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  5. IVY SPINE & ORTHOPEDICS, LLC

IVY SPINE & ORTHOPEDICS, LLC

Company Details

Entity Name: IVY SPINE & ORTHOPEDICS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 23 Dec 2016 (8 years ago)
Document Number: L16000231244
FEI/EIN Number 81-4772410
Address: 742 Harrison Avenue, Panama CIty, FL, 32401, US
Mail Address: 742 Harrison Avenue, Panama CIty, FL, 32401, US
ZIP code: 32401
County: Bay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1215534011 2020-10-05 2021-09-07 2532 CAPITAL MEDICAL BLVD, TALLAHASSEE, FL, 323084424, US 2532 CAPITAL MEDICAL BLVD, TALLAHASSEE, FL, 323084424, US

Contacts
Phone +1 850-628-7679
Fax 8502578099

Authorized person
Name JENNIFER GATES
Role PRACTICE MANAGER
Phone 8506287679

Taxonomy
Taxonomy Code 207X00000X - Orthopaedic Surgery Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
IVY SPINE & ORTHOPEDICS, LLC RETIREMENT PLAN 2023 814772410 2024-10-02 IVY SPINE & ORTHOPEDICS, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7656351104
Plan sponsor’s address 896 MAIN STREET, CHIPLEY, FL, 32428
IVY SPINE & ORTHOSPEDICS LLC 401(K) PROFIT SHARING PLAN & TRUST 2023 814772410 2024-04-04 IVY SPINE & ORTHOPEDICS LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 541990
Sponsor’s telephone number 8506287679
Plan sponsor’s address 742 HARRISON AVE, PANAMA CITY, FL, 324012524

Signature of
Role Plan administrator
Date 2024-04-04
Name of individual signing ANTHONY WARD AS ATTORNEY
Valid signature Filed with authorized/valid electronic signature
IVY SPINE & ORTHOPEDICS, LLC RETIREMENT PLAN 2022 814772410 2023-09-22 IVY SPINE & ORTHOPEDICS, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7656351104
Plan sponsor’s address 896 MAIN STREET, CHIPLEY, FL, 32428

Signature of
Role Plan administrator
Date 2023-09-22
Name of individual signing JAMES MCLOUGHLIN, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-09-22
Name of individual signing JAMES MCLOUGHLIN, MD
Valid signature Filed with authorized/valid electronic signature
IVY SPINE & ORTHOPEDICS LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 814772410 2023-04-08 IVY SPINE & ORTHOPEDICS LLC 9
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 541990
Sponsor’s telephone number 8506287679
Plan sponsor’s address 742 HARRISON AVE, PANAMA CITY, FL, 32401

Signature of
Role Plan administrator
Date 2023-04-07
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature
IVY SPINE & ORTHOPEDICS LLC 401(K) PROFIT SHARING PLAN & TRUST 2021 814772410 2022-06-14 IVY SPINE & ORTHOPEDICS LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 541990
Sponsor’s telephone number 8506287679
Plan sponsor’s address 742 HARRISON AVE, PANAMA CITY, FL, 32401

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2022-06-14
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature
IVY SPINE & ORTHOPEDICS LLC 401(K) PROFIT SHARING PLAN & TRUST 2020 814772410 2021-10-14 IVY SPINE & ORTHOPEDICS LLC 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 541990
Sponsor’s telephone number 8506287679
Plan sponsor’s address 742 HARRISON AVE, PANAMA CITY, FL, 32401

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing ERISA FIDUCIARY SERVICES, INC
Valid signature Filed with authorized/valid electronic signature
IVY SPINE & ORTHOPEDICS LLC 401(K) PROFIT SHARING PLAN & TRUST 2020 814772410 2021-10-14 IVY SPINE & ORTHOPEDICS LLC 7
Three-digit plan number (PN) 002
Effective date of plan 2020-01-01
Business code 541990
Sponsor’s telephone number 8506287679
Plan sponsor’s address 742 HARRISON AVE, PANAMA CITY, FL, 32401

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing ERISA FIDUCIARY SERVICES, INC
Valid signature Filed with authorized/valid electronic signature
IVY SPINE & ORTHOPEDICS LLC 401(K) PROFIT SHARING PLAN & TRUST 2020 814772410 2021-05-19 IVY SPINE & ORTHOPEDICS LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 541990
Sponsor’s telephone number 8506287679
Plan sponsor’s address 742 HARRISON AVE, PANAMA CITY, FL, 32401

Signature of
Role Plan administrator
Date 2021-05-19
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
TAYLOR GERALD W Agent 742 Harrison Avenue, Panama CIty, FL, 32401

Authorized Member

Name Role Address
MCLOUGHLIN JAMES C Authorized Member 742 Harrison Avenue, Panama CIty, FL, 32401

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2018-04-25 742 Harrison Avenue, Panama CIty, FL 32401 No data
CHANGE OF MAILING ADDRESS 2018-04-25 742 Harrison Avenue, Panama CIty, FL 32401 No data
REGISTERED AGENT ADDRESS CHANGED 2018-04-25 742 Harrison Avenue, Panama CIty, FL 32401 No data

Documents

Name Date
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-03-28
ANNUAL REPORT 2022-02-07
ANNUAL REPORT 2021-03-19
ANNUAL REPORT 2020-06-29
ANNUAL REPORT 2019-04-29
ANNUAL REPORT 2018-04-25
ANNUAL REPORT 2017-05-01
Florida Limited Liability 2016-12-23

Related by officers

MCLOUGHLIN JAMES C

JM OFFICE PROPERTIES, LLC

TAYLOR GERALD W

HARE TAYLOR, LLC ELECTRONIC SIGNALING, LLC 23RD STREET MANAGEMENT, INC. HARE TAYLOR & COMPANY, LLC GCT ADVISORS, LLC EXPRESS TAX ADVISORS, LLC RLT FAMILY HOLDINGS, LLC GCT CAPITAL PROPERTIES, L.L.C. ETA GROUP I, LLC APS ALLEN PERFORMANCE SERVICES, LLC

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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