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  5. CAPTIVATING DENTAL CARE, PA

CAPTIVATING DENTAL CARE, PA

Company Details

Entity Name: CAPTIVATING DENTAL CARE, PA
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 20 Jul 2012 (13 years ago)
Document Number: P12000063653
FEI/EIN Number 46-0656817
Address: 100 E. Sugarland Hwy, CLEWISTON, FL, 33440, US
Mail Address: 100 E. Sugarland Hwy, CLEWISTON, FL, 33440, US
ZIP code: 33440
County: Hendry
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CAPTIVATING DENTAL CARE, PA 401(K) PLAN 2023 460656817 2024-09-25 CAPTIVATING DENTAL CARE, PA 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 8639837361
Plan sponsor’s address 100 E. SUGARLAND HWY, CLEWISTON, FL, 33440

Signature of
Role Plan administrator
Date 2024-09-25
Name of individual signing MICHAEL VANDERFORD
Valid signature Filed with authorized/valid electronic signature
CAPTIVATING DENTAL CARE, PA 401(K) PLAN 2022 460656817 2023-09-21 CAPTIVATING DENTAL CARE, PA 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 8639837361
Plan sponsor’s address 100 E. SUGARLAND HWY, CLEWISTON, FL, 33440

Signature of
Role Plan administrator
Date 2023-09-21
Name of individual signing MICHAEL VANDERFORD
Valid signature Filed with authorized/valid electronic signature
CAPTIVATING DENTAL CARE, PA 401(K) PLAN 2021 460656817 2022-10-16 CAPTIVATING DENTAL CARE, PA 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 8639837361
Plan sponsor’s address 100 E. SUGARLAND HWY, CLEWISTON, FL, 33440

Signature of
Role Plan administrator
Date 2022-10-16
Name of individual signing KEVIN VAN
Valid signature Filed with authorized/valid electronic signature
CAPTIVATING DENTAL CARE, PA 401(K) PLAN 2020 460656817 2021-10-12 CAPTIVATING DENTAL CARE, PA 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 8639837361
Plan sponsor’s address 100 E. SUGARLAND HWY, CLEWISTON, FL, 33440

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing KEVIN VAN
Valid signature Filed with authorized/valid electronic signature
CAPTIVATING DENTAL CARE, PA 401(K) PLAN 2019 460656817 2020-10-12 CAPTIVATING DENTAL CARE, PA 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 8639837361
Plan sponsor’s address 100 E. SUGARLAND HWY, CLEWISTON, FL, 33440

Signature of
Role Plan administrator
Date 2020-10-12
Name of individual signing KEVIN VAN
Valid signature Filed with authorized/valid electronic signature
CAPTIVATING DENTAL CARE, PA 401(K) PLAN 2018 460656817 2019-08-20 CAPTIVATING DENTAL CARE, PA 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621210
Sponsor’s telephone number 8639837361
Plan sponsor’s address 100 E. SUGARLAND HWY, CLEWISTON, FL, 33440

Signature of
Role Plan administrator
Date 2019-08-20
Name of individual signing KEVIN VAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
VAN KEVIN D Agent 100 E. Sugarland Hwy, CLEWISTON, FL, 33440

President

Name Role Address
VAN KEVIN President 100 E. Sugarland Hwy, CLEWISTON, FL, 33440

Vice President

Name Role Address
VAN KEVIN Vice President 100 E. Sugarland Hwy, CLEWISTON, FL, 33440

Secretary

Name Role Address
VAN KEVIN Secretary 100 E. Sugarland Hwy, CLEWISTON, FL, 33440

Treasurer

Name Role Address
VAN KEVIN Treasurer 100 E. Sugarland Hwy, CLEWISTON, FL, 33440

Director

Name Role Address
VAN KEVIN Director 100 E. Sugarland Hwy, CLEWISTON, FL, 33440

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2018-04-02 100 E. Sugarland Hwy, CLEWISTON, FL 33440 No data
CHANGE OF MAILING ADDRESS 2018-04-02 100 E. Sugarland Hwy, CLEWISTON, FL 33440 No data
REGISTERED AGENT ADDRESS CHANGED 2018-04-02 100 E. Sugarland Hwy, CLEWISTON, FL 33440 No data

Documents

Name Date
ANNUAL REPORT 2024-03-02
ANNUAL REPORT 2023-04-27
ANNUAL REPORT 2022-04-16
ANNUAL REPORT 2021-04-24
ANNUAL REPORT 2020-05-02
ANNUAL REPORT 2019-04-09
ANNUAL REPORT 2018-04-02
ANNUAL REPORT 2017-01-22
ANNUAL REPORT 2016-02-28
ANNUAL REPORT 2015-03-12

Related by officers

VAN KEVIN

KHAA, LLC KHAA LEHIGH LLC ONE VISION HOLDINGS, LLC CLEWISTON TWO, LLC CLEWISTON ONE, LLC BOND STREET CLEWISTON, LLC VANTASTIC HONEY, L.L.C CLEWISTON RISING SUN, LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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