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  5. SAMUEL BUNDZ, M.D., P.A.

SAMUEL BUNDZ, M.D., P.A.

Company Details

Entity Name: SAMUEL BUNDZ, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 30 Mar 2001 (24 years ago)
Date of dissolution: 25 Sep 2015 (9 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 25 Sep 2015 (9 years ago)
Document Number: P01000032826
FEI/EIN Number 593709624
Address: 8112 CENTRALIA CT, SUITE 101, LEESBURG, FL, 34788
Mail Address: PO BOX 1250, TAVARES, FL, 32778-1250
ZIP code: 34788
County: Lake
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SAMUEL BUNDZ, M. D. , P. A. 401(K) PLAN AND TRUST 2015 593709624 2016-09-29 SAMUEL BUNDZ, M. D. , P. A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3527879111
Plan sponsor’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701

Signature of
Role Plan administrator
Date 2016-09-29
Name of individual signing SHARY WEIS
Valid signature Filed with authorized/valid electronic signature
SAMUEL BUNDZ, M. D. , P. A. 401(K) PLAN AND TRUST 2014 593709624 2015-09-28 SAMUEL BUNDZ, M. D. , P. A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3527879111
Plan sponsor’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701

Signature of
Role Plan administrator
Date 2015-09-26
Name of individual signing SAMUEL BUNDZ
Valid signature Filed with authorized/valid electronic signature
SAMUEL BUNDZ, M.D., P.A. 401(K) PLAN AND TRUST 2013 593709624 2014-07-29 SAMUEL BUNDZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3527879111
Plan sponsor’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701

Signature of
Role Plan administrator
Date 2014-07-29
Name of individual signing SAMUEL BUNDZ
Valid signature Filed with authorized/valid electronic signature
SAMUEL BUNDZ, M.D., P.A. 401(K) PLAN AND TRUST 2012 593709624 2013-07-24 SAMUEL BUNDZ, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3527879111
Plan sponsor’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701

Signature of
Role Plan administrator
Date 2013-07-24
Name of individual signing SAMUEL BUNDZ
Valid signature Filed with authorized/valid electronic signature
SAMUEL BUNDZ, M.D., P.A. 401(K) PLAN AND TRUST 2011 593709624 2012-09-05 SAMUEL BUNDZ, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3527879111
Plan sponsor’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701

Plan administrator’s name and address
Administrator’s EIN 593709624
Plan administrator’s name SAMUEL BUNDZ, M.D., P.A.
Plan administrator’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701
Administrator’s telephone number 3527879111

Signature of
Role Plan administrator
Date 2012-09-05
Name of individual signing SAMUEL BUNDZ
Valid signature Filed with authorized/valid electronic signature
SAMUEL BUNDZ, M.D., P.A. 401(K) PLAN AND TRUST 2010 593709624 2011-09-01 SAMUEL BUNDZ, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3527879111
Plan sponsor’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701

Plan administrator’s name and address
Administrator’s EIN 593709624
Plan administrator’s name SAMUEL BUNDZ, M.D., P.A.
Plan administrator’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701
Administrator’s telephone number 3527879111

Signature of
Role Plan administrator
Date 2011-09-01
Name of individual signing SAMUEL BUNDZ
Valid signature Filed with authorized/valid electronic signature
SAMUEL BUNDZ, M.D., P.A. 401(K) PLAN AND TRUST 2009 593709624 2010-10-11 SAMUEL BUNDZ, M.D., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3527879111
Plan sponsor’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701

Plan administrator’s name and address
Administrator’s EIN 593709624
Plan administrator’s name SAMUEL BUNDZ, M.D., P.A.
Plan administrator’s address 8112 CENTRALIA COURT, SUITE 101, LEESBURG, FL, 347883701
Administrator’s telephone number 3527879111

Signature of
Role Plan administrator
Date 2010-10-11
Name of individual signing SAMUEL BUNDZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BUNDZ SAMUEL M Agent 34426 WINDLEY CIRCLE, EUSTIS, FL, 32736

Director

Name Role Address
BUNDZ SAMUEL M Director 34426 WINDLEY CIRCLE, EUSTIS, FL, 32736

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2015-09-25 No data No data
CHANGE OF PRINCIPAL ADDRESS 2009-03-13 8112 CENTRALIA CT, SUITE 101, LEESBURG, FL 34788 No data
CHANGE OF MAILING ADDRESS 2005-02-16 8112 CENTRALIA CT, SUITE 101, LEESBURG, FL 34788 No data

Documents

Name Date
ANNUAL REPORT 2014-03-30
ANNUAL REPORT 2013-04-13
ANNUAL REPORT 2012-03-11
ANNUAL REPORT 2011-03-13
ANNUAL REPORT 2010-03-11
ANNUAL REPORT 2009-03-13
ANNUAL REPORT 2008-03-17
ANNUAL REPORT 2007-04-11
ANNUAL REPORT 2006-03-13
ANNUAL REPORT 2005-02-16

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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