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  5. GENESIS FAMILY PRACTICE LLC

GENESIS FAMILY PRACTICE LLC - Florida Company Profile

Company Details

Entity Name: GENESIS FAMILY PRACTICE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

GENESIS FAMILY PRACTICE 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: 24 Sep 2012 (13 years ago)
Document Number: L12000121864
FEI/EIN Number 46-1045369

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 1133 SAXON BLVD, ORANGE CITY, FL, 32763
Mail Address: 1133 SAXON BLVD, ORANGE CITY, FL, 32763
ZIP code: 32763
County: Volusia
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1447799242 2017-02-14 2022-11-28 1133 SAXON BLVD, STE 200, ORANGE CITY, FL, 327638425, US 800 S NOVA RD, SUITE I, ORMOND BEACH, FL, 321749048, US

Contacts
Phone +1 386-218-2353
Fax 3862289701
Phone +1 386-676-9300
Fax 3866769050

Authorized person
Name JAY C CHANMUGAM
Role OWNER
Phone 3862182353

Taxonomy
Taxonomy Code 208D00000X - General Practice Physician
License Number OS8600
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GENESIS FAMILY PRACTICE, LLC 401(K) PS PLAN 2019 461045369 2020-08-20 GENESIS FAMILY PRACTICE, LLC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 4073147539
Plan sponsor’s address 1133 SAXON BOULEVARD, SUITE 100, ORANGE CITY, FL, 327638425

Signature of
Role Plan administrator
Date 2020-08-20
Name of individual signing ANGELA M MYERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-08-20
Name of individual signing ANGELA M MYERS
Valid signature Filed with authorized/valid electronic signature
GENESIS FAMILY PRACTICE, LLC 401(K) PS PLAN 2018 461045369 2019-10-14 GENESIS FAMILY PRACTICE, LLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 4073147539
Plan sponsor’s address 1133 SAXON BOULEVARD, SUITE 100, ORANGE CITY, FL, 327638425

Signature of
Role Plan administrator
Date 2019-10-14
Name of individual signing ANGELA MYERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-14
Name of individual signing ANGELA MYERS
Valid signature Filed with authorized/valid electronic signature
GENESIS FAMILY PRACTICE, LLC 401(K) PROFIT SHARING PLAN 2017 461045369 2018-09-28 GENESIS FAMILY PRACTICE, LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3867479097
Plan sponsor’s address 1133 SAXON BLVD, SUITE 100, ORANGE CITY, FL, 327638425

Signature of
Role Plan administrator
Date 2018-09-28
Name of individual signing JAY CHANMUGAM
Valid signature Filed with authorized/valid electronic signature
GENESIS FAMILY PRACTICE, LLC 401(K) PROFIT SHARING PLAN 2016 461045369 2018-10-12 GENESIS FAMILY PRACTICE, LLC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3867479097
Plan sponsor’s address 1133 SAXON BLVD, SUITE 100, ORANGE CITY, FL, 327638425

Signature of
Role Plan administrator
Date 2018-10-12
Name of individual signing JAY CHANMUGAM
Valid signature Filed with authorized/valid electronic signature
GENESIS FAMILY PRACTICE, LLC 401(K) PROFIT SHARING PLAN 2016 461045369 2017-09-29 GENESIS FAMILY PRACTICE, LLC 1
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3867479097
Plan sponsor’s address 1133 SAXON BLVD, SUITE 100, ORANGE CITY, FL, 327638425

Signature of
Role Plan administrator
Date 2017-09-29
Name of individual signing JAY CHANMUGAM
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
CHANMUGAM JAY MGN 1133 SAXON BLVD, ORANGE CITY, FL, 32763
CHANMUGAM JAY Agent 1133 SAXON BLVD, ORANGE CITY, FL, 32763

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G15000051757 HOME DOC'S EXPIRED 2015-05-27 2020-12-31 - 1133 SAXON BLVD, STE 200, ORANGE CITY, FL, 32713

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2021-01-13 1133 SAXON BLVD, ORANGE CITY, FL 32763 -

Documents

Name Date
ANNUAL REPORT 2025-02-07
ANNUAL REPORT 2024-02-07
ANNUAL REPORT 2023-02-02
ANNUAL REPORT 2022-02-24
ANNUAL REPORT 2021-01-13
ANNUAL REPORT 2020-03-24
ANNUAL REPORT 2019-03-06
ANNUAL REPORT 2018-04-30
ANNUAL REPORT 2017-03-31
ANNUAL REPORT 2016-04-29

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2771007209 2020-04-16 0491 PPP 1133 Saxon Blvd,, orange city, FL, 32763-8425
Loan Status Date 2021-10-13
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 222500
Loan Approval Amount (current) 222500
Undisbursed Amount 0
Franchise Name -
Lender Location ID 2408
Servicing Lender Name Regions Bank
Servicing Lender Address 1900 Fifth Avenue North, BIRMINGHAM, AL, 35203
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address orange city, VOLUSIA, FL, 32763-8425
Project Congressional District FL-07
Number of Employees 15
NAICS code 621111
Borrower Race American Indian or Alaska Native
Borrower Ethnicity Not Hispanic or Latino
Business Type Limited Liability Company(LLC)
Originating Lender ID 2408
Originating Lender Name Regions Bank
Originating Lender Address BIRMINGHAM, AL
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 225584.52
Forgiveness Paid Date 2021-09-16

Companies related by officers

CHANMUGAM JAY

CJ MEDICAL SERVICES, LLC - Inactive
Florida Limited Liability Co. (2018 - 2019)
GENESIS GROUP OF FAMILY PRACTICES LLC - Active
Florida Limited Liability Co. (2017 )
GLOBAL HEALTH CARE SYSTEMS INC - Inactive
Domestic Non-Profit (2015 - 2018)
GLOBAL HEALTH CARE SYSTEMS INC - Inactive
Domestic Non-Profit (2015 - 2018)
C & J SAXON ENTERPRISES, INC. - Inactive
Domestic Profit (2013 - 2018)
C & J SAXON ENTERPRISES, INC. - Inactive
Domestic Profit (2013 - 2018)

Companies related by address

1133 SAXON BLVD, ORANGE CITY, FL, 32763

C & J SAXON ENTERPRISES, INC. EASON REALTY LLC DOC AT HOME LLC

1133 SAXON BLVD, ORANGE CITY, FL, 32763

C & J SAXON ENTERPRISES, INC. EASON REALTY LLC DOC AT HOME LLC

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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