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  5. HARBOUR ISLAND PEDIATRICS, LLC

HARBOUR ISLAND PEDIATRICS, LLC

Company Details

Entity Name: HARBOUR ISLAND PEDIATRICS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 23 Jul 2010 (15 years ago)
Document Number: L10000077710
FEI/EIN Number 273153744
Address: 1301 PLANTATION ISLAND DR., 105B, ST. AUGUSTINE, FL, 32080, US
Mail Address: 1301 PLANTATION ISLAND DR., #105B, ST. AUGUSTINE, FL, 32080, US
ZIP code: 32080
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790086429 2010-11-11 2010-11-11 2250 CAVALRY BLVD, JACKSONVILLE, FL, 322464201, US 1301 PLANTATION ISLAND DR S, SUITE 106-B, ST AUGUSTINE, FL, 320803108, US

Contacts
Phone +1 904-282-6331
Fax 9042821550
Phone +1 904-461-8906
Fax 9044618907

Authorized person
Name DR. HOMERO VARELA SICANGCO JR.
Role PRESIDENT
Phone 9042826331

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
License Number ME71363
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HARBOUR ISLAND PEDIATRICS 401(K) PROFIT SHARING PLAN & TRUST 2023 273153744 2024-05-02 HARBOUR ISLAND PEDIATRICS 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S STE 105, SAINT AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2024-05-02
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature
HARBOUR ISLAND PEDIATRICS 401(K) PROFIT SHARING PLAN & TRUST 2022 273153744 2023-03-29 HARBOUR ISLAND PEDIATRICS 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S STE 105, SAINT AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2023-03-29
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature
HARBOUR ISLAND PEDIATRICS 401(K) PROFIT SHARING PLAN & TRUST 2021 273153744 2022-05-16 HARBOUR ISLAND PEDIATRICS 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S STE 105, SAINT AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2022-05-16
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature
HARBOUR ISLAND PEDIATRICS 401(K) PROFIT SHARING PLAN & TRUST 2020 273153744 2021-06-04 HARBOUR ISLAND PEDIATRICS 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S STE 105, SAINT AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2021-06-04
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature
HARBOUR ISLAND PEDIATRICS 401(K) PROFIT SHARING PLAN & TRUST 2019 273153744 2020-05-12 HARBOUR ISLAND PEDIATRICS 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S STE 105, SAINT AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2020-05-12
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature
HARBOUR ISLAND PEDIATRICS 401 K PROFIT SHARING PLAN TRUST 2018 273153744 2019-05-17 HARBOUR ISLAND PEDIATRICS 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S STE 105, SAINT AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2019-05-17
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature
HARBOUR ISLAND PEDIATRICS 401 K PROFIT SHARING PLAN TRUST 2017 273153744 2018-07-19 HARBOUR ISLAND PEDIATRICS 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S ST, SAINT AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2018-07-19
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature
HARBOUR ISLAND PEDIATRICS 401 K PROFIT SHARING PLAN TRUST 2016 273153744 2017-07-20 HARBOUR ISLAND PEDIATRICS 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S ST, SAINT AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2017-07-20
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature
HARBOUR ISLAND PEDIATRICS 401 K PROFIT SHARING PLAN TRUST 2015 273153744 2016-07-14 HARBOUR ISLAND PEDIATRICS 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S ST, SAINT AUGUSTINE, FL, 320803110

Signature of
Role Plan administrator
Date 2016-07-14
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature
HARBOUR ISLAND PEDIATRICS 401 K PROFIT SHARING PLAN TRUST 2014 273153744 2015-05-21 HARBOUR ISLAND PEDIATRICS 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 9044618906
Plan sponsor’s address 1301 PLANTATION ISLAND DR S. S, SUITE 105B, SAINT AUGUSTINE, FL, 320803108

Signature of
Role Plan administrator
Date 2015-05-21
Name of individual signing HOMERO SICANGCO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SICANGCO HOMERO J Agent 1301 PLANTATION ISLAND DR., ST. AUGUSTINE, FL, 32080

Manager

Name Role Address
SICANGCO HOMERO J Manager 1301 PLANTATION ISLAND DR.#105B, ST. AUGUSTINE, FL, 32080

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2016-03-02 1301 PLANTATION ISLAND DR., 105B, ST. AUGUSTINE, FL 32080 No data
CHANGE OF MAILING ADDRESS 2016-03-02 1301 PLANTATION ISLAND DR., 105B, ST. AUGUSTINE, FL 32080 No data
REGISTERED AGENT ADDRESS CHANGED 2016-03-02 1301 PLANTATION ISLAND DR., #105B, ST. AUGUSTINE, FL 32080 No data

Documents

Name Date
ANNUAL REPORT 2024-02-09
ANNUAL REPORT 2023-01-24
ANNUAL REPORT 2022-01-27
ANNUAL REPORT 2021-02-02
ANNUAL REPORT 2020-01-27
ANNUAL REPORT 2019-02-19
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-11
ANNUAL REPORT 2016-03-02
ANNUAL REPORT 2015-01-14

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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