| Entity Name: | NIC 5 FOREST OAKS LEASING LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 15 Apr 2013 (12 years ago) |
| Date of dissolution: | 04 Dec 2019 (5 years ago) |
| Last Event: | LC WITHDRAWAL |
| Event Date Filed: | 04 Dec 2019 (5 years ago) |
| Document Number: | M13000002363 |
| FEI/EIN Number | 38-3903303 |
| Address: | 55 WEST 46TH STREET SUITE 2204, NEW YORK, NY 10036 |
| Mail Address: | 55 WEST 46TH STREET SUITE 2204, NEW YORK, NY 10036 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508200213 | 2013-04-24 | 2016-12-01 | PO BOX 1700 C/O HOLIDAY RETIREMENT, NIC 4 FOREST OAKS LEASING LLC, LAKE OSWEGO, OR, 97035, US | 8055 FOREST OAKS BLVD., SPRING HILL, FL, 34606, US | |||||||||||||||||||||||||||||
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| Phone | +1 971-245-8020 |
| Fax | 5034312295 |
| Phone | +1 352-683-3323 |
| Fax | 3526861465 |
Authorized person
| Name | JANE RYU |
| Role | PRESIDENT/CEO/CFO |
| Phone | 2124795270 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 7179 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 691830100 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| NIC 5 FLORIDA LEASING LLC | MEMBER | 55 WEST 46TH STREET SUITE 2204, NEW YORK, NY 10036 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000046186 | FOREST OAKS OF SPRING HILL | EXPIRED | 2013-05-15 | 2018-12-31 | No data | C/O FIG LLC, 1345 AVENUE OF THE AMERICAS, NEW YORK, NY, 10105 |
| G13000041976 | FOREST OAKS | EXPIRED | 2013-05-01 | 2018-12-31 | No data | C/O FIG LLC, 1345 AVENUE OF THE AMERICAS, NEW YORK, NY, 10105 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC WITHDRAWAL | 2019-12-04 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-17 | 55 WEST 46TH STREET SUITE 2204, NEW YORK, NY 10036 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-17 | 55 WEST 46TH STREET SUITE 2204, NEW YORK, NY 10036 | No data |
| LC STMNT OF RA/RO CHG | 2018-12-21 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-12-21 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-12-21 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| LC Withdrawal | 2019-12-04 |
| ANNUAL REPORT | 2019-04-17 |
| CORLCRACHG | 2018-12-21 |
| ANNUAL REPORT | 2018-04-11 |
| ANNUAL REPORT | 2017-04-03 |
| ANNUAL REPORT | 2016-04-12 |
| ANNUAL REPORT | 2015-04-16 |
| ANNUAL REPORT | 2014-05-01 |
| Foreign Limited | 2013-04-15 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
