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  5. TRACY S. FANSLER, M.D., LLC

TRACY S. FANSLER, M.D., LLC

Company Details

Entity Name: TRACY S. FANSLER, M.D., LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 14 Jun 2004 (21 years ago)
Date of dissolution: 22 Sep 2017 (7 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 22 Sep 2017 (7 years ago)
Document Number: L04000044819
FEI/EIN Number 201240476
Address: 12955 SEMINOLE BLVD, LARGO, FL, 33778
Mail Address: 12955 SEMINOLE BLVD, SEMINOLE, FL, 33776, US
ZIP code: 33778
County: Pinellas
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2021 201240476 2022-07-11 TRACY S. FANSLER, M.D., LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 13577 74TH AVENUE, SEMINOLE, FL, 33776

Signature of
Role Plan administrator
Date 2022-07-11
Name of individual signing KELLY MCDOWELL
Valid signature Filed with authorized/valid electronic signature
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2020 201240476 2021-09-01 TRACY S. FANSLER, M.D., LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 13577 74TH AVENUE, SEMINOLE, FL, 33776
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2019 201240476 2020-10-14 TRACY S. FANSLER, M.D., LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 13577 74TH AVENUE, SEMINOLE, FL, 33776
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2018 201240476 2019-10-14 TRACY S. FANSLER, M.D., LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 13577 74TH AVENUE, SEMINOLE, FL, 33776
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2017 201240476 2018-10-03 TRACY S. FANSLER, M.D., LLC 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 13577 74TH AVENUE, SEMINOLE, FL, 33776
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2016 201240476 2017-11-03 TRACY S. FANSLER, M.D., LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 13577 74TH AVENUE, SEMINOLE, FL, 33776

Signature of
Role Plan administrator
Date 2017-11-03
Name of individual signing TRACY FANSLER
Valid signature Filed with authorized/valid electronic signature
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2015 201240476 2016-09-09 TRACY S. FANSLER, M.D., LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 13577 74TH AVENUE, SEMINOLE, FL, 33776

Signature of
Role Plan administrator
Date 2016-09-09
Name of individual signing TRACY FANSLER
Valid signature Filed with authorized/valid electronic signature
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2014 201240476 2015-10-15 TRACY S. FANSLER, M.D., LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 13577 74TH AVENUE, SEMINOLE, FL, 33776

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing TRACY FANSLER
Valid signature Filed with authorized/valid electronic signature
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2013 201240476 2014-10-15 TRACY S. FANSLER, M.D., LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 12955 SEMINOLE BOULEVARD, LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2014-10-15
Name of individual signing TRACY FANSLER
Valid signature Filed with authorized/valid electronic signature
TRACY S. FANSLER, M.D., LLC 401(K) PLAN 2012 201240476 2013-10-15 TRACY S. FANSLER, M.D., LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 7275849500
Plan sponsor’s address 12955 SEMINOLE BOULEVARD, LARGO, FL, 33778

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing TRACY FANSLER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CANIANO JIM S Agent 2700 EAST BAY DR., LARGO, FL, 33771

Manager

Name Role Address
FANSLER TRACY SM.D. Manager 12955 SEMINOLE BLVD, SEMINOLE, FL, 33776

President

Name Role Address
FANSLER TRACY SM.D. President 12955 SEMINOLE BLVD, SEMINOLE, FL, 33776

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2017-09-22 No data No data
CHANGE OF MAILING ADDRESS 2015-05-01 12955 SEMINOLE BLVD, LARGO, FL 33778 No data
REINSTATEMENT 2014-05-13 No data No data
REGISTERED AGENT NAME CHANGED 2014-05-06 CANIANO, JIM S No data
REGISTERED AGENT ADDRESS CHANGED 2014-05-06 2700 EAST BAY DR., LARGO, FL 33771 No data
PENDING REINSTATEMENT 2014-04-25 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2010-09-24 No data No data
CHANGE OF PRINCIPAL ADDRESS 2009-05-07 12955 SEMINOLE BLVD, LARGO, FL 33778 No data

Documents

Name Date
ANNUAL REPORT 2016-05-02
ANNUAL REPORT 2015-05-01
Reinstatement 2014-05-13
ANNUAL REPORT 2009-05-07
ANNUAL REPORT 2008-05-01
ANNUAL REPORT 2007-03-25
ANNUAL REPORT 2006-04-20
ANNUAL REPORT 2005-05-01
Florida Limited Liabilites 2004-06-14

Related by officers

No related officers

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Date of last update: 03 Feb 2025

Sources: Florida Department of State

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