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  5. XACTFORM USA, INC.

XACTFORM USA, INC.

Company Details

Entity Name: XACTFORM USA, INC.
Jurisdiction: FLORIDA
Filing Type: Foreign Profit
Status: Active
Date Filed: 21 Apr 2006 (19 years ago)
Document Number: F06000002492
FEI/EIN Number 20-4551197
Address: 515 Evergreen Street, Panama City Beach, FL, 32407, US
Mail Address: P.O.Box 20307, Panama City Beach, FL, 32417, US
ZIP code: 32407
County: Bay
Place of Formation: DELAWARE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
XACTFORM USA INC 401(K) PROFIT SHARING PLAN & TRUST 2021 204551197 2022-11-17 XACTFORM USA INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 17704 ASHLEY DRIVE BLDG-C1, SUITE A, PANAMA CITY BEACH, FL, 324130000

Signature of
Role Plan administrator
Date 2022-11-17
Name of individual signing REBECCA A DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401(K) PROFIT SHARING PLAN & TRUST 2021 204551197 2022-06-29 XACTFORM USA INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 17704 ASHLEY DRIVE BLDG-C1, SUITE A, PANAMA CITY BEACH, FL, 324130000

Signature of
Role Plan administrator
Date 2022-06-29
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401(K) PROFIT SHARING PLAN & TRUST 2020 204551197 2021-04-14 XACTFORM USA INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 17704 ASHLEY DRIVE BLDG-C1, SUITE A, PANAMA CITY BEACH, FL, 324130000

Signature of
Role Plan administrator
Date 2021-04-14
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401(K) PROFIT SHARING PLAN & TRUST 2019 204551197 2020-05-07 XACTFORM USA INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 11 MIRACLE STRIP LOOP, SUITE A, PANAMA CITY BEACH, FL, 324070000

Signature of
Role Plan administrator
Date 2020-05-07
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2018 204551197 2019-07-08 XACTFORM USA INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 11 MIRACLE STRIP LOOP, SUITE A, PANAMA CITY BEACH, FL, 324070000

Signature of
Role Plan administrator
Date 2019-07-08
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC. 401 K PROFIT SHARING PLAN TRUST 2017 204551197 2018-05-25 XACTFORM USA INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 515 EVERGREEN, ST STE C, PANAMA CITY BEACH, FL, 324070000

Signature of
Role Plan administrator
Date 2018-05-25
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2016 204551197 2017-07-25 XACTFORM USA INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 515 EVERGREEN STREET, ST STE C, PANAMA CITY BEACH, FL, 324070000

Signature of
Role Plan administrator
Date 2017-07-25
Name of individual signing REBECCA DOMINGUEZ
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2015 204551197 2016-07-29 XACTFORM USA INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 515 EVERGREEN ST STE C, PANAMA CITY BEACH, FL, 324078408

Signature of
Role Plan administrator
Date 2016-07-29
Name of individual signing JOE BUTLER
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2014 204551197 2015-06-30 XACTFORM USA INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 11 MIRACLE STRIP LOOP STE A, PANAMA CITY BEACH, FL, 324078408

Signature of
Role Plan administrator
Date 2015-06-30
Name of individual signing JOSEPH W BUTLER II
Valid signature Filed with authorized/valid electronic signature
XACTFORM USA INC 401 K PROFIT SHARING PLAN TRUST 2013 204551197 2014-05-12 XACTFORM USA INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 541990
Sponsor’s telephone number 8502309848
Plan sponsor’s address 11 MIRACLE STRIP LOOP STE A, PANAMA CITY BEACH, FL, 324078408

Signature of
Role Plan administrator
Date 2014-05-12
Name of individual signing JOSEPH W BUTLER II
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
CORPORATION SERVICE COMPANY Agent

President

Name Role Address
Chave Pierre-Olivier President 2300 La Chaux-de-Fonds, Boulevard des Eplatures 42

Treasurer

Name Role Address
Coray Christian Treasurer 2300 La Chaux-de-Fonds, Boulevard des Eplatures 42

Secretary

Name Role Address
Domiquez Rebecca Secretary P.O.Box 20307, Panama City Beach, FL, 32417

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2025-01-08 515 Evergreen Street, Suite B, Panama City Beach, FL 32407 No data
CHANGE OF MAILING ADDRESS 2025-01-08 515 Evergreen Street, Suite B, Panama City Beach, FL 32407 No data
CHANGE OF PRINCIPAL ADDRESS 2024-08-05 1519 Ohio Avenue, Unit A, Lynn Haven, FL 32444 No data
CHANGE OF MAILING ADDRESS 2019-04-29 1519 Ohio Avenue, Unit A, Lynn Haven, FL 32444 No data
REGISTERED AGENT NAME CHANGED 2013-09-10 CORPORATION SERVICE COMPANY No data
REGISTERED AGENT ADDRESS CHANGED 2013-09-10 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 No data

Documents

Name Date
ANNUAL REPORT 2025-01-08
AMENDED ANNUAL REPORT 2024-08-05
ANNUAL REPORT 2024-01-30
ANNUAL REPORT 2023-04-13
ANNUAL REPORT 2022-04-24
ANNUAL REPORT 2021-04-23
ANNUAL REPORT 2020-02-14
ANNUAL REPORT 2019-04-29
ANNUAL REPORT 2018-01-16
ANNUAL REPORT 2017-03-24

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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