FLORIDA MEMORIAL UNIVERSITY, INC, FL

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1619472644

2018-03-30

5050 SPRING VALLEY RD, DALLAS, TX, 752443995, US

15800 NW 42ND AVE, MIAMI GARDENS, FL, 330546155, US

Contacts

Phone

+1 972-367-4845

Authorized person

Name	MOUZON BASS III
Role	ADMINISTRATOR
Phone	9723674845

Taxonomy

Taxonomy Code	207X00000X - Orthopaedic Surgery Physician
Is Primary	Yes

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

FLORIDA MEMORIAL COLLEGE 403B TAX SHELTERED ANNUITY PLAN

2020

590668483

2021-12-07

FLORIDA MEMORIAL UNIVERSITY, INC.

612

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3054300339
Plan sponsor’s mailing address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 330546155
Plan sponsor’s address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 330546155

Number of participants as of the end of the plan year

Active participants	506
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	40
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	335
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	2021-12-07
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2021-12-07
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

FLORIDA MEMORIAL COLLEGE 403B TAX SHELTERED ANNUITY PLAN

2019

590668483

2022-08-15

FLORIDA MEMORIAL UNIVERSITY, INC.

546

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3054300339
Plan sponsor’s mailing address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 330546155
Plan sponsor’s address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 330546155

Number of participants as of the end of the plan year

Active participants	484
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	39
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits	1
Number of participants with account balances as of the end of the plan year	335
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	2022-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2022-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

FLORIDA MEMORIAL COLLEGE 403B TAX SHELTERED ANNUITY PLAN

2017

590668483

2019-08-15

FLORIDA MEMORIAL UNIVERSITY, INC.

643

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3056263600
Plan sponsor’s mailing address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 330546155
Plan sponsor’s address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 330546155

Number of participants as of the end of the plan year

Active participants	534
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	78
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	338
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	2019-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2019-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

FLORIDA MEMORIAL COLLEGE 403B TAX SHELTERED ANNUITY PLAN

2016

590668483

2018-08-15

FLORIDA MEMORIAL UNIVERSITY, INC.

683

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3056263600
Plan sponsor’s mailing address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 330546155
Plan sponsor’s address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 33054

Number of participants as of the end of the plan year

Active participants	604
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	39
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	370
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	2018-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2018-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

FLORIDA MEMORIAL COLLEGE 403B TAX SHELTERED ANNUITY PLAN

2015

590668483

2017-08-15

FLORIDA MEMORIAL UNIVERSITY, INC.

726

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3056263600
Plan sponsor’s DBA name	FLORIDA MEMORIAL UNIVERSITY
Plan sponsor’s mailing address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 33054
Plan sponsor’s address	15800 NW 42ND AVE, MIAMI GARDENS, FL, 33054

Number of participants as of the end of the plan year

Active participants	626
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	57
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	390
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	2017-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

FLORIDA MEMORIAL COLLEGE 403B TAX SHELTERED ANNUITY PLAN

2014

590668483

2016-08-15

FLORIDA MEMORIAL UNIVERSITY, INC.

790

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3056263600
Plan sponsor’s mailing address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 330546155
Plan sponsor’s address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 330546155

Number of participants as of the end of the plan year

Active participants	661
Retired or separated participants receiving benefits	1
Other retired or separated participants entitled to future benefits	64
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	404
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	2016-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

FLORIDA MEMORIAL COLLEGE 403 (B) TAX SHELTERED ANNUITY PLAN

2013

590668483

2015-08-17

FLORIDA MEMORIAL UNIVERSITY, INC.

771

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3056263600
Plan sponsor’s mailing address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054
Plan sponsor’s address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054

Number of participants as of the end of the plan year

Active participants	707
Other retired or separated participants entitled to future benefits	83
Number of participants with account balances as of the end of the plan year	410
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	2015-08-17
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

FLORIDA MEMORIAL COLLEGE 403 (B) TAX SHELTERED ANNUITY PLAN

2012

590668483

2014-08-15

FLORIDA MEMORIAL UNIVERSITY, INC.

823

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3056263600
Plan sponsor’s mailing address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054
Plan sponsor’s address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054

Number of participants as of the end of the plan year

Active participants	771
Number of participants with account balances as of the end of the plan year	452
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	2014-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

FLORIDA MEMORIAL COLLEGE 403 (B) TAX SHELTERED ANNUITY PLAN

2010

590668483

2012-08-15

FLORIDA MEMORIAL UNIVERSITY, INC.

799

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3054300339
Plan sponsor’s mailing address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054
Plan sponsor’s address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054

Plan administrator’s name and address

Administrator’s EIN	590668483
Plan administrator’s name	FLORIDA MEMORIAL UNIVERSITY, INC.
Plan administrator’s address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054
Administrator’s telephone number	3054300339

Number of participants as of the end of the plan year

Active participants	831
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	454
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	2012-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

FLORIDA MEMORIAL COLLEGE 403 (B) TAX SHELTERED ANNUITY PLAN

2009

590668483

2011-08-15

FLORIDA MEMORIAL UNIVERSITY, INC.

802

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-11-01
Business code	611000
Sponsor’s telephone number	3054300339
Plan sponsor’s mailing address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054
Plan sponsor’s address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054

Plan administrator’s name and address

Administrator’s EIN	590668483
Plan administrator’s name	FLORIDA MEMORIAL UNIVERSITY, INC.
Plan administrator’s address	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054
Administrator’s telephone number	3054300339

Number of participants as of the end of the plan year

Active participants	799
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	46
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	799
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	2011-08-15
Name of individual signing	RODNEY SOBELSON
Valid signature	Filed with authorized/valid electronic signature

Agent

Name	Role
WEISS SEROTA HELFMAN COLE & BIERMAN, P.L.	Agent

Secretary

Name	Role	Address
McMillon Brittany	Secretary	6650 Corporate Center Parkway, Jacksonville, FL, 32216

Treasurer

Name	Role	Address
Phelps-Owens Deneshea L	Treasurer	762 Gleneagles Drive, Fort Wahington, MD, 20744

Chairman

Name	Role	Address
Weatherington Walter	Chairman	P.O. Box 2107, Bowie, MD, 20716

Vice Chairman

Name	Role	Address
Pinkney Mona-Lisa	Vice Chairman	13410 Bishops Court, Roswell, GA, 30075

President

Name	Role	Address
McCormick William	President	15800 N.W. 42nd AVE., MIAMI GARDENS, FL, 33054

Executive Vice President

Name	Role	Address
Bouie II Archie Dr.	Executive Vice President	15800 N.W. 42nd AVE., MIAMI GARDENS, FL, 33054

Events

Event Type	Filed Date	Value	Description
AMENDMENT	2018-08-08	No data	No data
AMENDMENT	2005-02-18	No data	No data
NAME CHANGE AMENDMENT	2004-12-10	FLORIDA MEMORIAL UNIVERSITY, INC.	No data
REINSTATEMENT	1994-12-14	No data	No data
ADMIN DISSOLUTION FOR ANNUAL REPORT	1994-08-26	No data	No data
AMENDMENT	1988-09-01	No data	No data
AMENDMENT	1976-03-17	No data	No data
EVENT CONVERTED TO NOTES	1975-08-08	No data	No data
EVENT CONVERTED TO NOTES	1975-08-06	No data	No data
EVENT CONVERTED TO NOTES	1974-10-21	No data	No data
EVENT CONVERTED TO NOTES	1966-12-09	No data	No data
EVENT CONVERTED TO NOTES	1964-01-31	No data	No data
EVENT CONVERTED TO NOTES	1963-06-04	No data	No data
NAME CHANGE AMENDMENT	1963-06-04	FLORIDA MEMORIAL COLLEGE, INC.	No data
EVENT CONVERTED TO NOTES	1962-08-30	No data	No data

Debts

Document Number	Status	Case Number	Name of Court	Date of Entry	Expiration Date	Amount Due	Plaintiff
J18000792754	TERMINATED	2016-CA-009456-O	CIR. CT. 9TH JUD. CIR. ORANGE	2018-12-10	2023-12-13	$895,906.26	INDEPENDENT COLLEGES AND UNIVERSITIES BENEFITS ASN. INC, 4850 MILLENIA BOULEVARD, SUITE 329, ORLANDO, FLORIDA 32839

Entity Name:	FLORIDA MEMORIAL UNIVERSITY, INC.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Non-Profit
Status:	Active
Date Filed:	30 Aug 1962 (62 years ago)
Document Number:	704467
FEI/EIN Number	590668483
Address:	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054, US
Mail Address:	15800 NW 42ND AVENUE, MIAMI GARDENS, FL, 33054, US
ZIP code:	33054
County:	Miami-Dade
Place of Formation:	FLORIDA

FLORIDA MEMORIAL UNIVERSITY, INC.

Company Details

National Provider Identifier

form 5500

Agent

Secretary

Treasurer

Chairman

Vice Chairman

President

Executive Vice President

Events

Debts

Related by officers

Related by address