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  5. ANDREWS INSTITUTE ASC, LLC

ANDREWS INSTITUTE ASC, LLC

Company Details

Entity Name: ANDREWS INSTITUTE ASC, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 18 Jan 2005 (20 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 12 Sep 2023 (a year ago)
Document Number: L05000005242
FEI/EIN Number 352274952
Address: 1040 GULF BREEZE PKWY, ATTN: Jessica Hill, GULF BREEZE, FL, 32561, US
Mail Address: 1040 Gulf Breeze Parkway, ATTN: Jessica Hill, Gulf Breeze, FL, 32561, US
ZIP code: 32561
County: Santa Rosa
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1104907328 2006-10-17 2020-08-22 1040 GULF BREEZE PARKWAY, SUITE 100, GULF BREEZE, FL, 32561, US 1040 GULF BREEZE PARKWAY, SUITE 100, GULF BREEZE, FL, 32561, US

Contacts
Phone +1 850-916-8500
Fax 8509168509

Authorized person
Name JOSEPH L STORY
Role CHAIRMAN OF BOARD OF MANAGERS
Phone 8504692338

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

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ANDREWS INSTITUTE ASC, INC. 401(K) PLAN 2023 352274952 2024-09-12 ANDREWS INSTITUTE ASC, LLC 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621493
Sponsor’s telephone number 8509168535
Plan sponsor’s address 1040 GULF BREEZE PKWY, STE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2024-09-12
Name of individual signing JESSICA HILL
Valid signature Filed with authorized/valid electronic signature
ANDREWS INSTITUTE ASC, INC. 401(K) PLAN 2023 352274952 2024-09-17 ANDREWS INSTITUTE ASC, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621493
Sponsor’s telephone number 8509168535
Plan sponsor’s address 1040 GULF BREEZE PKWY, STE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2024-09-17
Name of individual signing JESSICA HILL
Valid signature Filed with authorized/valid electronic signature
ANDREWS INSTITUTE ASC, 401(K) PLAN 2023 352274952 2024-10-14 ANDREWS INSTITUTE ASC, LLC 74
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2023-01-01
Business code 621493
Sponsor’s telephone number 4482279200
Plan sponsor’s address 1040 GULF BREEZE PARKWAY,, SUITE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2024-10-14
Name of individual signing JESSICA LAGE
Valid signature Filed with authorized/valid electronic signature
ANDREWS INSTITUTE ASC, INC. 401(K) PLAN 2022 352274952 2023-06-29 ANDREWS INSTITUTE ASC, LLC 89
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621493
Sponsor’s telephone number 8509168535
Plan sponsor’s address 1040 GULF BREEZE PKWY, STE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2023-06-29
Name of individual signing JESSICA HILL
Valid signature Filed with authorized/valid electronic signature
ANDREWS INSTITUTE ASC, INC. 401(K) PLAN 2021 352274952 2022-10-14 ANDREWS INSTITUTE ASC, LLC 77
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621493
Sponsor’s telephone number 8509168535
Plan sponsor’s address 1040 GULF BREEZE PKWY, STE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2022-10-14
Name of individual signing JESSICA HILL
Valid signature Filed with authorized/valid electronic signature
ANDREWS INSTITUTE ASC, INC. 401(K) PLAN 2020 352274952 2021-07-06 ANDREWS INSTITUTE ASC, LLC 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621493
Sponsor’s telephone number 8509168535
Plan sponsor’s address 1040 GULF BREEZE PKWY, STE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2021-07-06
Name of individual signing W. BENJAMIN PATTERSON, III
Valid signature Filed with authorized/valid electronic signature
ANDREWS INSTITUTE ASC, INC. 401(K) PLAN 2019 352274952 2020-12-03 ANDREWS INSTITUTE ASC, LLC 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621493
Sponsor’s telephone number 8509168535
Plan sponsor’s address 1040 GULF BREEZE PKWY, STE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2020-12-03
Name of individual signing W. BENJAMIN PATTERSON, III
Valid signature Filed with authorized/valid electronic signature
ANDREWS INSTITUTE ASC, INC. 401(K) PLAN 2018 352274952 2019-07-10 ANDREWS INSTITUTE ASC, LLC 71
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621493
Sponsor’s telephone number 8509168535
Plan sponsor’s address 1040 GULF BREEZE PKWY, STE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2019-07-10
Name of individual signing DEB STOCK
Valid signature Filed with authorized/valid electronic signature
ANDREWS INSTITUTE ASC, INC. 401(K) PLAN 2017 352274952 2018-07-17 ANDREWS INSTITUTE ASC, LLC 71
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621493
Sponsor’s telephone number 8509168535
Plan sponsor’s address 1040 GULF BREEZE PKWY, STE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2018-07-17
Name of individual signing DEB STOCK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-17
Name of individual signing DEB STOCK
Valid signature Filed with authorized/valid electronic signature
ANDREWS INSTITUTE ASC, INC. 401(K) PLAN 2016 352274952 2017-09-11 ANDREWS INSTITUTE ASC, LLC 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621493
Sponsor’s telephone number 8509168535
Plan sponsor’s address 1040 GULF BREEZE PKWY, STE 100, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2017-09-11
Name of individual signing DEB STOCK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
HILL JESSICA Agent 1040 GULF BREEZE PKWY STE 100, GULF BREEZE, FL, 32561

Member

Name Role Address
Jordan Steven Dr. Member 1040 Gulf Breeze Pkwy., Gulf Breeze, FL, 32561
Ostrander Roger Dr. Member 1040 Gulf Breeze Parkway, Gulf Breeze, FL, 32561
Aldridge Brett Member 1040 GULF BREEZE PKWY, GULF BREEZE, FL, 32561
Cardwell Julie Member 1040 Gulf Breeze Parkway, Gulf Breeze, FL, 32561

Chairman

Name Role Address
O'Grady Christopher Dr. Chairman 1040 Gulf Breeze Parkway, Gulf Breeze, FL, 32561

Treasurer

Name Role Address
Bookout Christopher Dr. Treasurer 1040 Gulf Breeze Parkway, Gulf Breeze, FL, 32561

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-02-06 1040 GULF BREEZE PKWY, ATTN: Jessica Hill, Suite 100, GULF BREEZE, FL 32561 No data
CHANGE OF MAILING ADDRESS 2024-02-06 1040 GULF BREEZE PKWY, ATTN: Jessica Hill, Suite 100, GULF BREEZE, FL 32561 No data
REGISTERED AGENT NAME CHANGED 2024-02-06 HILL, JESSICA No data
REGISTERED AGENT ADDRESS CHANGED 2024-02-06 1040 GULF BREEZE PKWY STE 100, GULF BREEZE, FL 32561 No data
LC AMENDMENT 2023-09-12 No data No data

Documents

Name Date
ANNUAL REPORT 2024-02-06
LC Amendment 2023-09-12
ANNUAL REPORT 2023-04-11
ANNUAL REPORT 2022-04-11
ANNUAL REPORT 2021-02-16
AMENDED ANNUAL REPORT 2020-06-16
ANNUAL REPORT 2020-03-17
ANNUAL REPORT 2019-03-11
ANNUAL REPORT 2018-03-14
ANNUAL REPORT 2017-04-24

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Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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