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  5. HENDERSON HAVEN, INC.

HENDERSON HAVEN, INC. - Florida Company Profile

Company Details

Entity Name: HENDERSON HAVEN, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
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: 13 Aug 2003 (22 years ago)
Document Number: N03000006945
FEI/EIN Number 571181811

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 772 Foxridge Center Dr, ORANGE PARK, FL, 32065, US
Mail Address: 772 Foxridge Center Dr, ORANGE PARK, FL, 32065, US
ZIP code: 32065
County: Clay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1427013655 2006-04-19 2022-07-21 2554 MOODY AVE, ORANGE PARK, FL, 320735937, US 2554 MOODY AVE, ORANGE PARK, FL, 320735937, US

Contacts
Phone +1 904-264-2522
Fax 9042157338

Authorized person
Name LEE HENDERSON
Role PRES CEO
Phone 9042642522

Taxonomy
Taxonomy Code 251C00000X - Developmentally Disabled Services Day Training Agency
License Number F001
State FL
Is Primary Yes
Taxonomy Code 251V00000X - Voluntary or Charitable Agency
License Number CH17033
State FL
Is Primary No
Taxonomy Code 305S00000X - Point of Service
License Number F001
State FL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 683650096
State FL
Issuer MEDICAID
Number 683650098
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HENDERSON HAVEN INC 401(K) PROFIT SHARING PLAN & TRUST 2023 571181811 2024-07-25 HENDERSON HAVEN, INC. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621498
Sponsor’s telephone number 9042642522
Plan sponsor’s address 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32065

Signature of
Role Plan administrator
Date 2024-07-25
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
HENDERSON HAVEN INC 401(K) PROFIT SHARING PLAN & TRUST 2022 571181811 2023-06-23 HENDERSON HAVEN, INC. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621498
Sponsor’s telephone number 9042642522
Plan sponsor’s address 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32065

Signature of
Role Plan administrator
Date 2023-06-23
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
HENDERSON HAVEN INC 401(K) PROFIT SHARING PLAN & TRUST 2021 571181811 2022-07-01 HENDERSON HAVEN, INC. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621498
Sponsor’s telephone number 9042642522
Plan sponsor’s address 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32065

Signature of
Role Plan administrator
Date 2022-07-01
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
HENDERSON HAVEN INC 401(K) PROFIT SHARING PLAN & TRUST 2020 571181811 2021-04-30 HENDERSON HAVEN, INC. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621498
Sponsor’s telephone number 9042642522
Plan sponsor’s address 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32065

Signature of
Role Plan administrator
Date 2021-04-30
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
HENDERSON HAVEN INC 401(K) PROFIT SHARING PLAN & TRUST 2019 571181811 2020-06-17 HENDERSON HAVEN, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621498
Sponsor’s telephone number 9042642522
Plan sponsor’s address 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32065

Signature of
Role Plan administrator
Date 2020-06-17
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
HENDERSON SHERRI A Director 2554 MOODY AVE, ORANGE PARK, FL, 32073
HENDERSON LEE Director 2554 MOODY AVE, ORANGE PARK, FL, 32073
Merwin Keith Director 5110 Siesta del Rio Dr, Jacksonville, FL, 32258
Pender Vanessa Director 309 Marisco Way, Jacksonville, FL, 32220
HENDERSON LEE . Agent 2554 MOODY AVE, ORANGE PARK, FL, 32073

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G12000086636 METAMORPHOSES ACTIVE 2012-09-04 2027-12-31 - 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32065
G11000080069 FREE 2 BE ME ACTIVE 2011-08-11 2025-12-31 - 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32065

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2016-01-28 772 Foxridge Center Dr, ORANGE PARK, FL 32065 -
CHANGE OF MAILING ADDRESS 2015-01-28 772 Foxridge Center Dr, ORANGE PARK, FL 32065 -
REGISTERED AGENT NAME CHANGED 2004-01-05 HENDERSON, LEE . -

Documents

Name Date
ANNUAL REPORT 2025-01-13
ANNUAL REPORT 2024-01-19
ANNUAL REPORT 2023-01-19
ANNUAL REPORT 2022-01-24
ANNUAL REPORT 2021-01-25
ANNUAL REPORT 2020-02-04
ANNUAL REPORT 2019-02-01
ANNUAL REPORT 2018-01-16
ANNUAL REPORT 2017-01-09
ANNUAL REPORT 2016-01-28

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
57-1181811 Corporation Unconditional Exemption 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32065-8714 2004-01
In Care of Name % LEE HENDERSON
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Organization that receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2023-12
Asset 100,000 to 499,999
Income 500,000 to 999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 431816
Income Amount 777368
Form 990 Revenue Amount 777368
National Taxonomy of Exempt Entities Human Services: Developmentally Disabled Centers
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name HENDERSON HAVEN INC
EIN 57-1181811
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name HENDERSON HAVEN INC
EIN 57-1181811
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name HENDERSON HAVEN INC
EIN 57-1181811
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name HENDERSON HAVEN INC
EIN 57-1181811
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name HENDERSON HAVEN INC
EIN 57-1181811
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name HENDERSON HAVEN INC
EIN 57-1181811
Tax Period 201612
Filing Type E
Return Type 990
File View File
Organization Name HENDERSON HAVEN INC
EIN 57-1181811
Tax Period 201512
Filing Type E
Return Type 990
File View File

Motor Carrier Census

USDOT Number Carrier Operation MCS-150 Form Date MCS-150 Mileage MCS-150 Year Power Units Drivers Operation Classification
2487582 Intrastate Non-Hazmat 2019-02-08 207859 2019 1 2 Priv. Pass. (Business)
Legal Name HENDERSON HAVEN INC
DBA Name -
Physical Address 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32073, US
Mailing Address 772 FOXRIDGE CENTER DR, ORANGE PARK, FL, 32073, US
Phone (904) 264-2522
Fax (904) 264-2522
E-mail LEEH@HENDERSONHAVEN.ORG

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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Merwin Keith

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Companies related by address

No other companies in our directory share the same address as HENDERSON HAVEN, INC.

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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