| Entity Name: | CLERMONT RADIOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Mar 2003 (22 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 12 Dec 2016 (8 years ago) |
| Document Number: | L03000010412 |
| FEI/EIN Number | 810607616 |
| Mail Address: | PO BOX 593869, ORLANDO, FL, 32859-3869, US |
| Address: | 871 Oakley Seaver Drive, Clermont, FL, 34711, US |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235770686 | 2019-10-07 | 2019-10-07 | PO BOX 593869, ORLANDO, FL, 328593869, US | 18 NE 1ST AVE, OCALA, FL, 344706658, US | |||||||||||||||
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| Phone | +1 352-241-6100 |
| Fax | 3522416101 |
Authorized person
| Name | MR. CARMEN RESTIVO |
| Role | CREDENTIALING/COMPLIANCE MANAGER |
| Phone | 3522416100 |
Taxonomy
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CLERMONT RADIOLOGY 401(K) PLAN | 2023 | 810607616 | 2024-09-06 | CLERMONT RADIOLOGY | 115 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-06 |
| Name of individual signing | LYDIA CHASTAIN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-09-06 |
| Name of individual signing | LYDIA CHASTAIN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621510 |
| Sponsor’s telephone number | 3522416100 |
| Plan sponsor’s address | 1101 S PARK AVE., SUITE 500, WINTER GARDEN, FL, 34787 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-06 |
| Name of individual signing | LYDIA CHASTAIN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2022-10-06 |
| Name of individual signing | LYDIA CHASTAIN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| KOLB ROBERT | Agent | 1101 S Park Ave, Winter Garden, FL, 347873827 |
| Name | Role | Address |
|---|---|---|
| Kolb Robert S | Manager | 1101 S Park Ave, Winter Garden, FL, 347873827 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000096365 | CLERMONT RADIOLOGY-OCALA | ACTIVE | 2019-09-04 | 2029-12-31 | No data | PO BOX 593869, ORLANDO, FL, 32859-3869 |
| G17000119261 | CLERMONT RADIOLOGY - KINGS RIDGE | ACTIVE | 2017-10-30 | 2027-12-31 | No data | PO BOX 593869, ORLANDO, FL, 32859-3869 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-12-26 | 871 Oakley Seaver Drive, Clermont, FL 34711 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-02-13 | 1101 S Park Ave, Suite 100, Winter Garden, FL 34787-3827 | No data |
| LC STMNT OF RA/RO CHG | 2016-12-12 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2016-12-12 | 871 Oakley Seaver Drive, Clermont, FL 34711 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-12-12 | KOLB, ROBERT | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| ANNUAL REPORT | 2023-03-08 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-02-13 |
| ANNUAL REPORT | 2019-04-23 |
| ANNUAL REPORT | 2018-03-27 |
| ANNUAL REPORT | 2017-04-12 |
| CORLCRACHG | 2016-12-12 |
| ANNUAL REPORT | 2016-05-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
