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  5. SOUTH LAKE MEDICAL CENTER, INC.

SOUTH LAKE MEDICAL CENTER, INC.

Company Details

Entity Name: SOUTH LAKE MEDICAL CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 12 Mar 2007 (18 years ago)
Document Number: P07000031970
FEI/EIN Number 208666890
Address: South Lake Medical Center, 1950 Hospital View Way, CLERMONT, FL, 34711, US
Mail Address: South Lake Medical Center, 1950 Hospital View Way, CLERMONT, 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
1144414038 2007-09-04 2015-07-28 PO BOX 754, MINNEOLA, FL, 347550754, US 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 347111926, US

Contacts
Phone +1 352-243-3443
Fax 3522433044

Authorized person
Name SHAZIA NASIR
Role OWNER
Phone 3522433443

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME88336
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH LAKE MEDICAL CENTER, INC. CASH BALANCE PLAN 2023 208666890 2024-10-14 SOUTH LAKE MEDICAL CENTER, INC. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
SOUTH LAKE MEDICAL CENTER, INC. 401K PROFIT SHARING PLAN AND TRUST 2023 208666890 2024-10-14 SOUTH LAKE MEDICAL CENTER, INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-03-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
SOUTH LAKE MEDICAL CENTER, INC. CASH BALANCE PLAN 2022 208666890 2023-06-06 SOUTH LAKE MEDICAL CENTER, INC. 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
SOUTH LAKE MEDICAL CENTER, INC. 401K PROFIT SHARING PLAN AND TRUST 2022 208666890 2023-06-06 SOUTH LAKE MEDICAL CENTER, INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-03-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
SOUTH LAKE MEDICAL CENTER, INC. 401K PROFIT SHARING PLAN AND TRUST 2021 208666890 2022-09-27 SOUTH LAKE MEDICAL CENTER, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-03-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
SOUTH LAKE MEDICAL CENTER, INC. CASH BALANCE PLAN 2021 208666890 2022-09-27 SOUTH LAKE MEDICAL CENTER, INC. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
SOUTH LAKE MEDICAL CENTER, INC. 401K PROFIT SHARING PLAN AND TRUST 2020 208666890 2021-10-07 SOUTH LAKE MEDICAL CENTER, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-03-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
SOUTH LAKE MEDICAL CENTER, INC. CASH BALANCE PLAN 2020 208666890 2021-10-07 SOUTH LAKE MEDICAL CENTER, INC. 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
SOUTH LAKE MEDICAL CENTER, INC. 401K PROFIT SHARING PLAN AND TRUST 2019 208666890 2020-09-23 SOUTH LAKE MEDICAL CENTER, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-03-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
SOUTH LAKE MEDICAL CENTER, INC. CASH BALANCE PLAN 2019 208666890 2020-09-23 SOUTH LAKE MEDICAL CENTER, INC. 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3522433443
Plan sponsor’s address 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711

Agent

Name Role Address
sharif nasir Agent South Lake Medical Center, CLERMONT, FL, 34711

President

Name Role Address
NASIR SHAZIA President South Lake Medical Center, CLERMONT, FL, 34711

Chief Executive Officer

Name Role Address
SHARIF NASIR Chief Executive Officer South Lake Medical Center, CLERMONT, FL, 34711

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G18000073244 SOUTH LAKE AESTHETICS ACTIVE 2018-07-02 2028-12-31 No data 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2021-01-11 sharif, nasir No data
CHANGE OF PRINCIPAL ADDRESS 2013-01-17 South Lake Medical Center, 1950 Hospital View Way, CLERMONT, FL 34711 No data
CHANGE OF MAILING ADDRESS 2013-01-17 South Lake Medical Center, 1950 Hospital View Way, CLERMONT, FL 34711 No data
REGISTERED AGENT ADDRESS CHANGED 2013-01-17 South Lake Medical Center, 1950 Hospital View Way, CLERMONT, FL 34711 No data

Documents

Name Date
ANNUAL REPORT 2024-01-11
ANNUAL REPORT 2023-01-11
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-01-11
ANNUAL REPORT 2020-01-14
ANNUAL REPORT 2019-04-15
ANNUAL REPORT 2018-01-08
ANNUAL REPORT 2017-04-20
ANNUAL REPORT 2016-03-03
ANNUAL REPORT 2015-01-12

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4524057204 2020-04-27 0491 PPP 1950 HOSPITAL VIEW WAY, CLERMONT, FL, 34711
Loan Status Date 2021-04-08
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 139280
Loan Approval Amount (current) 139280
Undisbursed Amount 0
Franchise Name -
Lender Location ID 17616
Servicing Lender Name Seacoast National Bank
Servicing Lender Address 815 Colorado Ave, STUART, FL, 34994-3053
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address CLERMONT, LAKE, FL, 34711-0001
Project Congressional District FL-11
Number of Employees 14
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 17616
Originating Lender Name Seacoast National Bank
Originating Lender Address STUART, FL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 140462.93
Forgiveness Paid Date 2021-03-08
6535988300 2021-01-27 0491 PPS 1950 Hospital View Way, Clermont, FL, 34711-1926
Loan Status Date 2021-12-07
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 146320
Loan Approval Amount (current) 146320
Undisbursed Amount 0
Franchise Name -
Lender Location ID 17616
Servicing Lender Name Seacoast National Bank
Servicing Lender Address 815 Colorado Ave, STUART, FL, 34994-3053
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Clermont, LAKE, FL, 34711-1926
Project Congressional District FL-11
Number of Employees 13
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 17616
Originating Lender Name Seacoast National Bank
Originating Lender Address STUART, FL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 147434.44
Forgiveness Paid Date 2021-11-10

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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