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  5. THE BOUGAINVILLA HOUSE, INC.

THE BOUGAINVILLA HOUSE, INC.

Company Details

Entity Name: THE BOUGAINVILLA HOUSE, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Not For Profit Corporation
Status: Active
Date Filed: 14 Jul 1981 (44 years ago)
Last Event: AMENDED AND RESTATED ARTICLES
Event Date Filed: 01 Feb 2013 (12 years ago)
Document Number: 759182
FEI/EIN Number 59-2120945
Address: 1721 S.E. 4TH AVENUE, FORT LAUDERDALE, FL 33316
Mail Address: 1721 S.E. 4TH AVENUE, FORT LAUDERDALE, FL 33316
ZIP code: 33316
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1700243300 2016-01-27 2016-01-27 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 333162515, US 1727 SE 4TH AVE, FORT LAUDERDALE, FL, 333162515, US

Contacts
Phone +1 954-764-7337
Fax 9547646283

Authorized person
Name KELI KORNMILLER
Role SENIOR CREDENTIALING SPECIALIST
Phone 5616728345

Taxonomy
Taxonomy Code 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center
Is Primary No
Taxonomy Code 261QR0800X - Recovery Care Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BOUGAINVILLA HOUSE INC 401(K) PROFIT SHARING PLAN & TRUST 2021 592120945 2022-03-31 BOUGAINVILLA HOUSE INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621420
Sponsor’s telephone number 9547647337
Plan sponsor’s address 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2022-03-31
Name of individual signing CICI KELLY
Valid signature Filed with authorized/valid electronic signature
BOUGAINVILLA HOUSE INC 401(K) PROFIT SHARING PLAN & TRUST 2020 592120945 2021-04-01 BOUGAINVILLA HOUSE INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621420
Sponsor’s telephone number 9547647337
Plan sponsor’s address 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2021-04-01
Name of individual signing CICI KELLY
Valid signature Filed with authorized/valid electronic signature
BOUGAINVILLA HOUSE INC 401(K) PROFIT SHARING PLAN & TRUST 2019 592120945 2020-04-09 BOUGAINVILLA HOUSE INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621420
Sponsor’s telephone number 9547647337
Plan sponsor’s address 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2020-04-09
Name of individual signing CICI KELLY
Valid signature Filed with authorized/valid electronic signature
BOUGAINVILLA HOUSE INC 401 K PROFIT SHARING PLAN TRUST 2018 592120945 2019-05-08 BOUGAINVILLA HOUSE INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621420
Sponsor’s telephone number 9547647337
Plan sponsor’s address 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2019-05-08
Name of individual signing CICI KELLY
Valid signature Filed with authorized/valid electronic signature
BOUGAINVILLA HOUSE INC 401 K PROFIT SHARING PLAN TRUST 2017 592120945 2018-03-20 BOUGAINVILLA HOUSE INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621420
Sponsor’s telephone number 9547647337
Plan sponsor’s address 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2018-03-20
Name of individual signing CICI KELLY
Valid signature Filed with authorized/valid electronic signature
BOUGAINVILLA HOUSE INC 401 K PROFIT SHARING PLAN TRUST 2016 592120945 2017-05-15 BOUGAINVILLA HOUSE INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621420
Sponsor’s telephone number 9547647337
Plan sponsor’s address 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2017-05-15
Name of individual signing CICI KELLY
Valid signature Filed with authorized/valid electronic signature
BOUGAINVILLA HOUSE INC 401 K PROFIT SHARING PLAN TRUST 2015 592120945 2016-07-08 BOUGAINVILLA HOUSE INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621420
Sponsor’s telephone number 9547647337
Plan sponsor’s address 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2016-07-08
Name of individual signing KENNETH BENSON
Valid signature Filed with authorized/valid electronic signature
BOUGAINVILLA HOUSE INC 401 K PROFIT SHARING PLAN TRUST 2014 592120945 2015-05-07 BOUGAINVILLA HOUSE INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621420
Sponsor’s telephone number 9547647337
Plan sponsor’s address 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2015-05-07
Name of individual signing KACEY BENSON
Valid signature Filed with authorized/valid electronic signature
BOUGAINVILLA HOUSE INC 401 K PROFIT SHARING PLAN TRUST 2013 592120945 2014-06-20 BOUGAINVILLA HOUSE INC 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621420
Sponsor’s telephone number 9547647337
Plan sponsor’s address 1721 SE 4TH AVE, FORT LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2014-06-20
Name of individual signing KACEY BENSON
Valid signature Filed with authorized/valid electronic signature
HOSPICECARE OF SOUTHEAST FLORIDA, INC GROUP BENEFIT PLAN 2011 592120945 2012-10-31 THE BOUGAINVILLA HOUSE, INC. 191
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1999-04-01
Business code 621610
Sponsor’s telephone number 9544677423
Plan sponsor’s mailing address 321 SE 18TH STREET, FORT LAUDERDALE, FL, 333162817
Plan sponsor’s address 321 SE 18TH STREET, FORT LAUDERDALE, FL, 333162817

Plan administrator’s name and address
Administrator’s EIN 592120945
Plan administrator’s name THE BOUGAINVILLA HOUSE, INC.
Plan administrator’s address 321 SE 18TH STREET, FORT LAUDERDALE, FL, 333162817

Number of participants as of the end of the plan year
Active participants 0

Signature of
Role Plan administrator
Date 2012-10-13
Name of individual signing JANET DAVIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Cartagena, Veronica Agent 1721 SE 4th Avenue, Ft. Lauderdale, FL 33316

Chairman

Name Role Address
Balzora, Lulrick Chairman 1721 SE 4th Avenue, Fort Lauderdale, FL 33316

Treasurer

Name Role Address
Bush, Mike Treasurer 1721 S.E. 4TH AVENUE, FORT LAUDERDALE, FL 33316

Director

Name Role Address
Herrlinger, Maria Teresa Director 1721 S.E. 4TH AVENUE, FORT LAUDERDALE, FL 33316
Felix, Keny, Dr. Director 1721 S.E. 4TH AVENUE, FORT LAUDERDALE, FL 33316
Yates, Christine Director 1721 S.E. 4TH AVENUE, FORT LAUDERDALE, FL 33316

Secretary

Name Role Address
Herrlinger, Maria Teresa Secretary 1721 S.E. 4TH AVENUE, FORT LAUDERDALE, FL 33316

President

Name Role Address
Cartagena, Veronica President 1721 SE 4th Avenue, Fort Lauderdale, FL 33316

Chief Executive Officer

Name Role Address
Cartagena, Veronica Chief Executive Officer 1721 SE 4th Avenue, Fort Lauderdale, FL 33316

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G15000111501 HOSPICE CARE OF SOUTHEAST FLORIDA ACTIVE 2015-11-02 2025-12-31 No data 1721 SE 4 AVE, FT. LAUDERDALE, FL, 33316
G09000185442 TILLI KIDS EXPIRED 2009-12-16 2014-12-31 No data 309 SE 18 STREET, FORT LAUDERDALE, FL, 33316

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2024-01-17 Cartagena, Veronica No data
REGISTERED AGENT ADDRESS CHANGED 2019-02-15 1721 SE 4th Avenue, Ft. Lauderdale, FL 33316 No data
AMENDED AND RESTATEDARTICLES 2013-02-01 No data No data
CHANGE OF MAILING ADDRESS 2012-10-03 1721 S.E. 4TH AVENUE, FORT LAUDERDALE, FL 33316 No data
REINSTATEMENT 2012-10-03 No data No data
CHANGE OF PRINCIPAL ADDRESS 2012-10-03 1721 S.E. 4TH AVENUE, FORT LAUDERDALE, FL 33316 No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2012-09-28 No data No data
NAME CHANGE AMENDMENT 2011-10-25 THE BOUGAINVILLA HOUSE, INC. No data
AMENDMENT 2010-11-16 No data No data
NAME CHANGE AMENDMENT 2001-02-08 HOSPICECARE OF SOUTHEAST FLORIDA, INC. No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J13001071761 TERMINATED 1000000512363 BROWARD 2013-05-31 2023-06-07 $ 26,006.70 STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149
J13000896952 TERMINATED 1000000428405 BROWARD 2013-05-06 2023-05-08 $ 26,667.05 STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149
J13000744087 TERMINATED 1000000443928 BROWARD 2013-04-11 2023-04-17 $ 42,914.83 STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149

Documents

Name Date
AMENDED ANNUAL REPORT 2024-01-17
ANNUAL REPORT 2024-01-11
AMENDED ANNUAL REPORT 2023-06-27
AMENDED ANNUAL REPORT 2023-03-29
ANNUAL REPORT 2023-03-21
AMENDED ANNUAL REPORT 2022-11-07
ANNUAL REPORT 2022-03-04
AMENDED ANNUAL REPORT 2021-06-16
ANNUAL REPORT 2021-03-12
AMENDED ANNUAL REPORT 2020-11-03

Related by officers

Yates, Christine

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Related by address

No related companies by address

Date of last update: 05 Feb 2025

Sources: Florida Department of State

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