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  5. BRENT W. CARMACK, M.D., P.A.

BRENT W. CARMACK, M.D., P.A.

Company Details

Entity Name: BRENT W. CARMACK, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 10 Mar 2004 (21 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 27 Oct 2020 (4 years ago)
Document Number: P04000044401
FEI/EIN Number 200848152
Address: 900 CARILLON PARKWAY, 111, ST PETERSBURG, FL, 33716
Mail Address: 900 CARILLON PARKWAY, 111, ST PETERSBURG, FL, 33716
ZIP code: 33716
County: Pinellas
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CARMACK 401(K) PLAN 2012 200848152 2013-04-05 BRENT W. CARMACK, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 7277892020
Plan sponsor’s address 900 CARILLON PARKWAY, SUITE 111, ST. PETERSBURG, FL, 33716

Signature of
Role Plan administrator
Date 2013-04-05
Name of individual signing DR. BRENT W CARMACK
Valid signature Filed with authorized/valid electronic signature
CARMACK 401(K) PLAN 2012 200848152 2013-09-26 BRENT W. CARMACK, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 7277892020
Plan sponsor’s address 900 CARILLON PARKWAY, SUITE 111, ST. PETERSBURG, FL, 33716

Signature of
Role Plan administrator
Date 2013-09-26
Name of individual signing DR. BRENT W CARMACK
Valid signature Filed with authorized/valid electronic signature
CARMACK 401(K) PLAN 2011 200848152 2012-06-01 BRENT W. CARMACK, M.D., P.A. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 7277892020
Plan sponsor’s address 900 CARILLON PARKWAY, SUITE 111, ST. PETERSBURG, FL, 33716

Plan administrator’s name and address
Administrator’s EIN 200848152
Plan administrator’s name BRENT W. CARMACK, M.D., P.A.
Plan administrator’s address 900 CARILLON PARKWAY, SUITE 111, ST. PETERSBURG, FL, 33716
Administrator’s telephone number 7277892020

Signature of
Role Plan administrator
Date 2012-06-01
Name of individual signing DR. BRENT W CARMACK
Valid signature Filed with authorized/valid electronic signature
CARMACK 401(K) PLAN 2010 200848152 2011-09-07 BRENT W. CARMACK, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 7277892020
Plan sponsor’s address 90 CARILLON PARKWAY, SUITE 401, ST. PETERSBURG, FL, 33716

Plan administrator’s name and address
Administrator’s EIN 200848152
Plan administrator’s name BRENT W. CARMACK, M.D., P.A.
Plan administrator’s address 90 CARILLON PARKWAY, SUITE 401, ST. PETERSBURG, FL, 33716
Administrator’s telephone number 7277892020

Signature of
Role Plan administrator
Date 2011-09-07
Name of individual signing DR. BRENT W CARMACK
Valid signature Filed with authorized/valid electronic signature
CARMACK 401(K) PLAN 2009 200848152 2010-10-15 BRENT W. CARMACK, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 7277892020
Plan sponsor’s address 90 CARILLON PARKWAY, SUITE 401, ST. PETERSBURG, FL, 33716

Plan administrator’s name and address
Administrator’s EIN 200848152
Plan administrator’s name BRENT W. CARMACK, M.D., P.A.
Plan administrator’s address 90 CARILLON PARKWAY, SUITE 401, ST. PETERSBURG, FL, 33716
Administrator’s telephone number 7277892020

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing FRANK HARRISON
Valid signature Filed with incorrect/unrecognized electronic signature
CARMACK 401(K) PLAN 2009 200848152 2010-10-15 BRENT W. CARMACK, M.D., P.A. 3
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 7277892020
Plan sponsor’s address 90 CARILLON PARKWAY, SUITE 401, ST. PETERSBURG, FL, 33716

Plan administrator’s name and address
Administrator’s EIN 200848152
Plan administrator’s name BRENT W. CARMACK, M.D., P.A.
Plan administrator’s address 90 CARILLON PARKWAY, SUITE 401, ST. PETERSBURG, FL, 33716
Administrator’s telephone number 7277892020

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing FRANK HARRISON
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Address
CARMACK BRENT W Agent 900 CARILLON PARKWAY SUITE 111, ST. PETERSBURG, FL, 33716

Director

Name Role Address
CARMACK BRENT W Director 900 CARILLON PARKWAY SUITE 111, ST. PETERSBURG, FL, 33716

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G10000085039 ST. PETERSBURG INSTITUTE OF OPHTHALMOLOGY ACTIVE 2010-09-16 2025-12-31 No data 900 CARILLON PARKWAY STE 111, SUITE 111, SAINT PETERSBURG, FL, 33716

Events

Event Type Filed Date Value Description
REINSTATEMENT 2020-10-27 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 No data No data
REINSTATEMENT 2019-10-18 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 No data No data
REGISTERED AGENT NAME CHANGED 2013-04-24 CARMACK, BRENT W. No data
REGISTERED AGENT ADDRESS CHANGED 2011-02-18 900 CARILLON PARKWAY SUITE 111, ST. PETERSBURG, FL 33716 No data
CHANGE OF MAILING ADDRESS 2010-02-17 900 CARILLON PARKWAY, 111, ST PETERSBURG, FL 33716 No data
CHANGE OF PRINCIPAL ADDRESS 2010-02-17 900 CARILLON PARKWAY, 111, ST PETERSBURG, FL 33716 No data

Documents

Name Date
ANNUAL REPORT 2024-04-26
ANNUAL REPORT 2023-05-02
ANNUAL REPORT 2022-04-29
ANNUAL REPORT 2021-03-24
REINSTATEMENT 2020-10-27
REINSTATEMENT 2019-10-18
ANNUAL REPORT 2018-04-26
ANNUAL REPORT 2017-03-24
ANNUAL REPORT 2016-04-14
ANNUAL REPORT 2015-04-21

Related by officers

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Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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