
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
51
Sponsors Telephone Number:
Plan Year:
2014
Number Of Participants:
108
Sponsors Telephone Number:
Plan Year:
2013
Number Of Participants:
105
Sponsors Telephone Number:
Plan Year:
2012
Number Of Participants:
98
Sponsors Telephone Number:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G16000092363 THE COTTAGE AT RIVER HOUSE EXPIRED 2016-08-25 2021-12-31 - 604 WALNUT ST, GREEN COVE SPRINGS, FL, 32043
G16000019596 JUDY'S PLACE, ADULT DAY PROGRAM EXPIRED 2016-02-23 2021-12-31 - 1701 PARK AVENUE, ORANGE PARK, FL, 32073
G14000060622 CAREGIVER CONNECTION EXPIRED 2014-06-16 2019-12-31 - 604 WALNUT ST., GREEN COVE SPINGS, FL, 32043

Events

Event Type Filed Date Value Description
VOLUNTARY DISS W/ NOTICE 2021-02-08 - -
CHANGE OF PRINCIPAL ADDRESS 2020-06-10 3530 Enterprise Way, 2019, GREEN COVE SPRINGS, FL 32043 -
CHANGE OF MAILING ADDRESS 2019-06-12 3530 Enterprise Way, 2019, GREEN COVE SPRINGS, FL 32043 -
REGISTERED AGENT NAME CHANGED 2018-04-09 Bowles, John -
REGISTERED AGENT ADDRESS CHANGED 2018-04-09 611 Custer Circle, Orange Park, FL 32073 -

Documents

Name Date
CORAPVDWN 2021-02-08
ANNUAL REPORT 2020-06-10
ANNUAL REPORT 2019-06-12
ANNUAL REPORT 2018-04-09
ANNUAL REPORT 2017-04-12
ANNUAL REPORT 2016-04-25
ANNUAL REPORT 2015-03-18
ANNUAL REPORT 2014-04-17
ANNUAL REPORT 2013-04-22
ANNUAL REPORT 2012-04-09

USAspending Awards / Contracts

Procurement Instrument Identifier:
36C24822N0313
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
64000.00
Base And Exercised Options Value:
64000.00
Base And All Options Value:
64000.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2022-04-01
Description:
ADULT DAY HEALTH CARE SERVICES
Naics Code:
624120: SERVICES FOR THE ELDERLY AND PERSONS WITH DISABILITIES
Product Or Service Code:
Q402: MEDICAL- NURSING HOME CARE CONTRACTS
Procurement Instrument Identifier:
36C24821N0440
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
65000.00
Base And Exercised Options Value:
65000.00
Base And All Options Value:
65000.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2021-04-01
Description:
ADULT DAY HEALTH CARE SERVICES
Naics Code:
624120: SERVICES FOR THE ELDERLY AND PERSONS WITH DISABILITIES
Product Or Service Code:
Q402: MEDICAL- NURSING HOME CARE CONTRACTS
Procurement Instrument Identifier:
36C24820N0348
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
41000.00
Base And Exercised Options Value:
41000.00
Base And All Options Value:
41000.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2020-04-01
Description:
ADULT DAY HEALTH CARE
Naics Code:
624120: SERVICES FOR THE ELDERLY AND PERSONS WITH DISABILITIES
Product Or Service Code:
Q402: MEDICAL- NURSING HOME CARE CONTRACTS

Date of last update: 02 Jun 2025

Sources: Florida Department of State