| Entity Name: | FLORIDA ASSISTED LIVING MANAGEMENT PROVIDER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 26 Jan 2012 (13 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Sep 2016 (8 years ago) |
| Document Number: | P12000008728 |
| FEI/EIN Number | 30-0779708 |
| Address: | 4901 NW 17th Way, Suite 303, Ft Lauderdale, FL 33309 |
| Mail Address: | 4901 NW 17th Way, Suite 303, Ft Lauderdale, FL 33309 |
| ZIP code: | 33309 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | FLORIDA ASSISTED LIVING MANAGEMENT PROVIDER, INC., MISSISSIPPI | 1247292 | MISSISSIPPI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FLORIDA ASSISTED LIVING MANAGEMENT PROVIDER, INC. 401(K) PLAN | 2021 | 300779708 | 2022-10-17 | FLORIDA ASSISTED LIVING MANAGEMENT PROVIDER, INC. | 62 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-10-17 |
| Name of individual signing | DMITRIY SHIRGANOV |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2022-10-17 |
| Name of individual signing | DMITRIY SHIRGANOV |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2017-04-01 |
| Business code | 621610 |
| Sponsor’s telephone number | 9542831048 |
| Plan sponsor’s address | 200 S ROSEMARY AVE., WEST PALM BEACH, FL, 33401 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-17 |
| Name of individual signing | DMITRIY SHIRGANOV |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2022-10-17 |
| Name of individual signing | DMITRIY SHIRGANOV |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2017-04-01 |
| Business code | 621610 |
| Sponsor’s telephone number | 9542831048 |
| Plan sponsor’s address | 200 S ROSEMARY AVE, WEST PALM BEACH, FL, 33401 |
Signature of
| Role | Plan administrator |
| Date | 2020-10-15 |
| Name of individual signing | DMITRY SHIRGANOV |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| ITSKOVICH, DAVID | Agent | 4901 NW 17th Way, Suite 303, Fort Lauderdale, FL 33309 |
| Name | Role | Address |
|---|---|---|
| KANETI, RICKI | President | 4901 NW 17th Way, Suite 303, Ft Lauderdale, FL 33309 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-25 | 4901 NW 17th Way, Suite 303, Fort Lauderdale, FL 33309 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-21 | 4901 NW 17th Way, Suite 303, Ft Lauderdale, FL 33309 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-21 | 4901 NW 17th Way, Suite 303, Ft Lauderdale, FL 33309 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-05-01 | ITSKOVICH, DAVID | No data |
| REINSTATEMENT | 2016-09-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14000487107 | TERMINATED | 1000000600815 | BROWARD | 2014-03-20 | 2024-05-01 | $ 528.42 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-21 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-05-01 |
| ANNUAL REPORT | 2019-05-01 |
| CORLCRACHG | 2018-12-13 |
| ANNUAL REPORT | 2018-04-02 |
| Reg. Agent Change | 2017-11-02 |
| ANNUAL REPORT | 2017-04-27 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
