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  5. BRAD A. BAGWELL, D.M.D., P.A.

BRAD A. BAGWELL, D.M.D., P.A.

Company Details

Entity Name: BRAD A. BAGWELL, D.M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 05 Dec 2001 (23 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 15 Jan 2014 (11 years ago)
Document Number: P01000115973
FEI/EIN Number 593761090
Address: 4200 STATE ROAD 524, COCOA, FL, 32926, US
Mail Address: 4200 STATE ROAD 524, COCOA, FL, 32926, US
ZIP code: 32926
County: Brevard
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2022 593761090 2023-10-13 BRAD A. BAGWELL, D.M.D., P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, SUITE 104, COCOA, FL, 32926

Signature of
Role Plan administrator
Date 2023-10-13
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-13
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2021 593761090 2022-10-17 BRAD A. BAGWELL, D.M.D., P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, SUITE 104, COCOA, FL, 32926

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-17
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2020 593761090 2021-10-15 BRAD A. BAGWELL, D.M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, SUITE 104, COCOA, FL, 32926

Signature of
Role Plan administrator
Date 2021-10-15
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-15
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2019 593761090 2020-10-12 BRAD A. BAGWELL, D.M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, SUITE 104, COCOA, FL, 32926

Signature of
Role Plan administrator
Date 2020-10-12
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-10-12
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2018 593761090 2019-10-02 BRAD A. BAGWELL, D.M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, SUITE 104, COCOA, FL, 32926

Signature of
Role Plan administrator
Date 2019-10-02
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-02
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2017 593761090 2018-06-28 BRAD A. BAGWELL, D.M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, SUITE 104, COCOA, FL, 32926

Signature of
Role Plan administrator
Date 2018-06-27
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-27
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2016 593761090 2017-04-20 BRAD A. BAGWELL, D.M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, SUITE 104, COCOA, FL, 32926

Signature of
Role Plan administrator
Date 2017-04-20
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-20
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2015 593761090 2016-06-13 BRAD A. BAGWELL, D.M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, SUITE 104, COCOA, FL, 32926

Signature of
Role Plan administrator
Date 2016-06-13
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-13
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2014 593761090 2015-07-02 BRAD A. BAGWELL, D.M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, SUITE 104, COCOA, FL, 32926

Signature of
Role Plan administrator
Date 2015-07-02
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-02
Name of individual signing BRAD BAGWELL
Valid signature Filed with authorized/valid electronic signature
BRAD A. BAGWELL, D.M.D., P.A. 401(K) PROFIT SHARING PLAN & TRUST 2013 593761090 2014-07-01 BRAD A. BAGWELL, D.M.D., P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 3216315558
Plan sponsor’s address 4200 STATE ROAD 524, COCOA, FL, 32926

Plan administrator’s name and address
Administrator’s EIN 593761090
Plan administrator’s name BRAD A. BAGWELL, D.M.D., P.A.
Plan administrator’s address 4200 STATE ROAD 524, COCOA, FL, 32926
Administrator’s telephone number 3216315558

Signature of
Role Plan administrator
Date 2014-07-01
Name of individual signing BRAD A. BAGWELL
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BAGWELL BRAD A Agent 4200 STATE ROAD 524, COCOA, FL, 32926

Director

Name Role Address
BAGWELL BRAD A Director 4200 STATE ROAD 524, COCOA, FL, 32926

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2015-04-21 4200 STATE ROAD 524, Suite 104, COCOA, FL 32926 No data
CHANGE OF MAILING ADDRESS 2015-04-21 4200 STATE ROAD 524, Suite 104, COCOA, FL 32926 No data
REINSTATEMENT 2014-01-15 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2013-09-27 No data No data
REGISTERED AGENT ADDRESS CHANGED 2007-01-19 4200 STATE ROAD 524, SUITE 104, COCOA, FL 32926 No data

Documents

Name Date
ANNUAL REPORT 2025-01-28
ANNUAL REPORT 2024-01-31
ANNUAL REPORT 2023-01-25
ANNUAL REPORT 2022-02-01
ANNUAL REPORT 2021-03-23
ANNUAL REPORT 2020-01-21
ANNUAL REPORT 2019-03-26
ANNUAL REPORT 2018-01-16
ANNUAL REPORT 2017-03-23
ANNUAL REPORT 2016-03-28

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Date of last update: 01 Feb 2025

Sources: Florida Department of State

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