| Entity Name: | SURGERY CENTER OF MOUNT DORA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Apr 2008 (17 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 22 Nov 2019 (5 years ago) |
| Document Number: | L08000038207 |
| FEI/EIN Number | 262446297 |
| Address: | 3710 LAKE CENTER DR, MOUNT DORA, FL, 32757, US |
| Mail Address: | 3710 LAKE CENTER DR, MOUNT DORA, FL, 32757, US |
| ZIP code: | 32757 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164656740 | 2009-05-11 | 2014-12-02 | 3710 LAKE CENTER DR., MOUNT DORA, FL, 32757, US | 3710 LAKE CENTER DR., MOUNT DORA, FL, 32757, US | |||||||||||||||
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| Phone | +1 352-383-1268 |
| Fax | 3523853199 |
Authorized person
| Name | MR. JUAN USON |
| Role | ADMINISTRATOR |
| Phone | 3523831268 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
| CIK number | Mailing Address | Business Address | Phone | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457921 | 4 WESTBROOK CORPORATE CENTER, SUITE 440, WESTCHESTER, IL, 60154 | 4 WESTBROOK CORPORATE CENTER, SUITE 440, WESTCHESTER, IL, 60154 | No data | |||||||||
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| Form type | REGDEX |
| File number | 021-127500 |
| Filing date | 2009-02-26 |
| File | View File |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SURGERY CENTER OF MOUNT DORA 401(K) PLAN | 2012 | 262446297 | 2013-12-16 | SURGERY CENTER OF MOUNT DORA | 22 | |||||||||||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2013-12-16 |
| Name of individual signing | SHIRLEY THOMAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-07-01 |
| Business code | 621493 |
| Sponsor’s telephone number | 3523831268 |
| Plan sponsor’s address | 3710 LAKE CENTER DRIVE, MOUNT DORA, FL, 32750 |
Signature of
| Role | Plan administrator |
| Date | 2013-05-31 |
| Name of individual signing | SHIRLEY THOMAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-07-01 |
| Business code | 621493 |
| Sponsor’s telephone number | 3523831268 |
| Plan sponsor’s address | 3710 LAKE CENTER DRIVE, MOUNT DORA, FL, 32750 |
Plan administrator’s name and address
| Administrator’s EIN | 262446297 |
| Plan administrator’s name | SURGERY CENTER OF MOUNT DORA |
| Plan administrator’s address | 3710 LAKE CENTER DRIVE, MOUNT DORA, FL, 32750 |
| Administrator’s telephone number | 3523831268 |
Signature of
| Role | Plan administrator |
| Date | 2012-07-31 |
| Name of individual signing | SHIRLEY THOMAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2012-07-31 |
| Name of individual signing | SHIRLEY THOMAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-07-01 |
| Business code | 621493 |
| Sponsor’s telephone number | 3523831268 |
| Plan sponsor’s address | 3710 LAKE CENTER DRIVE, MOUNT DORA, FL, 32750 |
Plan administrator’s name and address
| Administrator’s EIN | 262446297 |
| Plan administrator’s name | SURGERY CENTER OF MOUNT DORA |
| Plan administrator’s address | 3710 LAKE CENTER DRIVE, MOUNT DORA, FL, 32750 |
| Administrator’s telephone number | 3523831268 |
Signature of
| Role | Plan administrator |
| Date | 2011-09-21 |
| Name of individual signing | SHIRLEY THOMAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Coker Joey Jr. | Agent | 3710 LAKE CENTER DR, MOUNT DORA, FL, 32757 |
| Name | Role | Address |
|---|---|---|
| PRIMARY CARE ALLIANCE, LLC | Manager | No data |
| MANOOGIAN VREJ M | Manager | 1945 Bay Road, MOUNT DORA, FL, 32757 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-04-05 | Coker, Joey, Jr. | No data |
| LC STMNT OF RA/RO CHG | 2019-11-22 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2010-01-18 | 3710 LAKE CENTER DR, MOUNT DORA, FL 32757 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-08-27 | 3710 LAKE CENTER DR, MOUNT DORA, FL 32757 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-08-27 | 3710 LAKE CENTER DR, MOUNT DORA, FL 32757 | No data |
| LC AMENDMENT | 2008-04-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-04-05 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-01-20 |
| ANNUAL REPORT | 2020-04-17 |
| CORLCRACHG | 2019-11-22 |
| ANNUAL REPORT | 2019-01-07 |
| ANNUAL REPORT | 2018-04-03 |
| ANNUAL REPORT | 2017-01-23 |
| ANNUAL REPORT | 2016-04-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
