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  5. SUNRISE PRIMARY CARE INC

SUNRISE PRIMARY CARE INC

Company Details

Entity Name: SUNRISE PRIMARY CARE INC
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 30 Jul 2001 (24 years ago)
Date of dissolution: 27 Sep 2019 (5 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 27 Sep 2019 (5 years ago)
Document Number: P01000075664
FEI/EIN Number 593736354
Address: 100 ARRICOLA AVE, ST. AUGUSTINE, FL, 32080, US
Mail Address: 100 ARRICOLA AVE, ST. AUGUSTINE, FL, 32080, US
ZIP code: 32080
County: St. Johns
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1124294012 2008-05-01 2008-05-01 PO BOX 249, PALATKA, FL, 321780249, US 811 N SUMMIT ST, CRESCENT CITY, FL, 321122109, US

Contacts
Phone +1 386-698-2279
Fax 3866982239

Authorized person
Name ALBINO GAW
Role ADMINISTRATOR
Phone 3866982279

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
License Number ME076342
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 660181201
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SUNRISE PRIMARY CARE 401(K) TRUST 2018 593736354 2019-09-16 SUNRISE PRIMARY CARE 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N. SUMMIT ST., CRESCENT CITY, FL, 32112
SUNRISE PRIMARY CARE 401(K) TRUST 2017 593736354 2018-04-06 SUNRISE PRIMARY CARE 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N. SUMMIT ST., CRESCENT CITY, FL, 32112
SUNRISE PRIMARY CARE 401(K) TRUST 2016 593736354 2017-07-06 SUNRISE PRIMARY CARE 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N. SUMMIT ST., CRESCENT CITY, FL, 32112
SUNRISE PRIMARY CARE 401(K) TRUST 2015 593736354 2016-09-08 SUNRISE PRIMARY CARE 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112
SUNRISE PRIMARY CARE 401(K) TRUST 2014 593736354 2015-07-06 SUNRISE PRIMARY CARE 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing ALBINO GAW
Valid signature Filed with authorized/valid electronic signature
SUNRISE PRIMARY CARE 401(K) TRUST 2013 593736354 2014-09-15 SUNRISE PRIMARY CARE 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112

Signature of
Role Plan administrator
Date 2014-09-15
Name of individual signing ALBINO GAW
Valid signature Filed with authorized/valid electronic signature
SUNRISE PRIMARY CARE 401(K) TRUST 2012 593736354 2013-06-21 SUNRISE PRIMARY CARE 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112

Signature of
Role Plan administrator
Date 2013-06-21
Name of individual signing ALBINO GAW
Valid signature Filed with authorized/valid electronic signature
SUNRISE PRIMARY CARE 401(K) TRUST 2011 593736354 2012-06-18 SUNRISE PRIMARY CARE 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112

Plan administrator’s name and address
Administrator’s EIN 593736354
Plan administrator’s name SUNRISE PRIMARY CARE
Plan administrator’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112
Administrator’s telephone number 3866982279

Signature of
Role Plan administrator
Date 2012-06-18
Name of individual signing ALBINO GAW
Valid signature Filed with authorized/valid electronic signature
SUNRISE PRIMARY CARE 401(K) TRUST 2010 593736354 2011-09-07 SUNRISE PRIMARY CARE 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112

Plan administrator’s name and address
Administrator’s EIN 593736354
Plan administrator’s name SUNRISE PRIMARY CARE
Plan administrator’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112
Administrator’s telephone number 3866982279

Signature of
Role Plan administrator
Date 2011-09-07
Name of individual signing ALBINO GAW
Valid signature Filed with authorized/valid electronic signature
SUNRISE PRIMARY CARE 401(K) TRUST 2009 593736354 2010-10-21 SUNRISE PRIMARY CARE 9
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3866982279
Plan sponsor’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112

Plan administrator’s name and address
Administrator’s EIN 593736354
Plan administrator’s name SUNRISE PRIMARY CARE
Plan administrator’s address 811 N SUMMIT ST, CRESCENT CITY, FL, 32112
Administrator’s telephone number 3866982279

Signature of
Role Employer/plan sponsor
Date 2010-10-21
Name of individual signing MARIA-JOSEFINA S. RIVERA GAW
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CULVER DAVE Agent 100 ARRICOLA AVE, ST. AUGUSTINE, FL, 32080

Secretary

Name Role Address
GAW ALBINO Secretary 108 N. Bartram Trail, San Mateo, FL, 32187

President

Name Role Address
HINMAN ROY HII, MD President 100 ARRICOLA AVE, ST. AUGUSTINE, FL, 32080

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 No data No data
AMENDMENT 2019-01-30 No data No data
CHANGE OF PRINCIPAL ADDRESS 2019-01-30 100 ARRICOLA AVE, ST. AUGUSTINE, FL 32080 No data
CHANGE OF MAILING ADDRESS 2019-01-30 100 ARRICOLA AVE, ST. AUGUSTINE, FL 32080 No data
REGISTERED AGENT NAME CHANGED 2019-01-30 CULVER, DAVE No data
REGISTERED AGENT ADDRESS CHANGED 2019-01-30 100 ARRICOLA AVE, ST. AUGUSTINE, FL 32080 No data

Documents

Name Date
Amendment 2019-01-30
ANNUAL REPORT 2018-03-14
ANNUAL REPORT 2017-03-15
ANNUAL REPORT 2016-01-17
ANNUAL REPORT 2015-03-25
ANNUAL REPORT 2014-03-31
ANNUAL REPORT 2013-03-04
ANNUAL REPORT 2012-02-10
ANNUAL REPORT 2011-02-18
ANNUAL REPORT 2010-02-24

Related by officers

GAW ALBINO

168 PRIME A, LLC 168 PRIME B, LLC

CULVER DAVE

EDGEWATER INTERNAL MEDICINE ASSOCIATES, INC. MHC HOLDINGS, INC. FLORIDA STEM CELL, LLC FLORIDA MORTGAGE ADVANTAGE, INC.

Related by address

100 ARRICOLA AVE, ST. AUGUSTINE, FL, 32080, US

EDGEWATER INTERNAL MEDICINE ASSOCIATES, INC. BRAVE RIFLES, P.A.

100 ARRICOLA AVE, ST. AUGUSTINE, FL, 32080, US

EDGEWATER INTERNAL MEDICINE ASSOCIATES, INC. BRAVE RIFLES, P.A.

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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