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EAGLE LAKE FOUNDATION, INC. - Florida Company Profile

Company Details

Entity Name: EAGLE LAKE FOUNDATION, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 10 May 2005 (20 years ago)
Date of dissolution: 27 Sep 2024 (6 months ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 27 Sep 2024 (6 months ago)
Document Number: N05000004803
FEI/EIN Number 202813348

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 24641 US HWY 19 N, Clearwater, FL, 33763, US
Mail Address: 24641 US HWY 19 N, Clearwater, FL, 33763, US
ZIP code: 33763
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1225046584 2006-08-03 2010-11-05 24641 US HIGHWAY 19 N, CLEARWATER, FL, 337635007, US 1100 66TH ST N, ST PETERSBURG, FL, 337106224, US

Contacts

Phone +1 727-723-3000
Fax 7277233076
Phone +1 727-345-9331
Fax 7273457064

Authorized person

Name LYNDA HEBBELN
Role VP OF ACCT & FINANCE
Phone 7277233000

Taxonomy

Taxonomy Code 314000000X - Skilled Nursing Facility
License Number SNF15650961
State FL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 031106500
State FL
Issuer BLUE CROSS PROVIDER #
Number L43
State FL

Key Officers & Management

Name Role Address
Atkins Benjamin President 500 McLennan Street, CLEARWATER, FL, 33756
Hines Virginia Secretary 24641 US HWY 19 N, Clearwater, FL, 33763
C T CORPORATION SYSTEM Agent -

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2024-09-27 - -
REINSTATEMENT 2023-07-10 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2022-09-23 - -
CHANGE OF PRINCIPAL ADDRESS 2019-03-31 24641 US HWY 19 N, Clearwater, FL 33763 -
AMENDMENT 2015-09-21 - -
CHANGE OF MAILING ADDRESS 2015-03-12 24641 US HWY 19 N, Clearwater, FL 33763 -
AMENDMENT 2015-01-09 - -
AMENDMENT 2014-12-24 - -
AMENDMENT 2014-12-03 - -
REGISTERED AGENT ADDRESS CHANGED 2014-11-24 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 -

Documents

Name Date
REINSTATEMENT 2023-07-10
ANNUAL REPORT 2021-04-30
ANNUAL REPORT 2020-03-16
ANNUAL REPORT 2019-03-31
ANNUAL REPORT 2018-03-18
ANNUAL REPORT 2017-02-17
ANNUAL REPORT 2016-01-20
Amendment 2015-09-21
ANNUAL REPORT 2015-03-12
Amendment 2015-01-09

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
20-2813348 Corporation Unconditional Exemption 500 MCLENNAN ST, CLEARWATER, FL, 33756-2047 2006-02
In Care of Name % BEN ATKINS
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 Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2023-12
Asset 1 to 9,999
Income 0
Filing Requirement 990 - Required to file Form 990-N - Income less than $50,000 per year
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 1
Income Amount 0
Form 990 Revenue Amount 0
National Taxonomy of Exempt Entities Health Care: Hospitals and Related Primary Medical Care Facilities
Sort Name EAGLE LAKE REHAB & CARE CENTER

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 EAGLE LAKE FOUNDATION INC
EIN 20-2813348
Tax Period 202212
Filing Type E
Return Type 990EZ
File View File
Organization Name EAGLE LAKE FOUNDATION INC
EIN 20-2813348
Tax Period 202112
Filing Type E
Return Type 990EZ
File View File
Organization Name EAGLE LAKE FOUNDATION INC
EIN 20-2813348
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name EAGLE LAKE FOUNDATION INC
EIN 20-2813348
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name EAGLE LAKE FOUNDATION INC
EIN 20-2813348
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name EAGLE LAKE FOUNDATION INC
EIN 20-2813348
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name EAGLE LAKE FOUNDATION INC
EIN 20-2813348
Tax Period 201612
Filing Type E
Return Type 990
File View File
Organization Name EAGLE LAKE FOUNDATION INC
EIN 20-2813348
Tax Period 201512
Filing Type E
Return Type 990
File View File

Date of last update: 01 Mar 2025

Sources: Florida Department of State