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  5. LYLE E. WADSWORTH, M.D., P.A.

LYLE E. WADSWORTH, M.D., P.A.

Company Details

Entity Name: LYLE E. WADSWORTH, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 21 Aug 2000 (24 years ago)
Document Number: P00000080879
FEI/EIN Number 593674312
Address: 890 N BOUNDARY AVENUE, SUITE 102, DELAND, FL, 32720
Mail Address: 890 N BOUNDARY AVENUE, SUITE 102, DELAND, FL, 32720
ZIP code: 32720
County: Volusia
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2023 593674312 2024-04-14 LYLE E. WADSWORTH, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Signature of
Role Plan administrator
Date 2024-04-14
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2022 593674312 2023-05-30 LYLE E. WADSWORTH, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Signature of
Role Plan administrator
Date 2023-05-30
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2021 593674312 2022-04-12 LYLE E. WADSWORTH, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Signature of
Role Plan administrator
Date 2022-04-12
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2020 593674312 2021-07-01 LYLE E. WADSWORTH, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Signature of
Role Plan administrator
Date 2021-07-01
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2019 593674312 2020-05-11 LYLE E. WADSWORTH, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Signature of
Role Plan administrator
Date 2020-05-11
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2018 593674312 2019-03-16 LYLE E. WADSWORTH, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Signature of
Role Plan administrator
Date 2019-03-16
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2017 593674312 2018-02-18 LYLE E. WADSWORTH, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Signature of
Role Plan administrator
Date 2018-02-18
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2016 593674312 2017-01-15 LYLE E. WADSWORTH, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Signature of
Role Plan administrator
Date 2017-01-15
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2015 593674312 2016-03-17 LYLE E. WADSWORTH, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Signature of
Role Plan administrator
Date 2016-03-17
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature
LYLE E. WADSWORTH, M.D., P.A. 401(K) PROFIT SHARING PLAN 2014 593674312 2015-03-30 LYLE E. WADSWORTH, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3867400224
Plan sponsor’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720

Plan administrator’s name and address
Administrator’s EIN 593674312
Plan administrator’s name LYLE E. WADSWORTH, M.D., P.A.
Plan administrator’s address 890 NORTH BOUNDARY AVE, SUITE 102, DELAND, FL, 32720
Administrator’s telephone number 3867400224

Signature of
Role Plan administrator
Date 2015-03-30
Name of individual signing LYLE E. WADSWORTH, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
WEIDNER DONALD W Agent 11265 ALUMNI WAY STE 201, JACKSONVILLE, FL, 32246

Director

Name Role Address
WADSWORTH LYLE E Director 321 WASHINGTON OAKS DRIVE, DELAND, FL, 32720

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2001-03-06 890 N BOUNDARY AVENUE, SUITE 102, DELAND, FL 32720 No data
CHANGE OF MAILING ADDRESS 2001-03-06 890 N BOUNDARY AVENUE, SUITE 102, DELAND, FL 32720 No data

Documents

Name Date
ANNUAL REPORT 2024-02-03
ANNUAL REPORT 2023-03-09
ANNUAL REPORT 2022-01-25
ANNUAL REPORT 2021-02-04
ANNUAL REPORT 2020-01-20
ANNUAL REPORT 2019-04-08
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-06
ANNUAL REPORT 2016-02-05
ANNUAL REPORT 2015-05-06

Related by officers

WEIDNER DONALD W

HEAVENLY RODS, INC. DWWPLANE, INC. CITIZENS AGAINST POWER EXCHANGE, INC. GULF U.S. GROUP, INC. "A" CABINET-N-COUNTER, INC. GLOBAL TECHNOLOGY AND DEVELOPMENT CORPORATION ALLERGY, ASTHMA & ARTHRITIS SPECIALISTS, P.A. E. RAWSON GRIFFIN, III, M.D., P.A. RIVER CITY BALLET AND DANCE PRODUCTIONS, INC. CONSORTIUM FOR PASSENGER RAIL TRANSPORTATION, INC.

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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