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LORI D. NELSON, D.D.S., P.A.

LORI D. NELSON, D.D.S., P.A.

Company Details

Entity Name:	LORI D. NELSON, D.D.S., P.A.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Profit
Status:	Inactive
Date Filed:	02 Jun 1986 (39 years ago)
Document Number:	J17086
FEI/EIN Number	592699163
Address:	730 EMERSON DR NE, PALM BAY, FL, 32907, US
Mail Address:	730 EMERSON DR NE, PALM BAY, FL, 32907, US
ZIP code:	32907
County:	Brevard
Place of Formation:	FLORIDA

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

LORI D. NELSON, DDS, PA 401(K) PROFIT SHARING PLAN

2009

592699163

2010-10-14

LORI D. NELSON, D.D.S., P.A.

24

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	3219847878
Plan sponsor’s address	730 EMERSON DRIVE NE, PALM BAY, FL, 32907

Plan administrator’s name and address

Administrator’s EIN	592699163
Plan administrator’s name	LORI D. NELSON, D.D.S., P.A.
Plan administrator’s address	730 EMERSON DRIVE NE, PALM BAY, FL, 32907
Administrator’s telephone number	3219847878

Signature of

Role	Plan administrator
Date	2010-10-14
Name of individual signing	LORI NELSON
Valid signature	Filed with authorized/valid electronic signature

Agent

Name	Role	Address
SYTSEMA JACK	Agent	730 EMERSON DRIVE NE, PALM BAY, FL, 32907

DDS

Name	Role	Address
NELSON, LORI D., D.D.S.	DDS	730 EMERSON DR NE, PALM BAY, FL, 32907

Events

Event Type	Filed Date	Value	Description
CONVERSION	2009-09-04	No data	CONVERSION MEMBER. RESULTING CORPORATION WAS L09000086447. CONVERSION NUMBER 500000099175
CANCEL ADM DISS/REV	2007-05-01	No data	No data
ADMIN DISSOLUTION FOR ANNUAL REPORT	2006-09-15	No data	No data
REINSTATEMENT	1993-09-10	No data	No data
ADMIN DISSOLUTION FOR ANNUAL REPORT	1993-08-13	No data	No data

Date of last update: 02 Feb 2025

Sources: Florida Department of State