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CONWAY LAKES NC, LLC - Florida Company Profile

Company Details

Entity Name: CONWAY LAKES NC, LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Co.
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 27 Aug 2003 (22 years ago)
Document Number: M03000002857
FEI/EIN Number 760738978

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 1950 Lower Birmingham Rd, Canton, GA, 30115, US
Mail Address: 1950 Lower Birmingham Rd, Canton, GA, 30115, US
Place of Formation: GEORGIA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1649267212 2005-09-29 2022-02-14 5201 CURRY FORD RD, ORLANDO, FL, 328128741, US 5201 CURRY FORD RD, ORLANDO, FL, 328128741, US

Contacts
Phone +1 407-384-8838
Fax 4073847936

Authorized person
Name MR. SAMUEL B KELLETT
Role AS SOLE MEMBER OF SBK CAPITAL LLC
Phone 4042501846

Taxonomy
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number SNF11020963
State FL
Is Primary Yes

Other Provider Identifiers
Issuer VA
Number V673P-5339
Issuer MEDICAID
Number 026451200
State FL

Key Officers & Management

Name Role Address
C T CORPORATION SYSTEM Agent -
SBK CAPITAL, L.L.C. Managing Member 3450 Ridgewood Road, NW, ATLANTA, GA, 30327

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G11000099545 CONWAY LAKES HEALTH & REHABILITATION CENTER ACTIVE 2011-10-10 2026-12-31 - 3450 RIDGEWOOD ROAD NW, ATLANTA, GA, 30327

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-04-24 1950 Lower Birmingham Rd, Canton, GA 30115 -
CHANGE OF MAILING ADDRESS 2024-04-24 1950 Lower Birmingham Rd, Canton, GA 30115 -

Court Cases

Title Case Number Docket Date Status
CONWAY LAKES NC, LLC D/B/A CONWAY LAKES HEALTH AND REHABILITATION CENTER VS AGENCY FOR HEALTH CARE ADMINISTRATION 5D2021-2994 2021-12-07 Closed
Classification NOA Final - Administrative - Other
Court 5th District Court of Appeal
Originating Court Circuit Court for the Ninth Judicial Circuit, Orange County
DOAH21-1832

Administrative Agency
F1219-0659-001

Parties
Name CONWAY LAKES NC, LLC
Role Appellant
Status Active
Representations Taylor Huston
Name Conway Lakes Health and Rehabilitation Center
Role Appellant
Status Active
Name Clerk Agency Health Care
Role Appellee
Status Active
Representations Tracy Cooper George, Eugenia Keough Rains, Richard Santurri
Name Clerk Division of Administrative
Role Appellee
Status Active

Docket Entries
Docket Date 2021-12-07
Type Misc. Events
Subtype Fee Status
Description FP:Fee Paid Through Portal
On Behalf Of Conway Lakes NC, LLC
Docket Date 2021-12-07
Type Order
Subtype Order on Filing Fee
Description Order to pay filing fee - Administrative (300)
Docket Date 2022-03-23
Type Brief
Subtype Answer Brief
Description Appellee's Answer Brief
On Behalf Of Clerk Agency Health Care
Docket Date 2022-02-22
Type Order
Subtype Order Discharging Show Cause Order
Description ORD-Discharging Show Cause ~ RESPONSE ACKNOWLEDGED; IB ACCEPTED; OTSC DISCHARGED
Docket Date 2022-02-21
Type Brief
Subtype Initial Brief
Description Initial Brief on Merits
On Behalf Of Conway Lakes NC, LLC
Docket Date 2022-02-21
Type Response
Subtype Response
Description RESPONSE ~ PER 2/15 ORDER
On Behalf Of Conway Lakes NC, LLC
Docket Date 2022-02-18
Type Notice
Subtype Notice of Appearance
Description Notice of Appearance
On Behalf Of Clerk Agency Health Care
Docket Date 2022-02-15
Type Order
Subtype Show Cause
Description Show Cause Lack of Prosecution, Initial Brief ~ AA W/IN 10 DYS
Docket Date 2021-12-20
Type Record
Subtype Record on Appeal
Description Received Records ~ 244 PAGES
On Behalf Of Clerk Division of Administrative
Docket Date 2021-12-15
Type Order
Subtype Order
Description Miscellaneous Order ~ RESPONSE ACKNOWLEDGED; APPEAL SHALL NOT BE RESTRICTED
Docket Date 2021-12-14
Type Response
Subtype Response
Description RESPONSE ~ PER 12/8 ORDER- JOINT RESPONSE
On Behalf Of Clerk Agency Health Care
Docket Date 2021-12-09
Type Notice
Subtype Notice of Appearance
Description Notice of Appearance
On Behalf Of Clerk Agency Health Care
Docket Date 2021-12-08
Type Order
Subtype Order
Description Miscellaneous Order ~ PARTIES W/IN 10 DYS ADVISE RE: RESTRICT/MEDICAID
Docket Date 2021-12-07
Type Letter
Subtype Acknowledgment Letter
Description Acknowledgement Letter 1
Docket Date 2021-12-07
Type Notice
Subtype Notice of Appeal
Description Notice of Appeal Filed ~ FILED BELOW 12/6/21
On Behalf Of Conway Lakes NC, LLC
Docket Date 2022-10-25
Type Record
Subtype Returned Records
Description Returned Records ~ NO RECORD E-FILED
Docket Date 2022-10-25
Type Mandate
Subtype Mandate
Description Mandate
Docket Date 2022-10-04
Type Disposition by Opinion
Subtype Affirmed
Description Affirmed - Per Curiam Affirmed ~ PCA
Docket Date 2022-05-17
Type Notice
Subtype Notice
Description NOTICE OF PANEL ASSIGNMENT

Documents

Name Date
ANNUAL REPORT 2024-04-24
ANNUAL REPORT 2023-04-10
ANNUAL REPORT 2022-03-15
ANNUAL REPORT 2021-01-27
ANNUAL REPORT 2020-04-27
ANNUAL REPORT 2019-03-05
ANNUAL REPORT 2018-04-16
ANNUAL REPORT 2017-04-11
ANNUAL REPORT 2016-03-30
ANNUAL REPORT 2015-03-23

USAspending Awards. Contracts

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
DELIVERY ORDER AWARD 36C24824N0575 2024-04-18 2025-04-17 2025-04-17
Unique Award Key CONT_AWD_36C24824N0575_3600_36C24821D0054_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 1250000.00
Current Award Amount 1250000.00
Potential Award Amount 1250000.00

Description
Title COMMUNITY NURSING HOME SERVICES
NAICS Code 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product and Service Codes Q402: MEDICAL- NURSING HOME CARE CONTRACTS

Recipient Details
Recipient CONWAY LAKES NC, LLC
UEI H6HJEJAU7GG8
Recipient Address UNITED STATES, 5201 CURRY FORD RD, ORLANDO, ORANGE, FLORIDA, 328128741
- IDV 36C24821D0054 2021-04-18 - -
Unique Award Key CONT_IDV_36C24821D0054_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 0.00
Potential Award Amount 6250000.00

Description
Title EO14042 COMMUNITY NURSING HOME SERVICES
NAICS Code 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product and Service Codes Q402: MEDICAL- NURSING HOME CARE CONTRACTS

Recipient Details
Recipient CONWAY LAKES NC, LLC
UEI H6HJEJAU7GG8
Recipient Address UNITED STATES, 5201 CURRY FORD RD, ORLANDO, ORANGE, FLORIDA, 328128741
- IDV VA248BO0074 2008-05-01 - -
Unique Award Key CONT_IDV_VA248BO0074_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title CONTRACT COMMUNITY NURSING HOME CARE
NAICS Code 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient CONWAY LAKES NC, LLC
UEI H6HJEJAU7GG8
Legacy DUNS 156775368
Recipient Address 5201 CURRY FORD RD, ORLANDO, 328128741, UNITED STATES
- IDV VA248BO0074FY08 2007-10-01 - -
Unique Award Key CONT_IDV_VA248BO0074FY08_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title CONTRACT COMMUNITY NURSING HOME CARE
NAICS Code 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient CONWAY LAKES NC, LLC
UEI H6HJEJAU7GG8
Legacy DUNS 156775368
Recipient Address 5201 CURRY FORD RD, ORLANDO, 328128741, UNITED STATES
DO AWARD V673P5339FY08 2007-10-01 2008-09-30 2008-09-30
Unique Award Key CONT_AWD_V673P5339FY08_3600_V673P5339_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title COMMUNITY NURSING HOME EXPENDITURE - FY08
NAICS Code 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient CONWAY LAKES NC, LLC
UEI H6HJEJAU7GG8
Legacy DUNS 156775368
Recipient Address 5201 CURRY FORD RD, ORLANDO, 328128741, UNITED STATES

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
7467597307 2020-04-30 0491 PPP 5201 curry ford rd, ORLANDO, FL, 32812
Loan Status Date 2021-07-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 1545100
Loan Approval Amount (current) 1545100
Undisbursed Amount 0
Franchise Name -
Lender Location ID 98993
Servicing Lender Name Lake Michigan CU
Servicing Lender Address 5540 Glenwood Hills Pkwy SE, GRAND RAPIDS, MI, 49512-2044
Rural or Urban Indicator U
Hubzone N
LMI Y
Business Age Description Existing or more than 2 years old
Project Address ORLANDO, ORANGE, FL, 32812-1001
Project Congressional District FL-09
Number of Employees 230
NAICS code 623110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 111774
Originating Lender Name Pilot Bank
Originating Lender Address TAMPA, FL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 1561924.42
Forgiveness Paid Date 2021-06-11

U.S. Small Business Administration Profile

Status User ID Name of Firm Trade Name UEI Address
Active P0595417 CONWAY LAKES NC, LLC - H6HJEJAU7GG8 5201 CURRY FORD RD, ORLANDO, FL, 32812-8741
Capabilities Statement Link -
Phone Number 407-384-8838
Fax Number -
E-mail Address AJKusmierz@conwaylakesrehab.com
WWW Page -
E-Commerce Website -
Contact Person AJ KUSMIERZ
County Code (3 digit) 095
Congressional District 10
Metropolitan Statistical Area 5960
CAGE Code 3Y3W1
Year Established 2003
Accepts Government Credit Card No
Legal Structure LLC
Ownership and Self-Certifications -
Business Development Servicing Office NORTH FLORIDA DISTRICT OFFICE (SBA office code 0491)
Capabilities Narrative Conway Lakes Nursing Center our patients HAS expedient access to a full continuum of health care services, including physical, occupational and speech therapy.
Special Equipment/Materials (none given)
Business Type Percentages Service (100 %)
Keywords Nursing Center, Nursing, Health Care
Quality Assurance Standards (none given)
Electronic Data Interchange capable -

SBA Federal Certifications
HUBZone Certified No
Women Owned Certified No
Women Owned Pending No
Economically Disadvantaged Women Owned Certified No
Economically Disadvantaged Women Owned Pending No
Veteran-Owned Small Business Certified No
Veteran-Owned Small Business Joint Venture No
Service-Disabled Veteran-Owned Small Business Certified No
Service-Disabled Veteran-Owned Small Business Joint Venture No

Bonding Levels
Description Construction Bonding Level (per contract)
Level $0
Description Construction Bonding Level (aggregate)
Level $0
Description Service Bonding Level (per contract)
Level $0
Description Service Bonding Level (aggregate)
Level $0

NAICS Codes with Size Determinations by NAICS
Primary Yes
Code 623110
NAICS Code's Description Nursing Care Facilities (Skilled Nursing Facilities)
Small Yes

Export Profile (Trade Mission Online)
Exporter Firm hasn't answered this question yet
Export Business Activities (none given)
Exporting to (none given)
Desired Export Business Relationships (none given)
Description of Export Objective(s) (none given)

Motor Carrier Census

USDOT Number Carrier Operation MCS-150 Form Date MCS-150 Mileage MCS-150 Year Power Units Drivers Operation Classification
2572108 Intrastate Non-Hazmat 2023-01-19 15000 2022 2 2 Priv. Pass. (Business), Priv. Pass.(Non-business)
Legal Name CONWAY LAKES NC LLC
DBA Name CONWAY LAKES REHABILITATION CENTER
Physical Address 5201 CURRY FORD ROAD, ORLANDO, FL, 32812, US
Mailing Address 5201 CURRY FORD ROAD, ORLANDO, FL, 32812, US
Phone (321) 271-7116
Fax -
E-mail RSCHACHTER@CLEARCHOICEHC.COM

Safety Measurement System - All Transportation
Total Number of Inspections for the measurement period (24 months) 0
Driver Fitness BASIC Serious Violation Indicator No
Vehicle Maintenance BASIC Acute/Critical Indicator No
Unsafe Driving BASIC Acute/Critical Indicator No
Driver Fitness BASIC Roadside Performance measure value 0
Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value 0
Total Number of Driver Inspections for the measurment period 0
Vehicle Maintenance BASIC Roadside Performance measure value 0
Total Number of Vehicle Inspections for the measurement period 0
Controlled Substances and Alcohol BASIC Roadside Performance measure value 0
Unsafe Driving BASIC Roadside Performance Measure Value 0
Number of inspections with at least one Driver Fitness BASIC violation 0
Number of inspections with at least one Hours-of-Service BASIC violation 0
Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation 0
Number of inspections with at least one Vehicle Maintenance BASIC violation 0
Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation 0
Number of inspections with at least one Controlled Substances and Alcohol BASIC violation 0
Number of inspections with at least one Unsafe Driving BASIC violation 0

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SBK CAPITAL, L.L.C.

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Companies related by address

1950 Lower Birmingham Rd, Canton, GA, 30115, US

ALACHUA COUNTY HRC, LLC SBK CAPITAL, LLC POLK HEALTHCARE, L.P. (LTD.) PORT CHARLOTTE HEALTHCARE ASSOCIATES, LTD. MELBOURNE TERRACE RCC, LLC TALLAHASSEE HEALTHCARE ASSOCIATES, LTD. (L.P.) CENTRE POINTE HRC, LLC CLEAR CHOICE HEALTH CARE, LLC SUN CITY CENTER ASSOCIATES, LTD.(L.P.) PINELLAS III HEALTHCARE, LTD. (L.P.)

1950 Lower Birmingham Rd, Canton, GA, 30115, US

ALACHUA COUNTY HRC, LLC SBK CAPITAL, LLC POLK HEALTHCARE, L.P. (LTD.) PORT CHARLOTTE HEALTHCARE ASSOCIATES, LTD. MELBOURNE TERRACE RCC, LLC TALLAHASSEE HEALTHCARE ASSOCIATES, LTD. (L.P.) CENTRE POINTE HRC, LLC CLEAR CHOICE HEALTH CARE, LLC SUN CITY CENTER ASSOCIATES, LTD.(L.P.) PINELLAS III HEALTHCARE, LTD. (L.P.)

Date of last update: 02 Mar 2025

Sources: Florida Department of State

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