| Entity Name: | ORMOND INTERNAL MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Sep 2003 (21 years ago) |
| Document Number: | L03000035890 |
| FEI/EIN Number | 35-2214929 |
| Address: | 279 S YONGE STREET, ORMOND BEACH, FL 32174 |
| Mail Address: | 279 S YONGE STREET, ORMOND BEACH, FL 32174 |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023209095 | 2007-08-06 | 2024-07-25 | 279 S. YONGE ST., ORMOND BCH, FL, 32174, US | 279 S. YONGE ST., ORMOND BCH, FL, 32174, US | |||||||||||||||||||
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| Phone | +1 386-673-2133 |
| Fax | 3866732743 |
Authorized person
| Name | PATRICIA GAIL VANDIEPEN |
| Role | OWNER |
| Phone | 3866732133 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | OS7544 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ORMOND INTERNAL MEDICINE 401(K) PLAN | 2023 | 352214929 | 2024-07-18 | ORMOND INTERNAL MEDICINE, LLC | 12 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-18 |
| Name of individual signing | SHIRLEY HORNER |
| 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 | 621111 |
| Sponsor’s telephone number | 3866732133 |
| Plan sponsor’s address | 279 SOUTH YONGE STREET, ORMOND BEACH, FL, 32174 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-13 |
| Name of individual signing | SHIRLEY HORNER |
| 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 | 621111 |
| Sponsor’s telephone number | 3866732133 |
| Plan sponsor’s address | 279 SOUTH YONGE STREET, ORMOND BEACH, FL, 32174 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-13 |
| Name of individual signing | SHIRLEY HORNER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| VAN DIEPEN, GAIL | Agent | 1 ST. JOHN''S PLACE, ORMOND BEACH, FL 32176 |
| Name | Role | Address |
|---|---|---|
| VAN DIEPEN, GAIL | Managing Member | 1 ST JOHNS PL, ORMOND BEACH, FL 32176 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2007-03-13 | 279 S YONGE STREET, ORMOND BEACH, FL 32174 | No data |
| CHANGE OF MAILING ADDRESS | 2007-03-13 | 279 S YONGE STREET, ORMOND BEACH, FL 32174 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-04-12 | 1 ST. JOHN''S PLACE, ORMOND BEACH, FL 32176 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2023-03-21 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-06-10 |
| ANNUAL REPORT | 2019-04-14 |
| ANNUAL REPORT | 2018-07-17 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-02-29 |
| ANNUAL REPORT | 2015-02-20 |
Date of last update: 06 Jan 2025
Sources: Florida Department of State
