| Entity Name: | PALM BEACH COUNTY MEDICAL SOCIETY OF FLORIDA, INCORPORATED |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 30 Jun 1992 (33 years ago) |
| Document Number: | N49647 |
| FEI/EIN Number | 300130804 |
| Address: | 3540 FOREST HILL BLVD, SUITE 101, WEST PALM BEACH, FL, 33406, US |
| Mail Address: | 3540 FOREST HILL BLVD, SUITE 101, WEST PALM BEACH, FL, 33406, US |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EMPLOYEE BENEFIT PLAN OF PALM BEACH COUNTY MEDICAL SOCIETY OF FLORIDA, INCORPORATED | 2021 | 300130804 | 2022-07-25 | PALM BEACH COUNTY MEDICAL SOCIETY OF FLORIDA, INCORPORATED | 19 | |||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2022-07-25 |
| Name of individual signing | KELLY SKIDMORE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2009-01-01 |
| Business code | 561110 |
| Sponsor’s telephone number | 5614333940 |
| Plan sponsor’s address | 3540 FOREST HILL BLVD STE 101, WEST PALM BEACH, FL, 334065878 |
Signature of
| Role | Plan administrator |
| Date | 2021-03-25 |
| Name of individual signing | MINDY ACKERMAN GONZALEZ |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Skidmore Kelly | Agent | 3540 FOREST HILL BLVD., WEST PALM BEACH, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| Davanzo Dawn MD | President | 3540 Forest Hill Boulevard, West Palm Beach, FL, 33406 |
| Berkman Andrew MD | President | 3540 Forest Hill Boulevard, West Palm Beacvh, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| Norton Vicki | Vice President | 3540 Forest Hill Boulevard, West Palm Beach, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| Gottsegen Josh MD | Treasurer | 3540 Forest Hill Boulevard, West Palm Beach, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| Skidmore Kelly | Chief Executive Officer | 3540 Forest Hill Blvd. Suite 101, West Palm Beach, FL, 33406 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000094092 | PALM BEACH COUNTY MEDICAL SOCIETY | EXPIRED | 2015-09-14 | 2020-12-31 | No data | 3540 FOREST HILL BLVD., SUITE 101, WEST PALM BEACH, FL, 33406 |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13001174771 | TERMINATED | 1000000512325 | PALM BEACH | 2013-05-29 | 2023-07-10 | $ 1,845.58 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
