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  5. PHYSICIANS OF WINTER HAVEN, LLC

PHYSICIANS OF WINTER HAVEN, LLC

Company Details

Entity Name: PHYSICIANS OF WINTER HAVEN, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 09 Oct 2003 (21 years ago)
Document Number: L03000039709
FEI/EIN Number 200324393
Address: 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884
Mail Address: 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884
ZIP code: 33884
County: Polk
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1801811443 2006-07-13 2020-08-22 2400 DUNDEE RD, WINTER HAVEN, FL, 338841166, US 2400 DUNDEE RD, WINTER HAVEN, FL, 338841166, US

Contacts
Phone +1 863-293-8471
Fax 8635081390

Authorized person
Name DR. JORGE R VILLARREAL
Role VICE PRESIDENT & MEDICAL DIRECTOR
Phone 8632938471

Taxonomy
Taxonomy Code 261QA1903X - Ambulatory Surgical Clinic/Center
License Number 1246
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2020 200324393 2021-04-28 PHYSICIANS OF WINTER HAVEN, LLC 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 8632938471
Plan sponsor’s DBA name DAY
Plan sponsor’s address 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884

Signature of
Role Plan administrator
Date 2021-04-28
Name of individual signing BETTY LEES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-28
Name of individual signing BETTY LEES
Valid signature Filed with authorized/valid electronic signature
DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2019 200324393 2020-05-06 PHYSICIANS OF WINTER HAVEN, LLC 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 8632938471
Plan sponsor’s DBA name DAY
Plan sponsor’s address 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884

Signature of
Role Plan administrator
Date 2020-05-06
Name of individual signing BETTY LEES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-06
Name of individual signing BETTY LEES
Valid signature Filed with authorized/valid electronic signature
DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2017 200324393 2018-05-10 PHYSICIANS OF WINTER HAVEN, LLC 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621498
Sponsor’s telephone number 8632938471
Plan sponsor’s DBA name DAY
Plan sponsor’s address 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884

Signature of
Role Plan administrator
Date 2018-05-10
Name of individual signing BETTY LEES
Valid signature Filed with authorized/valid electronic signature
DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2016 200324393 2017-06-16 PHYSICIANS OF WINTER HAVEN, LLC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 111100
Sponsor’s telephone number 8632938471
Plan sponsor’s DBA name DAY
Plan sponsor’s address 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884

Signature of
Role Plan administrator
Date 2017-06-16
Name of individual signing BETTY LEES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-16
Name of individual signing BETTY LEES
Valid signature Filed with authorized/valid electronic signature
DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2015 200324393 2016-08-04 PHYSICIANS OF WINTER HAVEN, LLC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8632938471
Plan sponsor’s DBA name DAY SURGERY CENTER
Plan sponsor’s address 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884

Signature of
Role Plan administrator
Date 2016-08-04
Name of individual signing BETY LEES
Valid signature Filed with authorized/valid electronic signature
DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2014 200324393 2015-08-06 PHYSICIANS OF WINTER HAVEN, LLC 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8632938471
Plan sponsor’s DBA name DAY SURGERY CENTER
Plan sponsor’s address 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884

Signature of
Role Plan administrator
Date 2015-08-06
Name of individual signing BETTY LEES
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Lerner Robert KMD Agent 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884

President

Name Role Address
LERNER ROBERT K President 1298 MIRROR TERRACE, N.W., WINTER HAVEN, FL, 33881

Vice President

Name Role Address
VILLARREAL JORGE M Vice President 120 WYNDHAM DRIVE, WINTER HAVEN, FL, 33884

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G11000109544 DAY SURGERY CENTER ACTIVE 2011-11-10 2026-12-31 No data 2400 DUNDEE ROAD, WINTER HAVEN, FL, 33884

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2025-01-04 Lerner, Robert Kevin, MD No data
CHANGE OF PRINCIPAL ADDRESS 2006-01-04 2400 DUNDEE ROAD, WINTER HAVEN, FL 33884 No data
CHANGE OF MAILING ADDRESS 2006-01-04 2400 DUNDEE ROAD, WINTER HAVEN, FL 33884 No data
REGISTERED AGENT ADDRESS CHANGED 2006-01-04 2400 DUNDEE ROAD, WINTER HAVEN, FL 33884 No data

Documents

Name Date
ANNUAL REPORT 2025-01-04
ANNUAL REPORT 2024-01-03
ANNUAL REPORT 2023-01-03
ANNUAL REPORT 2022-01-03
ANNUAL REPORT 2021-01-05
ANNUAL REPORT 2020-01-21
ANNUAL REPORT 2019-02-11
ANNUAL REPORT 2018-01-09
ANNUAL REPORT 2017-01-09
ANNUAL REPORT 2016-01-22

Related by officers

LERNER ROBERT K

LMA FLORIDA, LLC

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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