| Entity Name: | MISSION FAMILY MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Mar 2021 (4 years ago) |
| Document Number: | L21000132107 |
| FEI/EIN Number | 86-3013918 |
| Address: | 1785 GARDEN STREET, TITUSVILLE, FL, 32796 |
| Mail Address: | 1785 GARDEN STREET, TITUSVILLE, FL, 32796 |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699447086 | 2021-10-04 | 2021-10-25 | 1785 GARDEN ST, TITUSVILLE, FL, 327963221, US | 1785 GARDEN ST, TITUSVILLE, FL, 327963221, US | |||||||||||||||
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| Phone | +1 321-269-9612 |
| Fax | 3212698433 |
Authorized person
| Name | KATIE FONTAINE |
| Role | ADMINISTRATOR |
| Phone | 3212699612 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MISSION FAMILY MEDICINE 401(K) PLAN | 2023 | 863013918 | 2024-05-08 | MISSION FAMILY MEDICINE LLC | 7 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-08 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3212699612 |
| Plan sponsor’s address | 1785 GARDEN STREET, TITUSVILLE, FL, 32796 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-03-21 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MARSHALL BENJAMIN G | Agent | 1785 GARDEN STREET, TITUSVILLE, FL, 32796 |
| Name | Role | Address |
|---|---|---|
| MARSHALL BENJAMIN G | Authorized Representative | 1733 CASTLE DRIVE, TITUSVILLE, FL, 32796 |
| MARSHALL MIRANDA B | Authorized Representative | 1733 CASTLE DRIVE, TITUSVILLE, FL, 32796 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G25000003984 | MISSION CONCIERGE CARE | ACTIVE | 2025-01-08 | 2030-12-31 | No data | 1785 GARDEN STREET, TITUSVILLE, FL, 32796 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-13 |
| ANNUAL REPORT | 2024-01-03 |
| ANNUAL REPORT | 2023-01-04 |
| ANNUAL REPORT | 2022-01-18 |
| Florida Limited Liability | 2021-03-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
