| Entity Name: | LEGACY SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Aug 2018 (6 years ago) |
| Last Event: | LC REVOCATION OF DISSOLUTION |
| Event Date Filed: | 04 May 2023 (2 years ago) |
| Document Number: | L18000202390 |
| FEI/EIN Number | 831722822 |
| Address: | 6918 Gunn HWY, Tampa, FL, 33625, US |
| Mail Address: | 6918 Gunn HWY, Tampa, FL, 33625, US |
| ZIP code: | 33625 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699256404 | 2018-08-29 | 2018-08-29 | 9131 ANSON WAY STE 304, RALEIGH, NC, 276153267, US | 6918 GUNN HWY STE E, TAMPA, FL, 336253853, US | |||||||||||||||||
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| Phone | +1 919-329-2882 |
Authorized person
| Name | MR. RICHARD SEAN RAMBO |
| Role | COO |
| Phone | 9193292882 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1369 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LEGACY SURGERY CENTER LLC 401(K) PLAN | 2023 | 831722822 | 2024-09-12 | LEGACY SURGERY CENTER LLC | 11 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-12 |
| Name of individual signing | NICK RICE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621493 |
| Sponsor’s telephone number | 8138522500 |
| Plan sponsor’s address | 6918 GUNN HWY, STE E, TAMPA, FL, 33625 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-12 |
| Name of individual signing | NICK RICE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621493 |
| Sponsor’s telephone number | 8138522500 |
| Plan sponsor’s address | 6918 GUNN HWY, STE E, TAMPA, FL, 33625 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-14 |
| Name of individual signing | SHIRLEY HORNER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| FASTMD ASC LLC | Agent |
| Name | Role | Address |
|---|---|---|
| Wijnmaalen Johannes | Manager | 3741 Wiregrass Road, New Port Richey, FL, 34655 |
| Negron Lyann | Manager | 6918 Gunn Hwy, Tampa, FL, 33625 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC REVOCATION OF DISSOLUTION | 2023-05-04 | No data | No data |
| VOLUNTARY DISSOLUTION | 2023-04-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-08-11 | 6918 Gunn HWY, Suite E, Tampa, FL 33625 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-08-11 | 2040 Short Avenue, Odessa, FL 33556 | No data |
| CHANGE OF MAILING ADDRESS | 2022-08-11 | 6918 Gunn HWY, Suite E, Tampa, FL 33625 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-08-11 | FASTMD ASC, LLC | No data |
| LC AMENDMENT | 2018-08-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-07-13 |
| LC Revocation of Dissolution | 2023-05-04 |
| VOLUNTARY DISSOLUTION | 2023-04-24 |
| AMENDED ANNUAL REPORT | 2022-12-22 |
| AMENDED ANNUAL REPORT | 2022-08-11 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-07-07 |
| ANNUAL REPORT | 2019-04-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
