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  5. LEWIS J. HERZBRUN, M.D., P.A.

LEWIS J. HERZBRUN, M.D., P.A.

Company Details

Entity Name: LEWIS J. HERZBRUN, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 14 Mar 2003 (22 years ago)
Document Number: P03000030210
FEI/EIN Number 320066920
Address: 30 W. Wilt Ave, EUSTIS, FL, 32726, US
Mail Address: P.O. BOX 1507, EUSTIS, FL, 32727
ZIP code: 32726
County: Lake
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2023 320066920 2024-08-21 LEWIS J. HERZBRUN, M. D. , P. A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 WEST WILT AVE., EUSTIS, FL, 32726

Signature of
Role Plan administrator
Date 2024-08-21
Name of individual signing LEWIS HERZBRUN
Valid signature Filed with authorized/valid electronic signature
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2022 320066920 2023-09-14 LEWIS J. HERZBRUN, M. D. , P. A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 WEST WILT AVE., EUSTIS, FL, 327262949

Signature of
Role Plan administrator
Date 2023-09-14
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-09-14
Name of individual signing LEWIS HERZBRUN
Valid signature Filed with authorized/valid electronic signature
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2021 320066920 2022-08-12 LEWIS J. HERZBRUN, M. D. , P. A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 WEST WILT AVE., EUSTIS, FL, 327262949

Signature of
Role Plan administrator
Date 2022-08-12
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-08-12
Name of individual signing LEWIS J HERZBRUN
Valid signature Filed with authorized/valid electronic signature
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2020 320066920 2021-10-14 LEWIS J. HERZBRUN, M. D. , P. A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 WEST WILT AVE., EUSTIS, FL, 327262949

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-14
Name of individual signing LEWIS J HERZBRUN
Valid signature Filed with authorized/valid electronic signature
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2019 320066920 2020-06-22 LEWIS J. HERZBRUN, M. D. , P. A. 3
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 WEST WILT AVE., EUSTIS, FL, 327262949

Signature of
Role Plan administrator
Date 2020-06-22
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-22
Name of individual signing LEWIS HERZBRUN
Valid signature Filed with authorized/valid electronic signature
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2019 320066920 2021-09-28 LEWIS J. HERZBRUN, M. D. , P. A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 WEST WILT AVE., EUSTIS, FL, 327262949

Signature of
Role Plan administrator
Date 2021-09-28
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-09-28
Name of individual signing LEWIS HERZBRUN
Valid signature Filed with authorized/valid electronic signature
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2018 320066920 2019-10-12 LEWIS J. HERZBRUN, M. D. , P. A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 W. WILT AVE., EUSTIS, FL, 327262949

Signature of
Role Plan administrator
Date 2019-10-11
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-11
Name of individual signing LEWIS HERZBRUN
Valid signature Filed with authorized/valid electronic signature
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2017 320066920 2018-09-27 LEWIS J. HERZBRUN, M. D. , P. A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 W. WILT AVE., EUSTIS, FL, 327262949

Signature of
Role Plan administrator
Date 2018-09-27
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2016 320066920 2017-12-20 LEWIS J. HERZBRUN, M. D. , P. A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 W. WILT AVE., EUSTIS, FL, 327262949

Signature of
Role Plan administrator
Date 2017-12-20
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature
LEWIS J. HERZBRUN, M. D. , P. A. 401(K) PLAN 2015 320066920 2016-09-29 LEWIS J. HERZBRUN, M. D. , P. A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 3523577342
Plan sponsor’s address 30 W. WILT AVE., EUSTIS, FL, 327262949

Signature of
Role Plan administrator
Date 2016-09-29
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-29
Name of individual signing LEWIS J. HERZBRUN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Herzbrun Lewis JMD Agent 30 W Wilt Ave, EUSTIS, FL, 32726

Director

Name Role Address
HERZBRUN LEWIS J Director 30 W. Wilt Ave, EUSTIS, FL, 32726

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2013-01-09 30 W. Wilt Ave, EUSTIS, FL 32726 No data
REGISTERED AGENT NAME CHANGED 2013-01-09 Herzbrun, Lewis J, MD No data
REGISTERED AGENT ADDRESS CHANGED 2013-01-09 30 W Wilt Ave, EUSTIS, FL 32726 No data
CHANGE OF MAILING ADDRESS 2006-05-12 30 W. Wilt Ave, EUSTIS, FL 32726 No data

Documents

Name Date
ANNUAL REPORT 2025-01-21
ANNUAL REPORT 2024-01-11
ANNUAL REPORT 2023-01-19
ANNUAL REPORT 2022-01-20
ANNUAL REPORT 2021-01-10
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-01-27
ANNUAL REPORT 2018-01-02
ANNUAL REPORT 2017-01-08
ANNUAL REPORT 2016-01-13

Related by officers

HERZBRUN LEWIS J

30 WILT LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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