| Entity Name: | FLORIDA ASSOCIATION OF SELF INSUREDS, 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: | 12 Jun 1969 (56 years ago) |
| Date of dissolution: | 25 Jan 2023 (2 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 25 Jan 2023 (2 years ago) |
| Document Number: | 716726 |
| FEI/EIN Number |
592192394
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 222 S WESTMONTE DRIVE, SUITE 111, ALTAMONTE SPRINGS, FL, 32714, US |
| Mail Address: | 222 S WESTMONTE DRIVE, SUITE 111, ALTAMONTE SPRINGS, FL, 32714, US |
| ZIP code: | 32714 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| Name | Role | Address |
|---|---|---|
| SHUFFER GAIL | PPD | 300 S ADAMS ST BOX A-34, TALLAHASSEE, FL, 32301 |
| Clayton Ryan | Executive Director | 222 S WESTMONTE DR SUITE 111, ALTAMONTE SPRINGS, FL, 32714 |
| MARTINEZ MARISA | Vice President | PO BOX 1289, TAMPA, FL, 33601 |
| PRITCHARD JOSIAH | President | 4500 SAN PABLO RD S, JACKSONVILLE, FL, 32224 |
| Boling Judy | Past | PO Box 12909, Tallahassee, FL, 32317 |
| Jensen Dane | President | 524 Stockton Street, Jacksonville, FL, 32204 |
| Clayton Ryan | Agent | 222 S WESTMONTE DRIVE SUITE 111, ALTAMONTE SPRINGS, FL, 32714 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-01-25 | - | - |
| REGISTERED AGENT NAME CHANGED | 2021-02-01 | Clayton, Ryan | - |
| REGISTERED AGENT ADDRESS CHANGED | 2019-01-28 | 222 S WESTMONTE DRIVE SUITE 111, ALTAMONTE SPRINGS, FL 32714 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2019-01-28 | 222 S WESTMONTE DRIVE, SUITE 111, ALTAMONTE SPRINGS, FL 32714 | - |
| CHANGE OF MAILING ADDRESS | 2019-01-28 | 222 S WESTMONTE DRIVE, SUITE 111, ALTAMONTE SPRINGS, FL 32714 | - |
| NAME CHANGE AMENDMENT | 2009-07-07 | FLORIDA ASSOCIATION OF SELF INSUREDS, INC. | - |
| NAME CHANGE AMENDMENT | 1988-04-15 | FLORIDA ASSOCIATION OF SELF INSURANCE, INC. | - |
| NAME CHANGE AMENDMENT | 1983-01-17 | FLORIDA ASSOCIATION OF SELF INSURERS, INC. | - |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2023-01-25 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-26 |
| ANNUAL REPORT | 2017-01-19 |
| ANNUAL REPORT | 2016-02-10 |
| ANNUAL REPORT | 2015-01-13 |
| ANNUAL REPORT | 2014-02-04 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
