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  5. ST. JOHNS COUNTY WELFARE FEDERATION

ST. JOHNS COUNTY WELFARE FEDERATION

Company Details

Entity Name: ST. JOHNS COUNTY WELFARE FEDERATION
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive
Date Filed: 24 Feb 1976 (49 years ago)
Document Number: 735039
FEI/EIN Number 590737904
Address: 161 MARINE STREET, ST AUGUSTINE, FL, 32084, US
Mail Address: 161 MARINE STREET, ST AUGUSTINE, FL, 32084, US
ZIP code: 32084
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1861548562 2007-01-26 2020-08-22 161 MARINE ST, ST AUGUSTINE, FL, 320845154, US 161 MARINE ST, ST AUGUSTINE, FL, 320845154, US

Contacts
Phone +1 904-829-3475
Fax 9048089908

Authorized person
Name LARRY LAKE
Role ADMINISTRATOR
Phone 9048242501

Taxonomy
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number SNF1489096
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RETIREMENT PLAN OF ST. JOHNS WELFARE FEDERATION 2023 590737904 2024-07-06 ST. JOHNS COUNTY WELFARE FEDERATION 76
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1993-06-01
Business code 624100
Sponsor’s telephone number 9045841562
Plan sponsor’s address 161 MARINE STREET, ST. AUGUSTINE, FL, 32084

Signature of
Role Plan administrator
Date 2024-07-06
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS COUNTY WELFARE FEDERATION HEALTH AND WELFARE BENEFIT PLAN 2020 590737904 2021-07-29 ST. JOHNS COUNTY WELFARE FEDERATION 118
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 9045841564
Plan sponsor’s mailing address 161 MARINE ST, SAINT AUGUSTINE, FL, 320845154
Plan sponsor’s address 161 MARINE ST, SAINT AUGUSTINE, FL, 320845154

Number of participants as of the end of the plan year
Active participants 122

Signature of
Role Plan administrator
Date 2021-07-28
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-28
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS COUNTY WELFARE FEDERATION HEALTH AND WELFARE BENEFIT PLAN 2019 590737904 2020-07-14 ST. JOHNS COUNTY WELFARE FEDERATION 121
Three-digit plan number (PN) 501
Effective date of plan 2019-01-01
Business code 623000
Sponsor’s telephone number 9045841564
Plan sponsor’s mailing address 161 MARINE ST, SAINT AUGUSTINE, FL, 320845154
Plan sponsor’s address 161 MARINE ST, SAINT AUGUSTINE, FL, 320845154

Number of participants as of the end of the plan year
Active participants 118

Signature of
Role Plan administrator
Date 2020-07-14
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-14
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS COUNTY WELFARE FEDERATION HEALTH AND WELFARE BENEFIT PLAN 2019 590737904 2020-07-21 ST. JOHNS COUNTY WELFARE FEDERATION 121
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-01-01
Business code 623000
Sponsor’s telephone number 9045841564
Plan sponsor’s mailing address 161 MARINE ST, SAINT AUGUSTINE, FL, 320845154
Plan sponsor’s address 161 MARINE ST, SAINT AUGUSTINE, FL, 320845154

Number of participants as of the end of the plan year
Active participants 118

Signature of
Role Plan administrator
Date 2020-07-21
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-21
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS COUNTY WELFARE FEDERATION HEALTH AND WELFARE BENEFIT PLAN 2018 590737904 2019-09-30 ST. JOHNS COUNTY WELFARE FEDERATION 152
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2018-01-01
Business code 623000
Sponsor’s telephone number 9045841564
Plan sponsor’s mailing address 161 MARINE ST, ST AUGUSTINE, FL, 320845154
Plan sponsor’s address 161 MARINE ST, ST AUGUSTINE, FL, 320845154

Number of participants as of the end of the plan year
Active participants 121

Signature of
Role Plan administrator
Date 2019-09-30
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS COUNTY WELFARE FEDERATION HEALTH AND WELFARE BENEFIT PLAN 2017 590737904 2018-07-09 ST. JOHNS COUNTY WELFARE FEDERATION 182
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2017-01-01
Business code 623000
Sponsor’s telephone number 9045841564
Plan sponsor’s mailing address 161 MARINE ST, ST AUGUSTINE, FL, 320845154
Plan sponsor’s address 161 MARINE ST, ST AUGUSTINE, FL, 320845154

Number of participants as of the end of the plan year
Active participants 125

Signature of
Role Plan administrator
Date 2018-07-09
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-09
Name of individual signing JAMES NORMAN
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS COUNTY WELFARE FEDERATION HEALTH AND WELFARE BENEFIT PLAN 2016 590737904 2017-07-06 ST. JOHNS COUNTY WELFARE FEDERATION 167
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2016-01-01
Business code 623000
Sponsor’s telephone number 9045841564
Plan sponsor’s mailing address 161 MARINE ST, SAINT AUGUSTINE, FL, 320845154
Plan sponsor’s address 161 MARINE ST, SAINT AUGUSTINE, FL, 320845154

Number of participants as of the end of the plan year
Active participants 147

Signature of
Role Plan administrator
Date 2017-07-06
Name of individual signing CATHY TAYLOR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-06
Name of individual signing CATHY TAYLOR
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS COUNTY WELFARE FEDERATION HEALTH AND WELFARE BENEFIT PLAN 2015 590737904 2016-07-18 ST. JOHNS COUNTY WELFARE FEDERATION 125
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2015-01-01
Business code 623000
Sponsor’s telephone number 9045841564
Plan sponsor’s mailing address 161 MARINE ST, SAINT AUGUSTINE, FL, 320845154
Plan sponsor’s address 161 MARINE STREET, SAINT AUGUSTINE, FL, 32084

Number of participants as of the end of the plan year
Active participants 125

Signature of
Role Plan administrator
Date 2016-07-18
Name of individual signing CATHY TAYLOR
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS COUNTY WELFARE FEDERATION HEALTH AND WELFARE BENEFIT PLAN 2014 590737904 2015-06-09 ST. JOHNS COUNTY WELFARE FEDERATION 157
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2014-01-01
Business code 623000
Sponsor’s telephone number 9045841564
Plan sponsor’s DBA name BAYVIEW
Plan sponsor’s mailing address 161 MARINE STREET, ST. AUGUSTINE, FL, 32084
Plan sponsor’s address 161 MARINE STREET, ST. AUGUSTINE, FL, 32084

Number of participants as of the end of the plan year
Active participants 157

Signature of
Role Plan administrator
Date 2015-06-09
Name of individual signing CATHY TAYLOR
Valid signature Filed with authorized/valid electronic signature
ST. JOHNS COUNTY WELFARE FEDERATION HEALTH & WELFARE BENEFIT PLAN 2013 590737904 2014-07-10 ST. JOHNS COUNTY WELFARE FEDERATION 163
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 9045841564
Plan sponsor’s DBA name BAYVIEW
Plan sponsor’s mailing address 161 MARINE STREET, ST. AUGUSTINE, FL, 32084
Plan sponsor’s address 161 MARINE STREET, ST. AUGUSTINE, FL, 32084

Number of participants as of the end of the plan year
Active participants 163

Signature of
Role Plan administrator
Date 2014-07-10
Name of individual signing ANETRA KING
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LAKE LARRY Dr. Agent 161 MARINE ST., ST. AUGUSTINE, FL, 32084

Secretary

Name Role Address
ABARE WILLIAM Secretary 112 Heron's Nest Lane, SAINT AUGUSTINE, FL, 32080

Vice President

Name Role Address
MEEKS JEROD Vice President 3865 HICKORY LANE, SAINT AUGUSTINE, FL, 32085

President

Name Role Address
BOLES, JR JOSEPH President 19 RIBERIA ST, ST AUGUSTINE, FL, 32084

Director

Name Role Address
Lake Larry Director 161 MARINE STREET, ST AUGUSTINE, FL, 32084
Prioleau John Director 400 Health Park Blvd, Ste 300, ST AUGUSTINE, FL, 32086
Batenhorst Todd Director 130 Health Park Blvd, ST AUGUSTINE, FL, 32086

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000007057 BAYVIEW ASSISTED LIVING AT THE PAVILION ACTIVE 2022-01-19 2027-12-31 No data 161 MARINE ST, ST. AUGUSTINE, FL, 32084
G22000007066 BAYVIEW REHAB AT SAMANTHA R. WILSON CARE CENTER ACTIVE 2022-01-19 2027-12-31 No data 161 MARINE ST, ST. AUGUSTINE, FL, 32084
G22000007076 BAYVIEW HEALTHCARE ACTIVE 2022-01-19 2027-12-31 No data 161 MARINE ST, ST. AUGUSTINE, FL, 32084
G22000019607 BAY VIEW ASSISTED LIVING AT THE PAVILION ACTIVE 2022-01-19 2027-12-31 No data 161 MARINE ST, ST. AUGUSTINE, FL, 32084
G22000007078 THE PAVILION ASSISTED LIVING FACILITY ACTIVE 2022-01-19 2027-12-31 No data 161 MARINE ST, ST AUGUSTINE, FL, 32084
G22000007070 SAMANTHA WILSON CARE CENTER ACTIVE 2022-01-19 2027-12-31 No data 161 MARINE ST, ST AUGUSTINE, FL, 32084

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2023-09-22 No data No data
AMENDMENT 2008-02-19 No data No data
AMENDMENT 1995-05-02 No data No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J23000500389 ACTIVE 1000000967485 ST JOHNS 2023-10-13 2033-10-18 $ 595.98 STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1415 W US HIGHWAY 90 STE 115, LAKE CITY FL320556156

Related by officers

ABARE WILLIAM

FLAGLER HEALTH CARE SYSTEM, INC.

MEEKS JEROD

MEEKS ENTERPRISES, LLC ARNETT HEATING & AIR CONDITIONING, INC.

Batenhorst Todd

FLAGLER HEALTH NETWORK, LLC

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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