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  5. SOUTHEASTERN MEDICAL SUPPLY, INC.

SOUTHEASTERN MEDICAL SUPPLY, INC.

Company Details

Entity Name: SOUTHEASTERN MEDICAL SUPPLY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 24 Jan 2002 (23 years ago)
Last Event: AMENDMENT
Event Date Filed: 17 Jul 2018 (7 years ago)
Document Number: P02000010352
FEI/EIN Number 030384756
Address: 3615 CENTURY BLVD.,, LAKELAND, FL, 33811, US
Mail Address: 3615 CENTURY BLVD.,, LAKELAND, FL, 33811, US
ZIP code: 33811
County: Polk
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHEASTERN EMPLOYEE RETIREMENT PLAN 2012 590384756 2013-09-25 SOUTHEASTERN MEDICAL SUPPLY, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 339110
Sponsor’s telephone number 9544866029
Plan sponsor’s address 398 DANIA BEACH BLVD, STE 373, DANIA BEACH, FL, 33004

Plan administrator’s name and address
Administrator’s EIN 590384756
Plan administrator’s name SOUTHEASTERN MEDICAL SUPPLY, INC.
Plan administrator’s address 398 DANIA BEACH BLVD, STE 373, DANIA BEACH, FL, 33004
Administrator’s telephone number 9544866029

Signature of
Role Plan administrator
Date 2013-09-25
Name of individual signing CELESTE METHOT
Valid signature Filed with authorized/valid electronic signature
SOUTHEASTERN EMPLOYEE RETIREMENT PLAN 2011 590384756 2012-07-25 SOUTHEASTERN MEDICAL SUPPLY, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 339110
Sponsor’s telephone number 9544866029
Plan sponsor’s address 398 DANIA BEACH BLVD, STE 373, DANIA BEACH, FL, 33004

Plan administrator’s name and address
Administrator’s EIN 590384756
Plan administrator’s name SOUTHEASTERN MEDICAL SUPPLY, INC.
Plan administrator’s address 398 DANIA BEACH BLVD, STE 373, DANIA BEACH, FL, 33004
Administrator’s telephone number 9544866029

Signature of
Role Plan administrator
Date 2012-07-25
Name of individual signing CELESTE METHOT
Valid signature Filed with authorized/valid electronic signature
SOUTHEASTERN EMPLOYEE RETIREMENT PLAN 2010 590384756 2011-09-08 SOUTHEASTERN MEDICAL SUPPLY, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 339110
Sponsor’s telephone number 9544866029
Plan sponsor’s address 398 DANIA BEACH BLVD, STE 373, DANIA BEACH, FL, 33004

Plan administrator’s name and address
Administrator’s EIN 590384756
Plan administrator’s name SOUTHEASTERN MEDICAL SUPPLY, INC.
Plan administrator’s address 398 DANIA BEACH BLVD, STE 373, DANIA BEACH, FL, 33004
Administrator’s telephone number 9544866029

Signature of
Role Plan administrator
Date 2011-09-08
Name of individual signing CELESTE METHOT
Valid signature Filed with authorized/valid electronic signature
SOUTHEASTERN EMPLOYEE RETIREMENT PLAN 2009 590384756 2010-09-29 SOUTHEASTERN MEDICAL SUPPLY, INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 339110
Sponsor’s telephone number 9544866029
Plan sponsor’s address 398 DANIA BEACH BLVD, STE 373, DANIA BEACH, FL, 33004

Plan administrator’s name and address
Administrator’s EIN 590384756
Plan administrator’s name SOUTHEASTERN MEDICAL SUPPLY, INC.
Plan administrator’s address 398 DANIA BEACH BLVD, STE 373, DANIA BEACH, FL, 33004
Administrator’s telephone number 9544866029

Signature of
Role Plan administrator
Date 2010-09-29
Name of individual signing CELESTE METHOT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ESCOBEDO JOSE Agent 3615 CENTURY BLVD., UNIT 1, LAKELAND, FL, 33811

President

Name Role Address
ESCOBEDO JOSE President 3615 CENTURY BLVD., UNIT 1, LAKELAND, FL, 33811

Vice President

Name Role Address
ESCOBEDO JENNIFER Vice President 3615 CENTURY BLVD., UNIT 1, LAKELAND, FL, 33811

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G09000162527 ACTIVE BY CHOICE EXPIRED 2009-10-06 2014-12-31 No data 378 E. DANIA BEACH BLVD., # 373, DANIA BEACH, FL, 33004

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2018-07-17 3615 CENTURY BLVD., UNIT 1, LAKELAND, FL 33811 No data
AMENDMENT 2018-07-17 No data No data
REGISTERED AGENT NAME CHANGED 2018-07-17 ESCOBEDO, JOSE No data
CHANGE OF PRINCIPAL ADDRESS 2016-06-07 3615 CENTURY BLVD.,, UNIT #1, LAKELAND, FL 33811 No data
CHANGE OF MAILING ADDRESS 2016-06-07 3615 CENTURY BLVD.,, UNIT #1, LAKELAND, FL 33811 No data
MERGER 2009-09-21 No data CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 900000099429
MERGER 2005-06-20 No data CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 500000052685
AMENDMENT 2004-10-08 No data No data
REINSTATEMENT 2003-09-29 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2003-09-19 No data No data

Documents

Name Date
ANNUAL REPORT 2025-01-13
ANNUAL REPORT 2024-01-15
ANNUAL REPORT 2023-01-09
ANNUAL REPORT 2022-01-10
ANNUAL REPORT 2021-01-11
ANNUAL REPORT 2020-01-20
ANNUAL REPORT 2019-02-07
Amendment 2018-07-17
ANNUAL REPORT 2018-03-19
ANNUAL REPORT 2017-03-14

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Date of last update: 01 Feb 2025

Sources: Florida Department of State

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