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  5. LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.

LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.

Company Details

Entity Name: LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 22 Feb 1977 (48 years ago)
Document Number: 526379
FEI/EIN Number 592097099
Address: 4548 clearwater harbor drive south, LARGO, FL, 33770, US
Mail Address: 4548 clearwater harbor drive south, LARGO, FL, 33770, US
ZIP code: 33770
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1366832305 2015-01-29 2015-01-29 7527 ULMERTON RD, LARGO, FL, 337714548, US 934 OAKFIELD DR, BRANDON, FL, 335114950, US

Contacts
Phone +1 727-586-0138
Fax 7275866954
Phone +1 813-242-5641
Fax 8136895486

Authorized person
Name MRS. ARLENE GUZIK
Role ASSISTANT MEDICAL DIRECTOR
Phone 7275327644

Taxonomy
Taxonomy Code 261QX0100X - Occupational Medicine Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKESIDE RETIREMENT PLAN 2016 592097099 2019-11-04 LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC. 122
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 7275860138
Plan sponsor’s mailing address 7527 ULMERTON RD, LARGO, FL, 337714548
Plan sponsor’s address 7527 ULMERTON RD, LARGO, FL, 337714548

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2019-11-04
Name of individual signing BRENDA JACOBSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-11-04
Name of individual signing BRENDA JACOBSEN
Valid signature Filed with authorized/valid electronic signature
LAKESIDE RETIREMENT PLAN 2013 592097099 2014-10-11 LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC. 111
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 7275860138
Plan sponsor’s address 7527 ULMERTON ROAD, LARGO, FL, 33771

Signature of
Role Plan administrator
Date 2014-10-11
Name of individual signing BRENDA JACOBSEN
Valid signature Filed with authorized/valid electronic signature
LAKESIDE RETIREMENT PLAN 2012 592097099 2013-07-11 LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC. 120
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 7275860138
Plan sponsor’s address 7527 ULMERTON ROAD, LARGO, FL, 33771

Signature of
Role Plan administrator
Date 2013-07-11
Name of individual signing BRENDA JACOBSEN
Valid signature Filed with authorized/valid electronic signature
LAKESIDE RETIREMENT PLAN 2010 592097099 2011-09-09 LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC. 100
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 7275860138
Plan sponsor’s address 7527 ULMERTON ROAD, LARGO, FL, 33771

Plan administrator’s name and address
Administrator’s EIN 592097099
Plan administrator’s name LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.
Plan administrator’s address 7527 ULMERTON ROAD, LARGO, FL, 33771
Administrator’s telephone number 7275860138

Signature of
Role Plan administrator
Date 2011-09-09
Name of individual signing BRENDA JACOBSEN
Valid signature Filed with authorized/valid electronic signature
LAKESIDE RETIREMENT PLAN 2009 592097099 2010-09-16 LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC. 91
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 7275860138
Plan sponsor’s address 7557 ULMERTON ROAD, LARGO, FL, 33771

Plan administrator’s name and address
Administrator’s EIN 592097099
Plan administrator’s name LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC.
Plan administrator’s address 7557 ULMERTON ROAD, LARGO, FL, 33771
Administrator’s telephone number 7275860138

Signature of
Role Plan administrator
Date 2010-09-16
Name of individual signing BRENDA JACOBSEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JOHNSON RICHARD F Agent 4548 clearwater harbor drive south, LARGO, FL, 33770

President

Name Role Address
JOHNSON RICHARD F President 4548 clearwater harbor drive south, LARGO, FL, 33770

sec

Name Role Address
johnson diana g sec 4548 clearwater harbor drive south, largo, FL, 33770

vice

Name Role Address
johnson diana g vice 4548 clearwater harbor drive south, LARGO, FL, 33770

Events

Event Type Filed Date Value Description
MERGER 2014-12-29 No data CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 300000147833
AMENDMENT AND NAME CHANGE 2007-02-15 LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC. No data
NAME CHANGE AMENDMENT 1997-07-28 LAKESIDE OCCUPATIONAL MEDICAL CENTERS PA No data
NAME CHANGE AMENDMENT 1993-03-08 LAKESIDE INDUSTRIAL MEDICAL CENTER, P.A. No data
REINSTATEMENT 1980-06-04 No data No data
INVOLUNTARILY DISSOLVED 1979-12-05 No data No data

Related by officers

JOHNSON RICHARD F

RANGE MARKETING INC. FREIGHT SALES CARPET AND TILE OF POLK COUNTY, L.L.C.

johnson diana g

7527 ULMERTON ROAD, LLC

Related by address

4548 clearwater harbor drive south, LARGO, FL, 33770, US

7527 ULMERTON ROAD, LLC 1400 EAST BAY DRIVE, LLC

4548 clearwater harbor drive south, LARGO, FL, 33770, US

7527 ULMERTON ROAD, LLC 1400 EAST BAY DRIVE, LLC

Date of last update: 03 Jan 2025

Sources: Florida Department of State

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