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  5. ENDOSCOPY CENTER OF GULF BREEZE, LLC

ENDOSCOPY CENTER OF GULF BREEZE, LLC

Company Details

Entity Name: ENDOSCOPY CENTER OF GULF BREEZE, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Company
Status: Inactive
Date Filed: 28 Jun 2005 (20 years ago)
Date of dissolution: 26 Sep 2014 (10 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 26 Sep 2014 (10 years ago)
Document Number: L05000064061
FEI/EIN Number 43-2086670
Address: 1116 GULF BREEZE PKWY, GULF BREEZE, FL 32561
Mail Address: 4828 NORTH DAVIS HIGHWAY, PENSACOLA, FL 32503
ZIP code: 32561
County: Santa Rosa
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1386730950 2006-10-04 2008-04-20 1116 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32561, US 1116 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32561, US

Contacts
Phone +1 850-934-4438
Fax 8509344211

Authorized person
Name MRS. ALICE L CARTEE
Role ADMINISTRATOR
Phone 8504748988

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

Other Provider Identifiers
Issuer AETNA
Number 7956778
Issuer CIGNA
Number 9256246
Issuer USA HEALTH NETWORK
Number 987294
Issuer BCBS OF FLORIDA
Number 6M1
State FL
Issuer RAILROAD MEDICARE
Number P00326955
Issuer HEALTH OPTIONS
Number 6M1

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ENDOSCOPY CENTER OF GULF BREEZE, LLC 401(K) PROFIT SHARING PLAN 2012 432086670 2014-01-03 ENDOSCOPY CENTER OF GULF BREEZE, LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621900
Sponsor’s telephone number 8504778109
Plan sponsor’s address 1116 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32561

Signature of
Role Plan administrator
Date 2014-01-03
Name of individual signing STEVE DUNN
Valid signature Filed with authorized/valid electronic signature
ENDOSCOPY CENTER OF GULF BREEZE, LLC 401(K) PROFIT SHARING PLAN 2011 432086670 2013-05-03 ENDOSCOPY CENTER OF GULF BREEZE, LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621900
Sponsor’s telephone number 8504778109
Plan sponsor’s address 1116 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32561

Plan administrator’s name and address
Administrator’s EIN 432086670
Plan administrator’s name ENDOSCOPY CENTER OF GULF BREEZE, LLC
Plan administrator’s address 1116 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32561
Administrator’s telephone number 8504778109

Signature of
Role Plan administrator
Date 2013-05-03
Name of individual signing STEVE DUNN
Valid signature Filed with authorized/valid electronic signature
ENDOSCOPY CENTER OF GULF BREEZE, LLC 401(K) PROFIT SHARING PLAN 2010 432086670 2012-04-30 ENDOSCOPY CENTER OF GULF BREEZE, LLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621900
Sponsor’s telephone number 8504778109
Plan sponsor’s address 1116 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32561

Plan administrator’s name and address
Administrator’s EIN 432086670
Plan administrator’s name ENDOSCOPY CENTER OF GULF BREEZE, LL
Plan administrator’s address 1116 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32561
Administrator’s telephone number 8504778109

Signature of
Role Plan administrator
Date 2012-04-30
Name of individual signing STEVE DUNN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-04-30
Name of individual signing STEVE DUNN
Valid signature Filed with authorized/valid electronic signature
ENDOSCOPY CENTER OF GULF BREEZE, LLC 401(K) PROFIT SHARING PLAN 2009 432086670 2011-04-04 ENDOSCOPY CENTER OF GULF BREEZE, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621900
Sponsor’s telephone number 8504778109
Plan sponsor’s address 1116 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32561

Plan administrator’s name and address
Administrator’s EIN 432086670
Plan administrator’s name ENDOSCOPY CENTER OF GULF BREEZE, LL
Plan administrator’s address 1116 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32561
Administrator’s telephone number 8504778109

Signature of
Role Plan administrator
Date 2011-04-04
Name of individual signing STEVE DUNN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-04-04
Name of individual signing STEVE DUNN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Dunn, Steve Agent 4810 NORTH DAVIS HIGHWAY, PENSACOLA, FL 32503

Manager

Name Role Address
SPEER, CARL Manager 4810 N DAVIS HWY, PENSACOLA, FL 32503
HARRIMAN, ROBERT Manager 100 W MORENO, PENSACOLA, FL 32501
CARTEE, WAYNE Manager 4810 N DAVIS HWY, PENSACOLA, FL 32503
PORTER, JOHN Manager 1000 W MORENO, PENSACOLA, FL 32501

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 No data No data
REGISTERED AGENT NAME CHANGED 2013-03-15 Dunn, Steve No data
CHANGE OF MAILING ADDRESS 2010-02-16 1116 GULF BREEZE PKWY, GULF BREEZE, FL 32561 No data
CHANGE OF PRINCIPAL ADDRESS 2009-04-03 1116 GULF BREEZE PKWY, GULF BREEZE, FL 32561 No data

Documents

Name Date
ANNUAL REPORT 2013-03-15
ANNUAL REPORT 2012-01-06
ANNUAL REPORT 2011-01-04
ANNUAL REPORT 2010-02-16
ANNUAL REPORT 2009-04-03
ANNUAL REPORT 2008-01-14
ANNUAL REPORT 2007-03-22
ANNUAL REPORT 2006-03-22
Florida Limited Liabilites 2005-06-28

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Dunn, Steve

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CARTEE, WAYNE

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PORTER, JOHN

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Related by address

No related companies by address

Date of last update: 04 Jan 2025

Sources: Florida Department of State

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