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  5. LEGACY FAMILY MEDICINE, LLC

LEGACY FAMILY MEDICINE, LLC

Company Details

Entity Name: LEGACY FAMILY MEDICINE, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 23 Oct 2009 (15 years ago)
Document Number: L09000102557
FEI/EIN Number 271442936
Address: 11602 LAKE UNDERHILL ROAD, ORLANDO, FL, 32825, US
Mail Address: 11602 LAKE UNDERHILL ROAD, STE 119, ORLANDO, FL, 32825, US
ZIP code: 32825
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1477878940 2010-03-29 2015-01-20 11602 LAKE UNDERHILL RD, SUITE 119, ORLANDO, FL, 328254458, US 11602 LAKE UNDERHILL RD STE 119, ORLANDO, FL, 328254460, US

Contacts
Phone +1 407-781-1000
Fax 4077811001

Authorized person
Name PHILIP T HARDY
Role PHYSICIAN/OWNER
Phone 4077811000

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LEGACY FAMILY MEDICINE LLC 401(K) PROFIT SHARING PLAN & TRUST 2023 271442936 2024-09-19 LEGACY FAMILY MEDICINE LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 4077811000
Plan sponsor’s address 11602 LAKE UNDERHILL RD., ORLANDO, FL, 32825

Signature of
Role Plan administrator
Date 2024-09-19
Name of individual signing LIZ HARDY
Valid signature Filed with authorized/valid electronic signature
LEGACY FAMILY MEDICINE LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 271442936 2023-09-26 LEGACY FAMILY MEDICINE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 4077811000
Plan sponsor’s address 11602 LAKE UNDERHILL RD., ORLANDO, FL, 32825

Signature of
Role Plan administrator
Date 2023-09-26
Name of individual signing LIZ HARDY
Valid signature Filed with authorized/valid electronic signature
LEGACY FAMILY MEDICINE LLC 401(K) PROFIT SHARING PLAN & TRUST 2021 271442936 2022-04-04 LEGACY FAMILY MEDICINE LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 4077811000
Plan sponsor’s address 11602 LAKE UNDERHILL RD., ORLANDO, FL, 32825

Signature of
Role Plan administrator
Date 2022-04-04
Name of individual signing LIZ HARDY
Valid signature Filed with authorized/valid electronic signature
LEGACY FAMILY MEDICINE LLC 401(K) PROFIT SHARING PLAN & TRUST 2020 271442936 2021-12-14 LEGACY FAMILY MEDICINE LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 4077811000
Plan sponsor’s address 11602 LAKE UNDERHILL RD., ORLANDO, FL, 32825

Signature of
Role Plan administrator
Date 2021-12-14
Name of individual signing LIZ HARDU
Valid signature Filed with authorized/valid electronic signature
LEGACY FAMILY MEDICINE LLC 401(K) PROFIT SHARING PLAN & TRUST 2019 271442936 2020-09-11 LEGACY FAMILY MEDICINE LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 4077811000
Plan sponsor’s address 11602 LAKE UNDERHILL RD., ORLANDO, FL, 32825

Signature of
Role Plan administrator
Date 2020-09-11
Name of individual signing LIZ HARDY
Valid signature Filed with authorized/valid electronic signature
LEGACY FAMILY MEDICINE LLC 401 K PROFIT SHARING PLAN TRUST 2018 271442936 2019-10-09 LEGACY FAMILY MEDICINE LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 4077811000
Plan sponsor’s address 11602 LAKE UNDERHILL RD., ORLANDO, FL, 32825

Signature of
Role Plan administrator
Date 2019-10-09
Name of individual signing LIZ HARDY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KATHRYN V ROSS CPA PA Agent 3823 N. ECONLOCKHATCHEE TRL,, ORLANDO, FL, 32817

Managing Member

Name Role Address
HARDY PHILIP T Managing Member 11602 LAKE UNDERHILL ROAD, ORLANDO, FL, 32825

Chief Financial Officer

Name Role Address
Hardy Liz Chief Financial Officer 11602 LAKE UNDERHILL ROAD, ORLANDO, FL, 32825

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2022-02-08 11602 LAKE UNDERHILL ROAD, STE 118-119, ORLANDO, FL 32825 No data
REGISTERED AGENT NAME CHANGED 2011-03-09 KATHRYN V ROSS CPA PA No data
REGISTERED AGENT ADDRESS CHANGED 2011-03-09 3823 N. ECONLOCKHATCHEE TRL,, STE D-5, ORLANDO, FL 32817 No data

Documents

Name Date
ANNUAL REPORT 2024-01-29
ANNUAL REPORT 2023-01-11
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-01-12
ANNUAL REPORT 2020-06-09
ANNUAL REPORT 2019-04-25
ANNUAL REPORT 2018-04-19
ANNUAL REPORT 2017-04-26
ANNUAL REPORT 2016-04-25
ANNUAL REPORT 2015-04-22

Related by officers

HARDY PHILIP T

PHILIP T. HARDY, MD, P.A. HARDY HEALTH, LLC BLUE CLOUD CBD INC. IVAPORATE, INC

Hardy Liz

PHILIP T. HARDY, MD, P.A. GREEN DRAGON PROPERTIES, LLC HARDY HEALTH, LLC BLUE CLOUD CBD INC.

Related by address

11602 LAKE UNDERHILL ROAD, ORLANDO, FL, 32825, US

DANZFORCE EXTREME, INC.

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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