| Entity Name: | BAYSHORE RETREAT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 19 Jul 2010 (15 years ago) |
| Date of dissolution: | 28 Oct 2024 (3 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 28 Oct 2024 (3 months ago) |
| Document Number: | L10000075907 |
| FEI/EIN Number | 27-3111562 |
| Address: | 457 CALHOUN AVENUE, DESTIN, FL 32541 |
| Mail Address: | 615 Sunnybrook Dr., Brentwood, TN 37027 |
| ZIP code: | 32541 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982991121 | 2011-07-08 | 2011-07-08 | PO BOX 365, DESTIN, FL, 325400365, US | 457 CAHOUN AVE, DESTIN, FL, 32541, US | |||||||||||||||||
|
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| Phone | +1 850-269-3975 |
Authorized person
| Name | JEFFREY JENKS |
| Role | COO |
| Phone | 8502693975 |
Taxonomy
| Taxonomy Code | 324500000X - Substance Abuse Rehabilitation Facility |
| License Number | 0146AD1561-01 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BAYSHORE RETREAT | 2022 | 273111562 | 2023-08-10 | BAYSHORE RETREAT | 13 | |||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2023-08-10 |
| Name of individual signing | MEGAN DEANE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 624310 |
| Sponsor’s telephone number | 8506876830 |
| Plan sponsor’s address | PO BOX 365, DESTIN, FL, 32540 |
Signature of
| Role | Plan administrator |
| Date | 2022-11-17 |
| Name of individual signing | MEGAN DEANE |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 624310 |
| Sponsor’s telephone number | 8506876830 |
| Plan sponsor’s address | PO BOX 365, DESTIN, FL, 32540 |
Signature of
| Role | Plan administrator |
| Date | 2022-11-11 |
| Name of individual signing | MEGAN DEANE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 624310 |
| Sponsor’s telephone number | 8506876830 |
| Plan sponsor’s address | PO BOX 365, DESTIN, FL, 32540 |
Signature of
| Role | Plan administrator |
| Date | 2021-10-07 |
| Name of individual signing | MEGAN DEANE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| WILLIAMSON, WAYNE | Agent | 167 E. PT. WASHINGTON RD., SANTA ROSA BEACH, FL 32459 |
| Name | Role | Address |
|---|---|---|
| Given, Carley | Estate of Judy Butler Personal Representative | 615 Sunnybrook Dr, Brentwood, TN 37027 |
| Name | Role | Address |
|---|---|---|
| GIVEN, CARLEY | Authorized Member | 615 SUNNYBROOK DR., BRENTWOOD, TN 37027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-10-28 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-03 | 457 CALHOUN AVENUE, DESTIN, FL 32541 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-09-15 | 167 E. PT. WASHINGTON RD., SANTA ROSA BEACH, FL 32459 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-09-15 | WILLIAMSON, WAYNE | No data |
| LC AMENDMENT | 2023-09-15 | No data | No data |
| REINSTATEMENT | 2022-10-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REINSTATEMENT | 2021-11-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REINSTATEMENT | 2020-10-09 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-10-28 |
| ANNUAL REPORT | 2024-04-03 |
| LC Amendment | 2023-09-15 |
| ANNUAL REPORT | 2023-04-04 |
| REINSTATEMENT | 2022-10-04 |
| REINSTATEMENT | 2021-11-17 |
| REINSTATEMENT | 2020-10-09 |
| REINSTATEMENT | 2019-11-07 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-04-11 |
Date of last update: 25 Jan 2025
Sources: Florida Department of State
