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  5. ALLIANT DERMATOLOGY PA

ALLIANT DERMATOLOGY PA

Company Details

Entity Name: ALLIANT DERMATOLOGY PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 05 Jul 2012 (13 years ago)
Last Event: AMENDMENT
Event Date Filed: 13 Oct 2016 (8 years ago)
Document Number: P12000059368
FEI/EIN Number 455622044
Address: 8620 E COUNTY ROAD 466, THE VILLAGES, FL, 32162, US
Mail Address: 8620 E COUNTY ROAD 466, THE VILLAGES, FL, 32162, US
ZIP code: 32162
County: Sumter
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1619232501 2012-07-07 2022-07-21 8620 E COUNTY ROAD 466, THE VILLAGES, FL, 321623670, US 8620 E COUNTY ROAD 466, THE VILLAGES, FL, 321623670, US

Contacts
Phone +1 352-399-7295
Fax 3523997294

Authorized person
Name DR. DAVID JOHN CASPER
Role CEO AND PHYSICIAN
Phone 4078839946

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number ME 108772
State FL
Is Primary Yes
Taxonomy Code 207ND0101X - MOHS-Micrographic Surgery Physician
Is Primary No
Taxonomy Code 207ND0900X - Dermatopathology Physician
Is Primary No

Other Provider Identifiers
Issuer BLUE CROSS BLUE SHIELD
Number QPF7T
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ALLIANT DERMATOLOGY 401(K) PLAN 2023 455622044 2024-02-16 ALLIANT DERMATOLOGY PA 52
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 5132633602
Plan sponsor’s address 8620A EAST COUNTY ROAD 466, THE VILLAGES, FL, 321623670
ALLIANT DERMATOLOGY 401(K) PLAN 2022 455622044 2023-07-19 ALLIANT DERMATOLOGY PA 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 5132633602
Plan sponsor’s address 8620A EAST COUNTY ROAD 466, THE VILLAGES, FL, 321623670
ALLIANT DERMATOLOGY 401(K) PLAN 2021 455622044 2022-09-20 ALLIANT DERMATOLOGY PA 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 5132633602
Plan sponsor’s address 8620A EAST COUNTY ROAD 466, THE VILLAGES, FL, 321623670
ALLIANT DERMATOLOGY 401(K) PLAN 2020 455622044 2021-07-13 ALLIANT DERMATOLOGY PA 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 5132633602
Plan sponsor’s address 8620A EAST COUNTY ROAD 466, THE VILLAGES, FL, 321623670
ALLIANT DERMATOLOGY 401(K) PLAN 2019 455622044 2020-08-20 ALLIANT DERMATOLOGY PA 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 5132633602
Plan sponsor’s address 8620A EAST COUNTY ROAD 466, THE VILLAGES, FL, 321623670
ALLIANT DERMATOLOGY 401(K) PLAN 2018 455622044 2019-10-14 ALLIANT DERMATOLOGY PA 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 5132633602
Plan sponsor’s address 8620 E COUNTY ROAD 466, THE VILLAGES, FL, 321623670

Signature of
Role Plan administrator
Date 2019-10-14
Name of individual signing DAVID W MOUNTFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-14
Name of individual signing DAVID W MOUNTFORD
Valid signature Filed with authorized/valid electronic signature
ALLIANT DERMATOLOGY 401(K) PLAN 2017 455622044 2018-10-03 ALLIANT DERMATOLOGY PA 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 3523997295
Plan sponsor’s address 8620A EAST COUNTY ROAD 466, THE VILLAGES, FL, 321623670

Signature of
Role Plan administrator
Date 2018-10-03
Name of individual signing LAURA CASPER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-03
Name of individual signing LAURA CASPER
Valid signature Filed with authorized/valid electronic signature
ALLIANT DERMATOLOGY 401(K) PLAN 2016 455622044 2017-07-11 ALLIANT DERMATOLOGY PA 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 3523997295
Plan sponsor’s address 8620A EAST COUNTY ROAD 466, THE VILLAGES, FL, 321623670

Signature of
Role Plan administrator
Date 2017-07-11
Name of individual signing LAURA CASPER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-11
Name of individual signing LAURA CASPER
Valid signature Filed with authorized/valid electronic signature
ALLIANT DERMATOLOGY 401(K) PLAN 2015 455622044 2016-07-11 ALLIANT DERMATOLOGY PA 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 3523997295
Plan sponsor’s address 8620A EAST COUNTY ROAD 466, THE VILLAGES, FL, 321623670

Signature of
Role Plan administrator
Date 2016-07-11
Name of individual signing DAVID CASPER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-11
Name of individual signing DAVID CASPER
Valid signature Filed with authorized/valid electronic signature
ALLIANT DERMATOLOGY 401(K) PLAN 2014 455622044 2015-04-08 ALLIANT DERMATOLOGY PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-10-01
Business code 621399
Sponsor’s telephone number 3523997295
Plan sponsor’s address 8620A EAST COUNTY ROAD 466, THE VILLAGES, FL, 321623670

Signature of
Role Plan administrator
Date 2015-04-08
Name of individual signing STEVEN CASPER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-08
Name of individual signing STEVEN CASPER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CASPER David Agent 8620 E COUNTY ROAD 466, THE VILLAGES, FL, 32162

Chief Executive Officer

Name Role Address
CASPER DAVID J Chief Executive Officer 8620A E COUNTY ROAD 466, THE VILLAGES, FL, 32162

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2019-03-03 8620 E COUNTY ROAD 466, THE VILLAGES, FL 32162 No data
CHANGE OF MAILING ADDRESS 2019-03-03 8620 E COUNTY ROAD 466, THE VILLAGES, FL 32162 No data
AMENDMENT 2016-10-13 No data No data
REGISTERED AGENT NAME CHANGED 2016-10-13 CASPER, David No data
REGISTERED AGENT ADDRESS CHANGED 2016-10-13 8620 E COUNTY ROAD 466, THE VILLAGES, FL 32162 No data
AMENDMENT 2012-12-26 No data No data

Documents

Name Date
ANNUAL REPORT 2024-03-12
ANNUAL REPORT 2023-03-17
ANNUAL REPORT 2022-01-30
ANNUAL REPORT 2021-02-26
ANNUAL REPORT 2020-02-27
ANNUAL REPORT 2019-03-03
ANNUAL REPORT 2018-04-01
ANNUAL REPORT 2017-01-28
Amendment 2016-10-13
ANNUAL REPORT 2016-03-06

Related by officers

CASPER David

ALLIANT MANAGEMENT GROUP, INC. EGG & I OCALA, LLC

Related by address

8620 E COUNTY ROAD 466, THE VILLAGES, FL, 32162, US

CREEKSIDE DERMATOLOGY, PA

8620 E COUNTY ROAD 466, THE VILLAGES, FL, 32162, US

CREEKSIDE DERMATOLOGY, PA

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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