| Entity Name: | CBR HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 04 Aug 2017 (7 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | REVOKED FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | M17000006677 |
| FEI/EIN Number | 82-2346019 |
| Address: | 18167 US HWY 19, SUITE 450, CLEARWATER, FL, 33764 |
| Mail Address: | 18167 US HWY 19, SUITE 450, CLEARWATER, FL, 33764 |
| ZIP code: | 33764 |
| County: | Pinellas |
| Place of Formation: | DELAWARE |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CBR HEALTH LLC 401 K PROFIT SHARING PLAN TRUST | 2018 | 822346019 | 2019-04-25 | CBR HEALTH LLC | 11 | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2019-04-25 |
| Name of individual signing | JACK CAPITO |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2017-01-01 |
| Business code | 524140 |
| Sponsor’s telephone number | 7272605130 |
| Plan sponsor’s address | 18167 US HWY 19 N STE 450, CLEARWATER, FL, 33764 |
Signature of
| Role | Plan administrator |
| Date | 2018-06-04 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Capito Jack M | Agent | 18167 US HWY 19, CLEARWATER, FL, 33764 |
| Name | Role | Address |
|---|---|---|
| MERCURIS CHERYL R | Manager | 18167 US HWY 19, CLEARWATER, FL, 33764 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000085310 | HEALTH SOURCE NETWORK | EXPIRED | 2017-08-07 | 2022-12-31 | No data | 18167 US HIGHWAY 19 NORTH, SUITE 450, CLEARWATER, FL, 33764 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REVOKED FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-05-01 | Capito, Jack Michael | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-05-01 | 18167 US HWY 19, SUITE 450, CLEARWATER, FL 33764 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-05-01 |
| Foreign Limited | 2017-08-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
