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  5. BRETT A OSBORN, DO, PLLC

BRETT A OSBORN, DO, PLLC

Company Details

Entity Name: BRETT A OSBORN, DO, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 10 Oct 2014 (10 years ago)
Date of dissolution: 03 Mar 2021 (4 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 03 Mar 2021 (4 years ago)
Document Number: L14000158803
FEI/EIN Number 47-2884774
Address: 600 Heritage Drive, Jupiter, FL, 33458, US
Mail Address: 600 Heritage Drive, Jupiter, FL, 33458, US
ZIP code: 33458
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1316334840 2015-04-22 2015-07-16 600 HERITAGE DR, SUITE 105, JUPITER, FL, 334583000, US 600 HERITAGE DR, SUITE 105, JUPITER, FL, 334583000, US

Contacts
Phone +1 561-935-9233
Fax 5613549314

Authorized person
Name DR. BRETT A OSBORN
Role OWNER/PHYSICIAN
Phone 5619359233

Taxonomy
Taxonomy Code 207T00000X - Neurological Surgery Physician
License Number OS8838
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BRETT A OSBORN, DO, PLLC 2019 472884774 2020-08-24 BRETT A OSBORN, DO, PLLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-06-01
Business code 621111
Sponsor’s telephone number 9542491867
Plan sponsor’s address 601 HERITAGE DRIVE SUITE 105, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2020-08-24
Name of individual signing BRETT OSBORN
Valid signature Filed with authorized/valid electronic signature
BRETT A. OSBORN, DO, PLLC CASH BALANCE PLAN 2018 472884774 2019-10-11 BRETT A. OSBORN, DO, PLLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 5619359233
Plan sponsor’s address 600 HERITAGE DRIVE SUITE 105, JUPITER, FL, 33458
BRETT A OSBORN, DO, PLLC 2018 472884774 2019-06-15 BRETT A OSBORN, DO, PLLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-06-01
Business code 621111
Sponsor’s telephone number 9542491867
Plan sponsor’s address 601 HERITAGE DRIVE SUITE 105, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2019-06-15
Name of individual signing BRETT OSBORN
Valid signature Filed with authorized/valid electronic signature
BRETT A OSBORN, DO, PLLC 2017 472884774 2018-07-23 BRETT A OSBORN, DO, PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-06-01
Business code 621111
Sponsor’s telephone number 9542491867
Plan sponsor’s address 601 HERITAGE DRIVE SUITE 105, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2018-07-23
Name of individual signing BRETT OSBORN
Valid signature Filed with authorized/valid electronic signature
BRETT A OSBORN, DO, PLLC 2016 472884774 2017-09-05 BRETT A OSBORN, DO, PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-06-01
Business code 621111
Sponsor’s telephone number 9542491867
Plan sponsor’s address 601 HERITAGE DRIVE SUITE 105, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2017-09-05
Name of individual signing BRETT OSBORN
Valid signature Filed with authorized/valid electronic signature
BRETT A OSBORN, DO, PLLC 2015 472884774 2018-10-08 BRETT A OSBORN, DO, PLLC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-06-01
Business code 621111
Sponsor’s telephone number 9542491867
Plan sponsor’s address 601 HERITAGE DRIVE SUITE 105, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2018-10-08
Name of individual signing BRETT OSBORN
Valid signature Filed with authorized/valid electronic signature
BRETT A OSBORN, DO, PLLC 2015 472884774 2018-08-24 BRETT A OSBORN, DO, PLLC 1
Three-digit plan number (PN) 001
Effective date of plan 2015-06-01
Business code 621111
Sponsor’s telephone number 9542491867
Plan sponsor’s address 601 HERITAGE DRIVE SUITE 105, JUPITER, FL, 33458

Signature of
Role Plan administrator
Date 2018-08-24
Name of individual signing ELIZABETH GINORI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
UNITED STATES CORPORATION AGENTS, INC. Agent

Authorized Member

Name Role Address
OSBORN BRETT ADAM Authorized Member 8716 WENDY LANE EAST, WEST PALM BEACH, FL, 33411

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2023-02-03 476 RIVERSIDE AVE., JACKSONVILLE, FL 32202 No data
VOLUNTARY DISSOLUTION 2021-03-03 No data No data
CHANGE OF PRINCIPAL ADDRESS 2015-02-26 600 Heritage Drive, Suite 105, Jupiter, FL 33458 No data
CHANGE OF MAILING ADDRESS 2015-02-26 600 Heritage Drive, Suite 105, Jupiter, FL 33458 No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2021-03-03
ANNUAL REPORT 2020-04-07
ANNUAL REPORT 2019-02-10
ANNUAL REPORT 2018-01-14
ANNUAL REPORT 2017-02-12
ANNUAL REPORT 2016-04-19
ANNUAL REPORT 2015-02-26
Florida Limited Liability 2014-10-10

Related by officers

OSBORN BRETT ADAM

SERIOUS INDUSTRY, LLC

Related by address

600 Heritage Drive, Jupiter, FL, 33458, US

HEALTHY LIVING SFL, LLC

600 Heritage Drive, Jupiter, FL, 33458, US

HEALTHY LIVING SFL, LLC

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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