| Entity Name: | CHAMPION MEDICAL SUPPLIES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
CHAMPION MEDICAL SUPPLIES, 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. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 20 Jun 2017 (8 years ago) |
| Date of dissolution: | 25 Sep 2020 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (5 years ago) |
| Document Number: | L17000134111 |
| FEI/EIN Number |
82-1943151
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 9600 W SAMPLE ROAD, CORAL SPRINGS, FL, 33065, US |
| Mail Address: | 9600 W SAMPLE ROAD, CORAL SPRINGS, FL, 33065, US |
| ZIP code: | 33065 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699295980 | 2017-06-27 | 2022-07-21 | 9600 W SAMPLE RD STE 206, CORAL SPRINGS, FL, 330654030, US | 9600 W SAMPLE RD STE 206, CORAL SPRINGS, FL, 330654030, US | |||||||||||||||
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| Phone | +1 888-505-3686 |
| Phone | +1 561-633-7341 |
Authorized person
| Name | ELIZABETH CROCKETT |
| Role | OWNER |
| Phone | 8885053686 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHAMPION MEDICAL SUPPLIES RETIREMENT SAVINGS PLAN | 2019 | 821943151 | 2020-07-28 | CHAMPION MEDICAL SUPPLIES, LLC | 3 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2020-07-28 |
| Name of individual signing | AMY JAYNES |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 5616337341 |
| Plan sponsor’s address | 9600 WEST SAMPLE RD. SUITE 206, CORAL SPRINGS, FL, 33065 |
Signature of
| Role | Plan administrator |
| Date | 2019-10-14 |
| Name of individual signing | AMY JAYNES |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| CROCKETT ELIZABETH | Manager | 8534 DUKE CT EAST, BOYNTON BEACH, FL, 33436 |
| CROCKETT SHANITA | Manager | 7526 SW 6TH ST, NORTH LAUDERDALE, FL, 33068 |
| CROCKETT ELIZABETH | Agent | 8534 DUKE CT EAST, BOYNTON BEACH, FL, 33436 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-30 | 8534 DUKE CT EAST, BOYNTON BEACH, FL 33436 | - |
| LC AMENDMENT | 2017-09-27 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2017-09-27 | 9600 W SAMPLE ROAD, SUITE 206, CORAL SPRINGS, FL 33065 | - |
| CHANGE OF MAILING ADDRESS | 2017-09-27 | 9600 W SAMPLE ROAD, SUITE 206, CORAL SPRINGS, FL 33065 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| LC Amendment | 2017-09-27 |
| Florida Limited Liability | 2017-06-20 |
Date of last update: 01 May 2025
Sources: Florida Department of State
