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  5. SOUTH LAKE GASTROENTEROLOGY, INC.

SOUTH LAKE GASTROENTEROLOGY, INC. - Florida Company Profile

Company Details

Entity Name: SOUTH LAKE GASTROENTEROLOGY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

SOUTH LAKE GASTROENTEROLOGY, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act.
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 22 Dec 2005 (19 years ago)
Last Event: AMENDED AND RESTATEDARTICLES/NAME CHANGE
Event Date Filed: 31 May 2013 (12 years ago)
Document Number: P05000165886
FEI/EIN Number 204102308

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 821 OAKLEY SEAVER DR, Clermont, FL, 34711, US
Mail Address: 17545 Deer Isle CIr, Winter Garden, FL, 34711, US
ZIP code: 34711
County: Lake
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1467647685 2007-09-11 2014-07-18 PO BOX 120930, CLERMONT, FL, 347120930, US 2040 OAKLEY SEAVER DR, CLERMONT, FL, 347111962, US

Contacts
Phone +1 352-242-1665
Fax 3522431649

Authorized person
Name MR. RAMESH RAMPERSAD
Role ADMINISTRATOR
Phone 3522421665

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number ME74082
State FL
Is Primary Yes

Other Provider Identifiers
Issuer AETNA
Number 5858631
State FL
Issuer MEDICARE INDIVIDUAL
Number E0302Z
State FL
Issuer MEDICAID
Number 256031300
State FL
Issuer FL BCBS
Number 43437
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH LAKE GASTROENTEROLOGY 401(K) PROFIT SHARING PLAN 2023 204102308 2024-09-13 SOUTH LAKE GASTROENTEROLOGY 29
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522428433
Plan sponsor’s address 2040 OAKLEY SEAVER DRIVE, CLERMONT FLORIDA, FL, 34711

Signature of
Role Plan administrator
Date 2024-09-13
Name of individual signing SHIRLEY HORNER
Valid signature Filed with authorized/valid electronic signature
SOUTH LAKE GASTROENTEROLOGY PENSION PLAN 2023 204102308 2024-10-15 SOUTH LAKE GASTROENTEROLOGY 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522421665
Plan sponsor’s address 821 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing ADEL ABOUELSEOUD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-15
Name of individual signing ADEL ABOUELSEOUD
Valid signature Filed with authorized/valid electronic signature
SOUTH LAKE GASTROENTEROLOGY 401(K) PROFIT SHARING PLAN 2022 204102308 2023-10-16 SOUTH LAKE GASTROENTEROLOGY 39
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522521665
Plan sponsor’s address 821 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711

Signature of
Role Plan administrator
Date 2023-10-16
Name of individual signing RAJAB ABUKHADRAH
Valid signature Filed with authorized/valid electronic signature
SOUTH LAKE GASTROENTEROLOGY PENSION PLAN 2022 204102308 2023-10-11 SOUTH LAKE GASTROENTEROLOGY 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522521665
Plan sponsor’s address 821 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711

Plan administrator’s name and address
Administrator’s EIN 204102308
Plan administrator’s name SOUTH LAKE GASTROENTEROLOGY
Plan administrator’s address 821 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711
Administrator’s telephone number 3522521665

Signature of
Role Plan administrator
Date 2023-10-11
Name of individual signing RAJAB ABUKHADRAH
Valid signature Filed with authorized/valid electronic signature
SOUTH LAKE GASTROENTEROLOGY PENSION PLAN 2021 204102308 2022-12-13 SOUTH LAKE GASTROENTEROLOGY 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522521665
Plan sponsor’s address 2040 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711

Plan administrator’s name and address
Administrator’s EIN 204102308
Plan administrator’s name SOUTH LAKE GASTROENTEROLOGY
Plan administrator’s address 2040 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711
Administrator’s telephone number 3522521665

Signature of
Role Plan administrator
Date 2022-12-13
Name of individual signing RAJAB ABUKHADRAH
Valid signature Filed with authorized/valid electronic signature
SOUTH LAKE GASTROENTEROLOGY 401(K) PROFIT SHARING PLAN 2021 204102308 2022-12-13 SOUTH LAKE GASTROENTEROLOGY 34
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522521665
Plan sponsor’s address 2040 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711

Signature of
Role Plan administrator
Date 2022-12-13
Name of individual signing RAJAB ABUKHADRAH
Valid signature Filed with authorized/valid electronic signature
SOUTH LAKE GASTROENTEROLOGY PENSION PLAN 2020 204102308 2021-11-23 SOUTH LAKE GASTROENTEROLOGY 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522521665
Plan sponsor’s address 2040 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711

Plan administrator’s name and address
Administrator’s EIN 204102308
Plan administrator’s name SOUTH LAKE GASTROENTEROLOGY
Plan administrator’s address 2040 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711
Administrator’s telephone number 3522521665

Signature of
Role Plan administrator
Date 2021-11-23
Name of individual signing RAJAB ABUKHADRAH
Valid signature Filed with authorized/valid electronic signature
SOUTH LAKE GASTROENTEROLOGY 401(K) PROFIT SHARING PLAN 2020 204102308 2021-11-23 SOUTH LAKE GASTROENTEROLOGY 28
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522521665
Plan sponsor’s address 2040 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711

Signature of
Role Plan administrator
Date 2021-11-23
Name of individual signing RAJAB ABUKHADRAH
Valid signature Filed with authorized/valid electronic signature
SOUTH LAKE GASTROENTEROLOGY 401(K) PROFIT SHARING PLAN 2019 204102308 2020-10-12 SOUTH LAKE GASTROENTEROLOGY 23
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522521665
Plan sponsor’s address 2040 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711

Signature of
Role Plan administrator
Date 2020-10-12
Name of individual signing RAJAB ABUKHADRAH
Valid signature Filed with authorized/valid electronic signature
SOUTH LAKE GASTROENTEROLOGY 401(K) PROFIT SHARING PLAN 2019 204102308 2021-11-23 SOUTH LAKE GASTROENTEROLOGY 25
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 3522521665
Plan sponsor’s address 2040 OAKLEY SEAVER DRIVE, CLERMONT, FL, 34711

Signature of
Role Plan administrator
Date 2021-11-23
Name of individual signing RAJAB ABUKHADRAH
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
ABU KHADRAH RAJAB KDR. President 821 OAKLEY SEAVER DR., CLERMONT, FL, 34711
ABUKHADRAH RAJAB Director 17545 Deer Isle Cir, Winter Garden, FL, 34787
ABUKHADRAH RAJAB Agent 17545 Deer Isle CIr, Winter Garden, FL, 34711

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2021-12-27 821 OAKLEY SEAVER DR, Clermont, FL 34711 -
CHANGE OF PRINCIPAL ADDRESS 2021-10-14 821 OAKLEY SEAVER DR, Clermont, FL 34711 -
REGISTERED AGENT ADDRESS CHANGED 2016-03-28 17545 Deer Isle CIr, Winter Garden, FL 34711 -
REGISTERED AGENT NAME CHANGED 2013-05-31 ABUKHADRAH, RAJAB -
AMENDED AND RESTATEDARTICLES/NAME CHANGE 2013-05-31 SOUTH LAKE GASTROENTEROLOGY, INC. -
REINSTATEMENT 2010-11-29 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2010-09-24 - -
CANCEL ADM DISS/REV 2009-10-09 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2009-09-25 - -
AMENDMENT AND NAME CHANGE 2006-02-07 SOUTH LAKE GASTROENTEROLOGY, P.A. -

Documents

Name Date
ANNUAL REPORT 2024-03-10
ANNUAL REPORT 2023-02-10
ANNUAL REPORT 2022-03-04
ANNUAL REPORT 2021-04-05
ANNUAL REPORT 2020-06-25
ANNUAL REPORT 2019-04-02
ANNUAL REPORT 2018-03-09
ANNUAL REPORT 2017-03-17
ANNUAL REPORT 2016-03-28
ANNUAL REPORT 2015-03-20

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8103697001 2020-04-08 0491 PPP 2040 Oakley Seaver Dr., CLERMONT, FL, 34711-1962
Loan Status Date 2021-02-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 369300
Loan Approval Amount (current) 369300
Undisbursed Amount 0
Franchise Name -
Lender Location ID 342931
Servicing Lender Name Mainstreet Community Bank of Florida
Servicing Lender Address 204 S Woodland Blvd, DE LAND, FL, 32720-5414
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address CLERMONT, LAKE, FL, 34711-1962
Project Congressional District FL-11
Number of Employees 30
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 342931
Originating Lender Name Mainstreet Community Bank of Florida
Originating Lender Address DE LAND, FL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 371769.79
Forgiveness Paid Date 2021-02-16
6278428610 2021-03-23 0491 PPS 2040 Oakley Seaver Dr, Clermont, FL, 34711-1962
Loan Status Date 2022-01-21
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 297955
Loan Approval Amount (current) 297955
Undisbursed Amount 0
Franchise Name -
Lender Location ID 342931
Servicing Lender Name Mainstreet Community Bank of Florida
Servicing Lender Address 204 S Woodland Blvd, DE LAND, FL, 32720-5414
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Clermont, LAKE, FL, 34711-1962
Project Congressional District FL-11
Number of Employees 37
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 342931
Originating Lender Name Mainstreet Community Bank of Florida
Originating Lender Address DE LAND, FL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 300173.11
Forgiveness Paid Date 2021-12-20

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Companies related by address

No other companies in our directory share the same address as SOUTH LAKE GASTROENTEROLOGY, INC.

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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