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  5. COLLINS ORTHOPEDIC LAB, INC.

COLLINS ORTHOPEDIC LAB, INC.

Company Details

Entity Name: COLLINS ORTHOPEDIC LAB, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 22 Feb 2006 (19 years ago)
Date of dissolution: 08 Oct 2014 (10 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 08 Oct 2014 (10 years ago)
Document Number: P06000026510
FEI/EIN Number 204354328
Address: 320 PINEY RIDGE RD., CASSELBERRY, FL, 32707
Mail Address: 320 PINEY RIDGE RD., CASSELBERRY, FL, 32707
ZIP code: 32707
County: Seminole
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1609973395 2006-09-17 2013-04-03 320 PINEY RIDGE RD, CASSELBERRY, FL, 327073806, US 320 PINEY RIDGE RD, CASSELBERRY, FL, 327073806, US

Contacts
Phone +1 407-388-0141
Fax 4073881121

Authorized person
Name MR. DALE HOWARD COLLINS
Role CEO
Phone 4073880141

Taxonomy
Taxonomy Code 335E00000X - Prosthetic/Orthotic Supplier
License Number POR 120
State FL
Is Primary Yes

Other Provider Identifiers
Issuer LICENSE P & O
Number POR 120
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COLLINS ORTHOPEDIC LAB, INC. 401(K) PROFIT SHARING PLAN 2012 204354328 2013-03-07 COLLINS ORTHOPEDIC LAB, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621510
Sponsor’s telephone number 4074681891
Plan sponsor’s address 2003 LONGWOOD LAKE MARY ROAD, SUITE 1007, LONGWOOD, FL, 32750

Signature of
Role Plan administrator
Date 2013-03-07
Name of individual signing DALE COLLINS
Valid signature Filed with authorized/valid electronic signature
COLLINS ORTHOPEDIC LAB, INC. 401(K) PROFIT SHARING PLAN 2011 204354328 2012-10-02 COLLINS ORTHOPEDIC LAB, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621510
Sponsor’s telephone number 4074681891
Plan sponsor’s address 320 PINEY RIDGE ROAD, CASSELBERRY, FL, 32707

Plan administrator’s name and address
Administrator’s EIN 204354328
Plan administrator’s name COLLINS ORTHOPEDIC LAB, INC.
Plan administrator’s address 320 PINEY RIDGE ROAD, CASSELBERRY, FL, 32707
Administrator’s telephone number 4074681891

Signature of
Role Plan administrator
Date 2012-10-02
Name of individual signing DALE COLLINS
Valid signature Filed with authorized/valid electronic signature
COLLINS ORTHOPEDIC LAB, INC. 401(K) PROFIT SHARING PLAN 2010 204354328 2011-09-12 COLLINS ORTHOPEDIC LAB, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621510
Sponsor’s telephone number 4074681891
Plan sponsor’s address 320 PINEY RIDGE ROAD, CASSELBERRY, FL, 32707

Plan administrator’s name and address
Administrator’s EIN 204354328
Plan administrator’s name COLLINS ORTHOPEDIC LAB, INC.
Plan administrator’s address 320 PINEY RIDGE ROAD, CASSELBERRY, FL, 32707
Administrator’s telephone number 4074681891

Signature of
Role Plan administrator
Date 2011-09-08
Name of individual signing DALE COLLINS
Valid signature Filed with authorized/valid electronic signature
COLLINS ORTHOPEDIC LAB, INC. 401(K) PROFIT SHARING PLAN 2009 204354328 2010-09-07 COLLINS ORTHOPEDIC LAB, INC. 4
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621510
Sponsor’s telephone number 4074681891
Plan sponsor’s address 2003 LONGWOOD LAKE MARY ROAD, STE 1007, LONGWOOD, FL, 32750

Plan administrator’s name and address
Administrator’s EIN 204354328
Plan administrator’s name COLLINS ORTHOPEDIC LAB, INC.
Plan administrator’s address 2003 LONGWOOD LAKE MARY ROAD, STE 1007, LONGWOOD, FL, 32750
Administrator’s telephone number 4074681891
COLLINS ORTHOPEDIC LAB, INC. 401(K) PROFIT SHARING PLAN 2009 204354328 2010-09-26 COLLINS ORTHOPEDIC LAB, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621510
Sponsor’s telephone number 4074681891
Plan sponsor’s address 2003 LONGWOOD LAKE MARY ROAD, STE 1007, LONGWOOD, FL, 32750

Plan administrator’s name and address
Administrator’s EIN 204354328
Plan administrator’s name COLLINS ORTHOPEDIC LAB, INC.
Plan administrator’s address 2003 LONGWOOD LAKE MARY ROAD, STE 1007, LONGWOOD, FL, 32750
Administrator’s telephone number 4074681891

Signature of
Role Plan administrator
Date 2010-09-24
Name of individual signing DALE COLLINS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
COLLINS DALE H Agent 1358 N. MARCY DR., LONGWOOD, FL, 32750

President

Name Role Address
COLLINS DALE H President 1358 N. MARCY DR., LONGWOOD, FL, 32750

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2014-10-08 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 No data No data
CHANGE OF PRINCIPAL ADDRESS 2011-06-06 320 PINEY RIDGE RD., CASSELBERRY, FL 32707 No data
CHANGE OF MAILING ADDRESS 2011-06-06 320 PINEY RIDGE RD., CASSELBERRY, FL 32707 No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2014-10-08
ANNUAL REPORT 2013-03-17
ANNUAL REPORT 2012-04-23
ADDRESS CHANGE 2011-06-30
ANNUAL REPORT 2011-03-15
ANNUAL REPORT 2010-04-19
ANNUAL REPORT 2009-04-11
ANNUAL REPORT 2008-04-28
ANNUAL REPORT 2007-04-20
Domestic Profit 2006-02-22

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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