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  5. SUMMERLIN BEND SURGERY CENTER, L.L.C.

SUMMERLIN BEND SURGERY CENTER, L.L.C.

Company Details

Entity Name: SUMMERLIN BEND SURGERY CENTER, L.L.C.
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Inactive
Date Filed: 19 Nov 1999 (25 years ago)
Date of dissolution: 20 Dec 2000 (24 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 20 Dec 2000 (24 years ago)
Document Number: L99000007969
FEI/EIN Number 650963008
Address: 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL, 33907
Mail Address: 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL, 33907
ZIP code: 33907
County: Lee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1770566192 2005-11-21 2012-06-25 5238 MASON CORBIN CT, STE 101, FT MYERS, FL, 339077738, US 5238 MASON CORBIN CT, STE 101, FT MYERS, FL, 339077738, US

Contacts
Phone +1 239-936-9700
Fax 2399369707

Authorized person
Name MS. LISA L KELLEY
Role ADMINISTRATOR
Phone 2399369700

Taxonomy
Taxonomy Code 261QA1903X - Ambulatory Surgical Clinic/Center
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 070785600
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SUMMERLIN BEND SURGERY CENTER 401(K) PROFIT SHARING PLAN & TRUST 2023 651005912 2024-07-01 SUMMERLIN BEND SURGERY CENTER 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621510
Sponsor’s telephone number 2399369700
Plan sponsor’s address 5238 MASON CORBIN CT, SUITE 101, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2024-07-01
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
SUMMERLIN BEND SURGERY CENTER, 401(K) PROFIT SHARING PLAN & TRUST 2022 651005912 2023-06-27 SUMMERLIN BEND SURGERY CENTER 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621510
Sponsor’s telephone number 2399369700
Plan sponsor’s address 5238 MASON CORBIN COURT, SUITE 101, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2023-06-27
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
SUMMERLIN BEND SURGERY CENTER, 401(K) PROFIT SHARING PLAN & TRUST 2021 651005912 2022-08-05 SUMMERLIN BEND SURGERY CENTER 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621510
Sponsor’s telephone number 2399369700
Plan sponsor’s address 5238 MASON CORBIN COURT, SUITE 101, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2022-08-05
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
SUMMERLIN BEND SURGERY CENTER, 401(K) PROFIT SHARING PLAN & TRUST 2020 651005912 2021-05-05 SUMMERLIN BEND SURGERY CENTER 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621510
Sponsor’s telephone number 2399369700
Plan sponsor’s address 5238 MASON CORBIN COURT, SUITE 101, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2021-05-05
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
SUMMERLIN BEND SURGERY CENTER, 401(K) PROFIT SHARING PLAN & TRUST 2019 651005912 2020-06-10 SUMMERLIN BEND SURGERY CENTER 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621510
Sponsor’s telephone number 2399369700
Plan sponsor’s address 5238 MASON CORBIN COURT, SUITE 101, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2020-06-10
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
SUMMERLIN BEND SURGERY CENTER, 401 K PROFIT SHARING PLAN TRUST 2018 651005912 2019-05-30 SUMMERLIN BEND SURGERY CENTER 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621510
Sponsor’s telephone number 2399369700
Plan sponsor’s address 5238 MASON CORBIN COURT, SUITE 101, FORT MYERS, FL, 33907

Plan administrator’s name and address
Administrator’s EIN 264477125
Plan administrator’s name 401K GENERATION
Plan administrator’s address 195 INTERNATIONAL PKWY, S #311, LAKE MARY, FL, 32746
Administrator’s telephone number 8669985879

Signature of
Role Plan administrator
Date 2019-05-30
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
SUMMERLIN BEND SURGERY CENTER, 401 K PROFIT SHARING PLAN TRUST 2017 651005912 2018-07-17 SUMMERLIN BEND SURGERY CENTER 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621510
Sponsor’s telephone number 2399369700
Plan sponsor’s address 5238 MASON CORBIN COURT, SUITE, FORT MYERS, FL, 33907

Signature of
Role Plan administrator
Date 2018-07-17
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
HOLBERG STEVEN E Manager 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL, 33907
ANDREW DAVID S Manager 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL, 33907
CASTELLANO BRADLEY D Manager 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL, 33907
GOLDSTEIN JEROLD S Manager 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL, 33907
KLIMOWICN CHRIS D Manager 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL, 33907
IMANVEL HOWARD E Manager 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL, 33907

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2000-12-20 No data No data
CHANGE OF PRINCIPAL ADDRESS 2000-01-24 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL 33907 No data
CHANGE OF MAILING ADDRESS 2000-01-24 63 BARKLEY CIRCLE, S.W., SUITE 102, FORT MYERS, FL 33907 No data

Documents

Name Date
Voluntary Dissolution 2000-12-20
Reg. Agent Resignation 2000-12-11
ANNUAL REPORT 2000-01-24
Florida Limited Liabilites 1999-11-19

Related by officers

HOLBERG STEVEN E

S & K WORKS LLC EVENUP HOLDINGS, LLC SOUTHWEST INDEPENDENT PRACTICE ASSOCIATION, INC. MID-COLONIAL INVESTMENT, LLC HONER PARADISE YACHT CHARTERS, INC.

ANDREW DAVID S

JAPW INVESTMENTS, L.L.C.

CASTELLANO BRADLEY D

EVENUP HOLDINGS, LLC EVENUP, LLC BRADLEY D. CASTELLANO, D.P.M., P.A.

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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