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  5. LAKE CANCER MEDICAL CENTER, P.A.

LAKE CANCER MEDICAL CENTER, P.A.

Company Details

Entity Name: LAKE CANCER MEDICAL CENTER, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 09 Nov 2004 (20 years ago)
Date of dissolution: 23 Sep 2016 (8 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 23 Sep 2016 (8 years ago)
Document Number: P04000153377
FEI/EIN Number 201858776
Address: 732 NORTH THIRD STREET, LEESBURG, FL, 34748
Mail Address: 732 NORTH THIRD STREET, LEESBURG, FL, 34748
ZIP code: 34748
County: Lake
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKE CANCER MEDICAL CENTER, P. A. 401(K) PROFIT SHARING PLAN 2014 201858776 2015-10-05 LAKE CANCER MEDICAL CENTER, P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Signature of
Role Plan administrator
Date 2015-10-05
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-05
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
LAKE CANCER MEDICAL CENTER, P.A. 401(K) PROFIT SHARING PLAN 2014 201858776 2015-07-23 LAKE CANCER MEDICAL CENTER, P.A. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Signature of
Role Plan administrator
Date 2015-07-23
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-23
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
LAKE CANCER MEDICAL CENTER, P.A. PROFIT SHARING PLAN 2014 201858776 2015-07-23 LAKE CANCER MEDICAL CENTER, P.A. 25
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Signature of
Role Plan administrator
Date 2015-07-23
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-23
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
LAKE CANCER MEDICAL CENTER, P.A. 401K PROFIT SHARING PLAN 2013 201858776 2014-06-20 LAKE CANCER MEDICAL CENTER, P.A. 23
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Signature of
Role Plan administrator
Date 2014-06-20
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-20
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
LAKE CANCER MEDICAL CENTER, P.A. 401K PROFIT SHARING PLAN 2013 201858776 2015-07-23 LAKE CANCER MEDICAL CENTER, P.A. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Signature of
Role Plan administrator
Date 2015-07-23
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-23
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
LAKE CANCER MEDICAL CENTER, P.A. PROFIT SHARING PLAN 2013 201858776 2015-07-23 LAKE CANCER MEDICAL CENTER, P.A. 23
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Signature of
Role Plan administrator
Date 2015-07-23
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-23
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
LAKE CANCER MEDICAL CENTER, P.A. 401K PROFIT SHARING PLAN 2013 201858776 2014-07-28 LAKE CANCER MEDICAL CENTER, P.A. 23
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Signature of
Role Plan administrator
Date 2014-07-28
Name of individual signing PA BLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-28
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
LAKE CANCER MEDICAL CENTER, P.A. 401K PROFIT SHARING PLAN 2012 201858776 2013-07-22 LAKE CANCER MEDICAL CENTER, P.A. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Signature of
Role Plan administrator
Date 2013-07-22
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-22
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
LAKE CANCER MEDICAL CENTER, P.A. 401K PROFIT SHARING PLAN 2011 201858776 2012-06-05 LAKE CANCER MEDICAL CENTER, P.A. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Plan administrator’s name and address
Administrator’s EIN 201858776
Plan administrator’s name LAKE CANCER MEDICAL CENTER, P.A.
Plan administrator’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748
Administrator’s telephone number 3527282532

Signature of
Role Plan administrator
Date 2012-06-05
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-05
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
LAKE CANCER MEDICAL CENTER, P.A. 401K PROFIT SHARING PLAN 2010 201858776 2011-07-22 LAKE CANCER MEDICAL CENTER, P.A. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 3527282532
Plan sponsor’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748

Plan administrator’s name and address
Administrator’s EIN 201858776
Plan administrator’s name LAKE CANCER MEDICAL CENTER, P.A.
Plan administrator’s address 732 NORTH 3RD STREET, LEESBURG, FL, 34748
Administrator’s telephone number 3527282532

Signature of
Role Plan administrator
Date 2011-07-22
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-22
Name of individual signing PABLO REYES
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MATHEW LOURDES M Agent 732 NORTH THIRD STREET, LEESBURG, FL, 34748

Director

Name Role Address
MATHEW LOURDES M Director 732 NORTH THIRD STREET, LEESBURG, FL, 34748
REYES PABLO J Director 732 NORTH THIRD STREET, LEESBURG, FL, 34748

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data
CHANGE OF PRINCIPAL ADDRESS 2005-04-25 732 NORTH THIRD STREET, LEESBURG, FL 34748 No data
CHANGE OF MAILING ADDRESS 2005-04-25 732 NORTH THIRD STREET, LEESBURG, FL 34748 No data
REGISTERED AGENT ADDRESS CHANGED 2005-04-25 732 NORTH THIRD STREET, LEESBURG, FL 34748 No data

Documents

Name Date
ANNUAL REPORT 2015-04-27
ANNUAL REPORT 2014-03-03
ANNUAL REPORT 2013-04-30
ANNUAL REPORT 2012-04-10
ANNUAL REPORT 2011-02-15
ANNUAL REPORT 2010-01-19
ANNUAL REPORT 2009-04-21
ANNUAL REPORT 2008-04-21
ANNUAL REPORT 2007-04-16
ANNUAL REPORT 2006-05-01

Related by officers

MATHEW LOURDES M

LAKE CANCER & HEMATOLOGY, P.A. LOURDES M. MATHEW, M.D., P.A.

REYES PABLO J

J REYES SERVICES INC REYES MASONRY CORPORATION

Related by address

732 NORTH THIRD STREET, LEESBURG, FL, 34748

LAKE CANCER & HEMATOLOGY, P.A.

732 NORTH THIRD STREET, LEESBURG, FL, 34748

LAKE CANCER & HEMATOLOGY, P.A.

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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