| Entity Name: | LAKE WOMEN FOR WOMEN OB/GYN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 05 Mar 2012 (13 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | L12000031486 |
| FEI/EIN Number | 800791827 |
| Address: | 2 NORTH EUSTIS STREET, EUSTIS, FL, 32726 |
| Mail Address: | 2 NORTH EUSTIS STREET, EUSTIS, FL, 32726 |
| ZIP code: | 32726 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043585169 | 2012-03-22 | 2012-03-22 | PO BOX 780, TAVARES, FL, 327780780, US | 2 N EUSTIS ST, EUSTIS, FL, 327263408, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 352-589-6005 |
| Fax | 3524840189 |
Authorized person
| Name | DR. MAMIE ROGERS |
| Role | OWNER |
| Phone | 3525896005 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE WOMEN FOR WOMEN OB-GYN LLC 401(K) PROFIT SHARING PLAN AND TRUST | 2015 | 800791827 | 2018-01-16 | LAKE WOMEN FOR WOMEN OB/GYN LLC | 6 | |||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2018-01-16 |
| Name of individual signing | MARILYN MAYNE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2018-01-16 |
| Name of individual signing | MARILYN MAYNE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| ROGERS MAMIE M | Agent | 2 NORTH EUSTIS STREET, EUSTIS, FL, 32726 |
| Name | Role | Address |
|---|---|---|
| ROGERS MAMIE M | Managing Member | 2 NORTH EUSTIS STREET, EUSTIS, FL, 32726 |
| MAYNE MARILYN D | Managing Member | 2 NORTH EUSTIS STREET, EUSTIS, FL, 32726 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| LC AMENDMENT | 2012-05-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-05-23 | 2 NORTH EUSTIS STREET, EUSTIS, FL 32726 | No data |
| CHANGE OF MAILING ADDRESS | 2012-05-23 | 2 NORTH EUSTIS STREET, EUSTIS, FL 32726 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-05-23 | ROGERS, MAMIE M.D. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-05-23 | 2 NORTH EUSTIS STREET, EUSTIS, FL 32726 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-02-12 |
| ANNUAL REPORT | 2014-02-18 |
| ANNUAL REPORT | 2013-03-13 |
| LC Amendment | 2012-05-23 |
| Florida Limited Liability | 2012-03-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
