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  5. ANCIENT CITY PEDIATRICS, LLC

ANCIENT CITY PEDIATRICS, LLC - Florida Company Profile

Company Details

Entity Name: ANCIENT CITY PEDIATRICS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

ANCIENT CITY PEDIATRICS, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 26 Oct 2005 (19 years ago)
Last Event: AMENDMENT
Event Date Filed: 19 Dec 2005 (19 years ago)
Document Number: L05000105126
FEI/EIN Number 593544464

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL, 32080
Mail Address: 1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL, 32080
ZIP code: 32080
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1053598292 2008-01-30 2024-10-23 1301 PLANTATION ISLAND DR S STE 104, SAINT AUGUSTINE, FL, 320803108, US 1301 PLANTATION ISLAND DR S STE 104, SAINT AUGUSTINE, FL, 320803108, US

Contacts
Phone +1 904-461-1560
Fax 9044614304

Authorized person
Name ADRIENNE MCCOY
Role OFFICE MANAGER
Phone 9044611560

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2023 592951584 2024-07-16 ANCIENT CITY PEDIATRICS 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2022 592951584 2023-06-20 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2023-06-20
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2021 592951584 2022-05-31 ANCIENT CITY PEDIATRICS 15
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2022-05-31
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2020 592951584 2021-07-15 ANCIENT CITY PEDIATRICS 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2019 592951584 2020-03-24 ANCIENT CITY PEDIATRICS 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2020-03-24
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2018 592951584 2019-05-14 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2019-05-14
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2017 592951584 2018-07-26 ANCIENT CITY PEDIATRICS 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2018-07-26
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2016 592951584 2017-07-25 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2017-07-25
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-25
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2015 592951584 2016-09-07 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE S, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2016-09-07
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-07
Name of individual signing MIGUEL A. MAS, JR.
Valid signature Filed with authorized/valid electronic signature
ANCIENT CITY PEDIATRICS 401(K) PROFIT SHARING PLAN 2014 592951584 2015-07-29 ANCIENT CITY PEDIATRICS 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 9044611560
Plan sponsor’s address 1301 PLANTATION ISLAND DRIVE, SUITE 404, ST. AUGUSTINE, FL, 32080

Signature of
Role Plan administrator
Date 2015-07-29
Name of individual signing MIGUEL MAS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-29
Name of individual signing MIGUEL MAS
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
MCLEOD ROBERT L Agent 1200 PLANTATION ISLAND DRIVE SOUTH, ST. AUGUSTINE, FL, 32080
MAS MIGUEL A Managing Member 1301 PLANTATION ISLAND DRIVE SOUTH, #404, ST. AUGUSTINE, FL, 32084

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2010-02-15 1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL 32080 -
AMENDMENT 2005-12-19 - -

Documents

Name Date
ANNUAL REPORT 2024-03-18
ANNUAL REPORT 2023-02-23
ANNUAL REPORT 2022-03-12
ANNUAL REPORT 2021-03-13
ANNUAL REPORT 2020-03-19
ANNUAL REPORT 2019-03-13
ANNUAL REPORT 2018-03-12
ANNUAL REPORT 2017-02-03
ANNUAL REPORT 2016-02-29
ANNUAL REPORT 2015-02-22

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8915538600 2021-03-25 0491 PPS 1301 Plantation Island Dr S Ste 404, St Augustine, FL, 32080-3118
Loan Status Date 2022-03-10
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 156500
Loan Approval Amount (current) 156500
Undisbursed Amount 0
Franchise Name -
Lender Location ID 51009
Servicing Lender Name First-Citizens Bank & Trust Company
Servicing Lender Address 100 E. Tryon Rd DAC - 90, Raleigh, NC, 27603-3581
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address St Augustine, SAINT JOHNS, FL, 32080-3118
Project Congressional District FL-05
Number of Employees 15
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 51009
Originating Lender Name First-Citizens Bank & Trust Company
Originating Lender Address Raleigh, NC
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 157846.33
Forgiveness Paid Date 2022-02-08
1674697406 2020-05-04 0491 PPP 1301 PLANTATION ISLAND DR S STE 404, ST AUGUSTINE, FL, 32080
Loan Status Date 2021-05-14
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 123800
Loan Approval Amount (current) 123800
Undisbursed Amount 0
Franchise Name -
Lender Location ID 51009
Servicing Lender Name First-Citizens Bank & Trust Company
Servicing Lender Address 100 E. Tryon Rd DAC - 90, Raleigh, NC, 27603-3581
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description New Business or 2 years or less
Project Address ST AUGUSTINE, SAINT JOHNS, FL, 32080-0001
Project Congressional District FL-05
Number of Employees 17
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 51009
Originating Lender Name First-Citizens Bank & Trust Company
Originating Lender Address Raleigh, NC
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 124922.68
Forgiveness Paid Date 2021-04-08

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MAS MIGUEL A

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Companies related by address

1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL, 32080

HEMANT K. BHARGAVA, M.D., P.A.

1301 PLANTATION ISLAND DRIVE SOUTH, SUITE 404, ST. AUGUSTINE, FL, 32080

HEMANT K. BHARGAVA, M.D., P.A.

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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