| Entity Name: | LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
LAKESIDE OCCUPATIONAL MEDICAL CENTERS, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| 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: | 22 Feb 1977 (48 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 29 Dec 2014 (10 years ago) |
| Document Number: | 526379 |
| FEI/EIN Number |
592097099
Federal Employer Identification (FEI) Number assigned by the IRS. |
| 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 |
| 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 | |||||||||||||||||||
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| 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 |
| 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 | |||||||||||||||||||||||||||||||||||||||||||||||
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| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| Name | Role | Address |
|---|---|---|
| JOHNSON RICHARD F | President | 4548 clearwater harbor drive south, LARGO, FL, 33770 |
| johnson diana g | sec | 4548 clearwater harbor drive south, largo, FL, 33770 |
| johnson diana g | vice | 4548 clearwater harbor drive south, LARGO, FL, 33770 |
| JOHNSON RICHARD F | Agent | 4548 clearwater harbor drive south, LARGO, FL, 33770 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-05 | 4548 clearwater harbor drive south, LARGO, FL 33770 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-05 | 4548 clearwater harbor drive south, LARGO, FL 33770 | - |
| CHANGE OF MAILING ADDRESS | 2017-04-05 | 4548 clearwater harbor drive south, LARGO, FL 33770 | - |
| MERGER | 2014-12-29 | - | 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. | - |
| REGISTERED AGENT NAME CHANGED | 2006-01-12 | JOHNSON, RICHARD FMD | - |
| NAME CHANGE AMENDMENT | 1997-07-28 | LAKESIDE OCCUPATIONAL MEDICAL CENTERS PA | - |
| NAME CHANGE AMENDMENT | 1993-03-08 | LAKESIDE INDUSTRIAL MEDICAL CENTER, P.A. | - |
| REINSTATEMENT | 1980-06-04 | - | - |
| INVOLUNTARILY DISSOLVED | 1979-12-05 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-22 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-03-21 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-03-27 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-04-19 |
| Reg. Agent Change | 2015-05-28 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 315671263 | 0420600 | 2011-05-24 | 3303 S SEMORAN BLVD., ORLANDO, FL, 32822 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Citation ID | 01001 |
| Citaton Type | Serious |
| Standard Cited | 19101030 C01 IVB |
| Issuance Date | 2011-08-08 |
| Abatement Due Date | 2011-09-10 |
| Current Penalty | 2231.25 |
| Initial Penalty | 2975.0 |
| Nr Instances | 1 |
| Nr Exposed | 3 |
| Gravity | 05 |
| Citation ID | 01002 |
| Citaton Type | Serious |
| Standard Cited | 19101030 C01 V |
| Issuance Date | 2011-08-08 |
| Abatement Due Date | 2011-09-10 |
| Current Penalty | 2231.25 |
| Initial Penalty | 2975.0 |
| Nr Instances | 1 |
| Nr Exposed | 3 |
| Gravity | 05 |
| Citation ID | 01003 |
| Citaton Type | Serious |
| Standard Cited | 19101030 G02 I |
| Issuance Date | 2011-08-08 |
| Abatement Due Date | 2011-09-10 |
| Current Penalty | 2231.25 |
| Initial Penalty | 2975.0 |
| Nr Instances | 1 |
| Nr Exposed | 3 |
| Gravity | 05 |
| Citation ID | 01004 |
| Citaton Type | Serious |
| Standard Cited | 19101200 H |
| Issuance Date | 2011-08-08 |
| Abatement Due Date | 2011-09-10 |
| Current Penalty | 1338.75 |
| Initial Penalty | 1785.0 |
| Nr Instances | 1 |
| Nr Exposed | 3 |
| Gravity | 01 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
