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  5. JAY AVASHIA, M.D., P.A.

JAY AVASHIA, M.D., P.A.

Company Details

Entity Name: JAY AVASHIA, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 03 Feb 2006 (19 years ago)
Date of dissolution: 04 Jul 2017 (8 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 04 Jul 2017 (8 years ago)
Document Number: P06000018025
FEI/EIN Number 204268031
Address: 40107 HW 27, Davenport, FL, 33837, US
Mail Address: P.O. BOX 1740, EAGLE LAKE, FL, 33839, US
ZIP code: 33837
County: Polk
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HEARTLAND CANCER CARE 401(K) RETIREMENT PLAN 2015 204268031 2016-07-22 JAY AVASHIA,M.D.,P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8634248977
Plan sponsor’s address 40107 HWY 27, DAVENPORT, FL, 33837

Signature of
Role Plan administrator
Date 2016-07-22
Name of individual signing BJ AVASHIA
Valid signature Filed with authorized/valid electronic signature
HEARTLAND CANCER CARE 401(K) RETIREMENT PLAN 2015 204268031 2016-12-28 JAY AVASHIA, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8634248977
Plan sponsor’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844

Signature of
Role Plan administrator
Date 2016-12-28
Name of individual signing BJ AVASHIA
Valid signature Filed with authorized/valid electronic signature
HEARTLAND CANCER CARE 401(K) RETIREMENT PLAN 2014 204268031 2015-07-13 JAY AVASHIA,M.D.,P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8634248977
Plan sponsor’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844

Signature of
Role Plan administrator
Date 2015-07-13
Name of individual signing BJ AVASHIA
Valid signature Filed with authorized/valid electronic signature
HEARTLAND CANCER CARE 401(K) RETIREMENT PLAN 2013 204268031 2014-08-25 JAY AVASHIA,M.D.,P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8634248977
Plan sponsor’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844

Signature of
Role Plan administrator
Date 2014-08-25
Name of individual signing BJ AVASHIA
Valid signature Filed with authorized/valid electronic signature
HEARTLAND CANCER CARE 401(K) RETIREMENT PLAN 2012 204268031 2013-07-03 JAY AVASHIA,M.D.,P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8634248977
Plan sponsor’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844

Signature of
Role Plan administrator
Date 2013-07-03
Name of individual signing BJ AVASHIA
Valid signature Filed with authorized/valid electronic signature
HEARTLAND CANCER CARE 401(K) RETIREMENT PLAN 2011 204268031 2012-08-22 JAY AVASHIA,M.D.,P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8634248977
Plan sponsor’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844

Plan administrator’s name and address
Administrator’s EIN 204268031
Plan administrator’s name JAY AVASHIA,M.D.,P.A.
Plan administrator’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844
Administrator’s telephone number 8634248977

Signature of
Role Plan administrator
Date 2012-08-22
Name of individual signing JAY AVASHIA, MD
Valid signature Filed with authorized/valid electronic signature
HEARTLAND CANCER CARE 401(K) RETIREMENT PLAN 2010 204268031 2011-05-31 JAY AVASHIA,M.D.,P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8634248977
Plan sponsor’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844

Plan administrator’s name and address
Administrator’s EIN 204268031
Plan administrator’s name JAY AVASHIA,M.D.,P.A.
Plan administrator’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844
Administrator’s telephone number 8634248977

Signature of
Role Plan administrator
Date 2011-05-31
Name of individual signing AUTHORIZED SIGNER
Valid signature Filed with authorized/valid electronic signature
HEARTLAND CANCER CARE 401(K) RETIREMENT PLAN 2009 204268031 2010-08-16 JAY AVASHIA,M.D.,P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8634248977
Plan sponsor’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844

Plan administrator’s name and address
Administrator’s EIN 204268031
Plan administrator’s name JAY AVASHIA,M.D.,P.A.
Plan administrator’s address 131 PATTERSON ROAD, HAINES CITY, FL, 33844
Administrator’s telephone number 8634248977

Signature of
Role Plan administrator
Date 2010-08-16
Name of individual signing AUTHORIZED SIGNER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Roger Ingley Agent 230 E TILLMAN ROAD, LAKE WALES, FL, 33853

President

Name Role Address
AVASHIA JAY President P.O. BOX 1740, EAGLE LAKE, FL, 33839

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G15000121311 HEARTLAND CANCER SPECIALISTS EXPIRED 2015-12-02 2020-12-31 No data PO BOX 1740, EAGLE LAKE, FL, 33839
G08134700026 HEARTLAND CANCER CAFE EXPIRED 2008-05-13 2013-12-31 No data PO BOX 1740, EAGLE LAKE, FL, 33839

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2017-07-04 No data No data
REINSTATEMENT 2017-01-03 No data No data
CHANGE OF PRINCIPAL ADDRESS 2017-01-03 40107 HW 27, Davenport, FL 33837 No data
REGISTERED AGENT NAME CHANGED 2017-01-03 Roger, Ingley No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data
REINSTATEMENT 2011-10-26 No data No data
REGISTERED AGENT ADDRESS CHANGED 2011-10-26 230 E TILLMAN ROAD, LAKE WALES, FL 33853 No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2010-09-24 No data No data
CANCEL ADM DISS/REV 2008-11-10 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2008-09-26 No data No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2017-07-04
REINSTATEMENT 2017-01-03
ANNUAL REPORT 2015-01-09
ANNUAL REPORT 2014-01-13
ANNUAL REPORT 2013-04-04
ANNUAL REPORT 2012-03-26
REINSTATEMENT 2011-10-26
ANNUAL REPORT 2009-01-26
REINSTATEMENT 2008-11-10
REINSTATEMENT 2007-10-05

Related by officers

No related officers

Related by address

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Date of last update: 02 Feb 2025

Sources: Florida Department of State

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