| Entity Name: | SOUTHWEST SPINE AND SPORT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 24 Jan 2002 (23 years ago) |
| Date of dissolution: | 23 Dec 2014 (10 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 23 Dec 2014 (10 years ago) |
| Document Number: | P02000008103 |
| FEI/EIN Number | 043597257 |
| Address: | 12734 KENWOOD LANE, FORT MYERS, FL, 33907, US |
| Mail Address: | 12734 KENWOOD LANE, FORT MYERS, FL, 33917, US |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316153661 | 2007-05-15 | 2020-08-22 | 1722 DEL PRADO BLVD S STE 4, CAPE CORAL, FL, 339905522, US | 1722 DEL PRADO BLVD S STE 4, CAPE CORAL, FL, 339905522, US | |||||||||||||||||||||
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| Phone | +1 239-772-8888 |
Authorized person
| Name | DR. KEITH Q WARDE |
| Role | PRESIDENT |
| Phone | 2397728888 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 70007 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SOUTHWEST SPINE AND SPORT INC 401(K) PROFIT SHARING PLAN & TRUST | 2011 | 043597257 | 2012-11-29 | SOUTHWEST SPINE AND SPORT INC | 5 | |||||||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 043597257 |
| Plan administrator’s name | SOUTHWEST SPINE AND SPORT INC |
| Plan administrator’s address | 12734 KENWOOD LN STE 32, FORT MYERS, FL, 33907 |
Number of participants as of the end of the plan year
| Active participants | 0 |
| Retired or separated participants receiving benefits | 0 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants with account balances as of the end of the plan year | 0 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Plan administrator |
| Date | 2012-11-29 |
| Name of individual signing | KRISTA CARTWRIGHT |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2008-01-01 |
| Business code | 621310 |
| Sponsor’s telephone number | 2392748005 |
| Plan sponsor’s mailing address | 12734 KENWOOD LN STE 32, FORT MYERS, FL, 33907 |
| Plan sponsor’s address | 12734 KENWOOD LN STE 32, FORT MYERS, FL, 33907 |
Plan administrator’s name and address
| Administrator’s EIN | 043597257 |
| Plan administrator’s name | SOUTHWEST SPINE AND SPORT INC |
| Plan administrator’s address | 12734 KENWOOD LN STE 32, FORT MYERS, FL, 33907 |
| Administrator’s telephone number | 2392748005 |
Number of participants as of the end of the plan year
| Active participants | 4 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 1 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants with account balances as of the end of the plan year | 3 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Plan administrator |
| Date | 2012-11-29 |
| Name of individual signing | KRISTA CARTWRIGHT |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| WARDE KEITH | Agent | 12734 KENWOOD LANE, FORT MYERS, FL, 33907 |
| Name | Role | Address |
|---|---|---|
| WARDE KEITH | President | 12734 KENWOOD LANE #32, FT MYERS, FL, 33907 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2014-12-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-14 | 12734 KENWOOD LANE, #32, FORT MYERS, FL 33907 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-14 | 12734 KENWOOD LANE, #32, FORT MYERS, FL 33907 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-14 | 12734 KENWOOD LANE, #32, FORT MYERS, FL 33907 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-03-28 | WARDE, KEITH | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2014-12-23 |
| ANNUAL REPORT | 2014-01-14 |
| ANNUAL REPORT | 2013-03-08 |
| ANNUAL REPORT | 2012-03-28 |
| ANNUAL REPORT | 2011-01-11 |
| ANNUAL REPORT | 2010-03-24 |
| ANNUAL REPORT | 2009-02-10 |
| ANNUAL REPORT | 2008-01-28 |
| ANNUAL REPORT | 2007-02-06 |
| ANNUAL REPORT | 2006-03-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
