| Entity Name: | PRIMARY MEDICAL CENTER OF LAKELAND, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 30 Jun 2005 (20 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L05000065196 |
| FEI/EIN Number | 90-0928363 |
| Address: | 1417 LAKELAND HILLS BLVD, 106, LAKELAND, FL, 33805, US |
| Mail Address: | PO BOX 7550, LAKELAND, FL, 33807, US |
| ZIP code: | 33805 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780621607 | 2006-05-31 | 2016-11-08 | 1417 LAKELAND HILLS BLVD, SUITE #106, LAKELAND, FL, 338053200, US | 1417 LAKELAND HILLS BLVD, SUITE #106, LAKELAND, FL, 338053200, US | |||||||||||||||||||
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| Phone | +1 863-687-4575 |
| Fax | 8636161342 |
Authorized person
| Name | MARC A GUERRIER JR. |
| Role | MANAGER MEMBER |
| Phone | 8636874575 |
Taxonomy
| Taxonomy Code | 173000000X - Legal Medicine |
| License Number | ME27448 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PRIMARY MEDICAL CENTER OF LAKELAND LLC 401K PLAN | 2021 | 900928363 | 2022-09-07 | PRIMARY MEDICAL CENTER OF LAKELAND LLC | 3 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-09-07 |
| Name of individual signing | MARC GUERRIER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2013-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8636874575 |
| Plan sponsor’s address | 1417 LAKELAND HILLS BLVD, STE 106, LAKELAND, FL, 33805 |
Signature of
| Role | Plan administrator |
| Date | 2019-05-16 |
| Name of individual signing | RHEA SAUZ |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Guerrier Marc Dr. | Agent | 1417 LAKELAND HILLS BLVD, LAKELAND, FL, 33807 |
| Name | Role | Address |
|---|---|---|
| GUERRIER MARC A | Managing Member | 1417 LAKELAND HILLS BLVD, LAKELAND, FL, 33805 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000055481 | PRIMARY MEDICAL CENTER OF LAKELAND | EXPIRED | 2012-06-08 | 2017-12-31 | No data | P.O. BOX 5917, LAKELAND, FL, 33807 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-07 | 1417 LAKELAND HILLS BLVD, 106, LAKELAND, FL 33805 | No data |
| REINSTATEMENT | 2015-11-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-05-01 | 1417 LAKELAND HILLS BLVD, 106, LAKELAND, FL 33805 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-05-01 | 1417 LAKELAND HILLS BLVD, 106, LAKELAND, FL 33807 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-04-30 | Guerrier, Marc, Dr. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J21000380984 | TERMINATED | 1000000896285 | POLK | 2021-07-26 | 2031-07-28 | $ 1,213.95 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKELAND SERVICE CENTER, 115 S MISSOURI AVE STE 202, LAKELAND FL338154644 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-04-19 |
| ANNUAL REPORT | 2017-03-30 |
| ANNUAL REPORT | 2016-04-25 |
| REINSTATEMENT | 2015-11-11 |
| ANNUAL REPORT | 2014-05-01 |
| ANNUAL REPORT | 2013-04-30 |
| ANNUAL REPORT | 2012-03-21 |
| ANNUAL REPORT | 2011-04-29 |
| ANNUAL REPORT | 2010-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
