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  5. JERZY GRZEBIELUCH, MD, LLC

JERZY GRZEBIELUCH, MD, LLC - Florida Company Profile

Company Details

Entity Name: JERZY GRZEBIELUCH, MD, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.

JERZY GRZEBIELUCH, MD, 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.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 10 Jul 2019 (6 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 16 Sep 2019 (6 years ago)
Document Number: L19000177507
FEI/EIN Number 84-2608554

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 4 2ND STREET, SE, FORT WALTON BEACH, FL, 32548, US
Mail Address: 4 2ND STREET, SE, FORT WALTON BEACH, FL, 32548, US
ZIP code: 32548
County: Okaloosa
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1447809298 2019-09-04 2019-09-04 4 2ND ST SE, FORT WALTON BEACH, FL, 325485502, US 4 2ND ST SE, FORT WALTON BEACH, FL, 325485502, US

Contacts
Phone +1 850-864-2008
Fax 8508645008

Authorized person
Name JERZY GRZEBIELUCH
Role OWNER
Phone 8508642008

Taxonomy
Taxonomy Code 261Q00000X - Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2023 842608554 2024-07-09 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2024-07-09
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature
JERZY GRZEBIELUCH, MD, LLC 401(K) PLAN 2023 842608554 2024-04-29 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2024-04-29
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature
JERZY GRZEBIELUCH, MD, LLC 401(K) PLAN 2022 842608554 2023-06-28 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2023-06-28
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature
JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2022 842608554 2023-07-24 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2023-07-24
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature
JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2021 842608554 2022-03-16 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2022-03-16
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature
JERZY GRZEBIELUCH, MD, LLC 401(K) PLAN 2021 842608554 2022-02-19 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2022-02-19
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature
JERZY GRZEBIELUCH, MD, LLC 401(K) PLAN 2020 842608554 2021-01-18 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2021-01-18
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature
JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2020 842608554 2021-01-18 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2021-01-18
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature
JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2019 842608554 2020-09-21 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2020-09-21
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature
JERZY GRZEBIELUCH, MD, LLC 401(K) PLAN 2019 842608554 2020-05-25 JERZY GRZEBIELUCH, MD, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 8508642008
Plan sponsor’s address 4 2ND STREET SE, FORT WALTON BEACH, FL, 32548

Signature of
Role Plan administrator
Date 2020-05-25
Name of individual signing JERZY GRZEBIELUCH
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
GRZEBIELUCH JERZY MD Authorized Member 4 2ND STREET, SE, FORT WALTON BEACH, FL, 32548
GRZEBIELUCH JERZY MD Agent 4 2ND STREET, SE, FORT WALTON BEACH, FL, 32548

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2025-02-01 4 2ND STREET, SE, FORT WALTON BEACH, FL 32548 -
CHANGE OF MAILING ADDRESS 2025-02-01 4 2ND STREET, SE, FORT WALTON BEACH, FL 32548 -
CHANGE OF PRINCIPAL ADDRESS 2024-02-01 4 2ND STREET, SE, FORT WALTON BEACH, FL 32548 -
CHANGE OF MAILING ADDRESS 2024-02-01 4 2ND STREET, SE, FORT WALTON BEACH, FL 32548 -
LC AMENDMENT 2019-09-16 - -

Documents

Name Date
ANNUAL REPORT 2025-01-20
ANNUAL REPORT 2024-01-20
ANNUAL REPORT 2023-01-30
ANNUAL REPORT 2022-01-12
ANNUAL REPORT 2021-02-01
ANNUAL REPORT 2020-01-16
LC Amendment 2019-09-16
Florida Limited Liability 2019-07-10

Companies related by officers

No other companies in our directory share the same officers as JERZY GRZEBIELUCH, MD, LLC

Companies related by address

No other companies in our directory share the same address as JERZY GRZEBIELUCH, MD, LLC

Date of last update: 03 May 2025

Sources: Florida Department of State

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