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  5. COALITION FOR INDEPENDENT LIVING OPTIONS, INC.

COALITION FOR INDEPENDENT LIVING OPTIONS, INC.

Company Details

Entity Name: COALITION FOR INDEPENDENT LIVING OPTIONS, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 12 Jan 1990 (35 years ago)
Document Number: N36147
FEI/EIN Number 650174695
Address: 4400 N CONGRESS AVE, WEST PALM BEACH, FL, 33407, US
Mail Address: 4400 N CONGRESS AVE, WEST PALM BEACH, FL, 33407, US
ZIP code: 33407
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790031219 2012-08-02 2012-08-02 6800 FOREST HILL BLVD, GREENACRES, FL, 334133310, US 6800 FOREST HILL BLVD, GREENACRES, FL, 334133310, US

Contacts
Phone +1 561-966-4288
Fax 5616416619

Authorized person
Name MS. GENEVIEVE T COUSMINER
Role EXECUTIVE DIRECTOR
Phone 5619664288

Taxonomy
Taxonomy Code 251B00000X - Case Management Agency
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 002045200
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EMPLOYEE BENEFIT PLAN OF COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 2021 650174695 2023-02-09 COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 624310
Sponsor’s telephone number 5619664288
Plan sponsor’s address 4400 N CONGRESS AVE STE 203, WEST PALM BEACH, FL, 334073221

Signature of
Role Plan administrator
Date 2023-02-09
Name of individual signing JOSHUA NELSON
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 2020 650174695 2021-10-07 COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 624310
Sponsor’s telephone number 5619664288
Plan sponsor’s address 4400 N CONGRESS AVE STE 203, WEST PALM BEACH, FL, 334073221

Signature of
Role Plan administrator
Date 2021-10-07
Name of individual signing DAN SHORTER
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 2019 650174695 2020-07-29 COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 624310
Sponsor’s telephone number 5619664288
Plan sponsor’s address 2751 S DIXIE HWY, WEST PALM BEACH, FL, 334051233

Signature of
Role Plan administrator
Date 2020-07-29
Name of individual signing PETRA PITKONEN
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFIT PLAN OF COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 2018 650174695 2019-08-21 COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 624100
Sponsor’s telephone number 5619664288
Plan sponsor’s address 2751 S DIXIE HWY, WEST PALM BEACH, FL, 334051233

Signature of
Role Plan administrator
Date 2019-08-21
Name of individual signing PETRA PITKONEN
Valid signature Filed with authorized/valid electronic signature
COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 401(K) PLAN 2014 650174695 2015-05-12 COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 624100
Sponsor’s telephone number 5619664288
Plan sponsor’s address 6800 FOREST HILL BOULEVARD, WEST PALM BEACH, FL, 33413
COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 401(K) PLAN 2013 650174695 2014-08-15 COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 624100
Sponsor’s telephone number 5619664288
Plan sponsor’s address 6800 FOREST HILL BOULEVARD, WEST PALM BEACH, FL, 33413
TAX DEFERRED ANNUNITY PLAN OF COALITION FOR INDEPENDENT LIVING OPTIONS 2012 650174695 2013-01-14 COALITION FOR INDEPENDENT LIVING OPTIONS INC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-03-01
Business code 624100
Plan sponsor’s address 6800 FOREST HILL BLVD, WEST PALM BEACH, FL, 33413

Signature of
Role Plan administrator
Date 2013-01-14
Name of individual signing ELLEN FEIR
Valid signature Filed with authorized/valid electronic signature
COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 401(K) PLAN 2012 650174695 2013-10-04 COALITION FOR INDEPENDENT LIVING OPTIONS, INC. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 624100
Sponsor’s telephone number 5619664288
Plan sponsor’s address 6800 FOREST HILL BOULEVARD, WEST PALM BEACH, FL, 33413

Signature of
Role Plan administrator
Date 2013-10-04
Name of individual signing ELLEN FEIR
Valid signature Filed with authorized/valid electronic signature
TAX DEFFERED ANNUNITY PLAN OF COALITION FOR INDEPENDENT LIVING OPTIONS 2011 650174695 2012-06-29 COALITION FOR INDEPENDENT LIVING OPTIONS 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-03-01
Business code 624100
Plan sponsor’s address 6800 FOREST HILL BLVD, WEST PALM BEACH, FL, 33413

Plan administrator’s name and address
Administrator’s EIN 650174695
Plan administrator’s name COALITION FOR INDEPENDENT LIVING OPTIONS
Plan administrator’s address 6800 FOREST HILL BLVD, WEST PALM BEACH, FL, 33413

Signature of
Role Plan administrator
Date 2012-06-29
Name of individual signing ELLEN FEIR
Valid signature Filed with authorized/valid electronic signature
TAX DEFFERED ANNUITY PLAN OF COALITION FOR INDEPENDENT LIVING OPTIONS 2010 650174695 2011-07-29 COALITION FOR INDEPENDENT LIVING OPTIONS 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-03-01
Business code 624100
Sponsor’s telephone number 5619664288
Plan sponsor’s address 6800 FOREST HILL BLVD., WEST PALM BEACH, FL, 33413

Plan administrator’s name and address
Administrator’s EIN 650174695
Plan administrator’s name COALITION FOR INDEPENDENT LIVING OPTIONS
Plan administrator’s address 6800 FOREST HILL BLVD., WEST PALM BEACH, FL, 33413
Administrator’s telephone number 5619664288

Signature of
Role Plan administrator
Date 2011-07-29
Name of individual signing ELLEN FEIR
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
FIELDS JOSEPH RESQ Agent 1818 SOUTH AUSTRALIAN AVE, WEST PALM BEACH, FL, 33409

President

Name Role Address
FIELDS JOSEPH E President 4400 N CONGRESS AVE, WEST PALM BEACH, FL, 33407

Chief Executive Officer

Name Role Address
SHORTER DAN Chief Executive Officer 4400 N CONGRESS AVE, WEST PALM BEACH, FL, 33407

Treasurer

Name Role Address
Aguirre Lucrecia Treasurer 4400 N CONGRESS AVE, WEST PALM BEACH, FL, 33407

Vice President

Name Role Address
Peterson Lisa Vice President 4400 N CONGRESS AVE, WEST PALM BEACH, FL, 33407

Director

Name Role Address
Wenger Charles E Director 4400 N CONGRESS AVE, WEST PALM BEACH, FL, 33407

Secretary

Name Role Address
Kline Goldstein Lisa Esq. Secretary 4400 N CONGRESS AVE, WEST PALM BEACH, FL, 33407

Events

Event Type Filed Date Value Description
AMENDMENT 2013-09-27 No data No data
AMENDMENT 2012-09-10 No data No data
AMENDMENT 2009-01-12 No data No data

Related by officers

FIELDS JOSEPH E

PALM BEACH SAILING 4 KIDS, INC.

SHORTER DAN

FLORIDA ASSOCIATION OF CENTERS FOR INDEPENDENT LIVING, INC.

Peterson Lisa

AA PETERSON & ASSOCIATES, INC

Related by address

No related companies by address

Date of last update: 02 Jan 2025

Sources: Florida Department of State

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