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  5. ADVANTACARE MULTI-SPECIALTY GROUP, LLC

ADVANTACARE MULTI-SPECIALTY GROUP, LLC

Company Details

Entity Name: ADVANTACARE MULTI-SPECIALTY GROUP, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 21 Dec 2015 (9 years ago)
Last Event: LC STMNT OF RA/RO CHG
Event Date Filed: 23 Aug 2021 (3 years ago)
Document Number: L15000210475
FEI/EIN Number 81-0920909
Address: 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701, US
Mail Address: 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701, US
ZIP code: 32701
County: Seminole
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1043674187 2016-04-05 2016-04-05 697 MAITLAND AVE, SUITE 1001, ALTAMONTE SPRINGS, FL, 327016821, US 9 PINE CONE DR, SUITE 104A, PALM COAST, FL, 321378686, US

Contacts
Phone +1 407-539-2111
Fax 4075391211

Authorized person
Name KERRI HERZOG
Role MEMBER
Phone 4075392111

Taxonomy
Taxonomy Code 208100000X - Physical Medicine & Rehabilitation Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ADVANTACARE MULTI-SPECIALTY GROUP, LLC 401(K) PROFIT SHARING PLAN 2023 810920909 2024-04-22 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2024-04-22
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-04-22
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
ADVANTACARE MULTI- SPECIALTY GROUP, LLC CASH BALANCE PLAN 2023 810920909 2024-04-22 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 40
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2024-04-22
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-04-22
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
ADVANTACARE MULTI-SPECIALTY GROUP, LLC 401(K) PROFIT SHARING PLAN 2022 810920909 2023-07-06 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 51
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2023-07-06
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-06
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
ADVANTACARE MULTI- SPECIALTY GROUP, LLC CASH BALANCE PLAN 2022 810920909 2023-07-05 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 43
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2023-07-05
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-05
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
ADVANTACARE MULTI-SPECIALTY GROUP, LLC 401(K) PROFIT SHARING PLAN 2021 810920909 2022-07-13 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2022-07-13
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-13
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
ADVANTACARE MULTI- SPECIALTY GROUP, LLC CASH BALANCE PLAN 2021 810920909 2022-07-13 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 61
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2022-07-13
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-13
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
ADVANTACARE MULTI-SPECIALTY GROUP, LLC 401(K) PROFIT SHARING PLAN 2020 810920909 2021-09-29 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 92
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2021-09-29
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-09-29
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
ADVANTACARE MULTI- SPECIALTY GROUP, LLC CASH BALANCE PLAN 2020 810920909 2021-09-23 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 64
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2021-09-23
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-09-23
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
ADVANTACARE MULTI- SPECIALTY GROUP, LLC CASH BALANCE PLAN 2019 810920909 2020-10-09 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 65
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2020-10-09
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-10-09
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
ADVANTACARE MULTI-SPECIALTY GROUP, LLC 401(K) PROFIT SHARING PLAN 2019 810920909 2020-09-30 ADVANTACARE MULTI-SPECIALTY GROUP, LLC 86
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4075392111
Plan sponsor’s address 697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701

Signature of
Role Plan administrator
Date 2020-09-30
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-09-30
Name of individual signing KERRIANN FITZPATRICK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BARR CHAD AESQ Agent 238 N WESTMONTE DR, ALTAMONTE SPRINGS, FL, 32714

Manager

Name Role Address
MANCUSO JOHN Manager 697 Maitland Ave, Altamonte Springs, FL, 32701

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000127871 ADVANTACARE ACTIVE 2022-10-12 2027-12-31 No data 697 MAITLAND AVENUE, ALTAMONTE SPRINGS, FL, 32701
G16000058334 ADVANTACARE EXPIRED 2016-06-14 2021-12-31 No data 697 MAITLAND AVENUE, ALTAMONTE SPRINGS, FL, 32701

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-12-12 697 MAITLAND AVE, Suite 1001, ALTAMONTE SPRINGS, FL 32701 No data
CHANGE OF PRINCIPAL ADDRESS 2024-12-12 697 MAITLAND AVE, Suite 1001, ALTAMONTE SPRINGS, FL 32701 No data
LC STMNT OF RA/RO CHG 2021-08-23 No data No data
REGISTERED AGENT NAME CHANGED 2021-08-23 BARR, CHAD A, ESQ No data
REGISTERED AGENT ADDRESS CHANGED 2021-08-23 238 N WESTMONTE DR, STE 200, ALTAMONTE SPRINGS, FL 32714 No data

Documents

Name Date
AMENDED ANNUAL REPORT 2024-12-12
ANNUAL REPORT 2024-04-08
ANNUAL REPORT 2023-04-17
ANNUAL REPORT 2022-04-05
CORLCRACHG 2021-08-23
ANNUAL REPORT 2021-03-26
ANNUAL REPORT 2020-05-04
ANNUAL REPORT 2019-04-29
ANNUAL REPORT 2018-04-18
ANNUAL REPORT 2017-04-15

Related by officers

MANCUSO JOHN

FLORIDA PRIME HOLDINGS, LLC KKJ CONSULTING SERVICES, LLC JAT FOOD, LLC MANCUSO TRUCKING, LLC ALTAMONTE SPRINGS IMAGING, L.C. EDGWATER COMMITTEE FOR RESPONSIBLE DEVELOPMENT, INC. MEDICAL CLINICS, INC.

Related by address

697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701, US

ADVANTACARE MEDICAL ASSOCIATES, LLC

697 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 32701, US

ADVANTACARE MEDICAL ASSOCIATES, LLC

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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