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  5. BEAN SPROUT, INC.

BEAN SPROUT, INC.

Company Details

Entity Name: BEAN SPROUT, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 03 Oct 2012 (12 years ago)
Document Number: P12000083880
FEI/EIN Number 800855560
Address: 2008 Riverside Avenue, Suite 1, JACKSONVILLE, FL, 32204, US
Mail Address: 5045 TOPROYAL LANE, JACKSONVILLE, FL, 32277, US
ZIP code: 32204
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1942698204 2015-01-08 2015-01-08 2008 RIVERSIDE AVE, SUITE 101, JACKSONVILLE, FL, 322044443, US 2008 RIVERSIDE AVE, SUITE 101, JACKSONVILLE, FL, 322044443, US

Contacts
Phone +1 904-372-3260
Fax 9043853704

Authorized person
Name DR. JODI MASON
Role PEDIATRIC DENTIST
Phone 9043723260

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number 17658
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BEAN SPROUT 401(K) PLAN 2023 800855560 2024-05-02 BEAN SPROUT, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 9043723260
Plan sponsor’s address 2008 RIVERSIDE AVENUE, SUITE 101, JACKSONVILLE, FL, 32204

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-05-02
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
BEAN SPROUT 401(K) PLAN 2022 800855560 2023-05-26 BEAN SPROUT, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 9043723260
Plan sponsor’s address 2008 RIVERSIDE AVENUE, SUITE 101, JACKSONVILLE, FL, 32204

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2023-05-26
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
BEAN SPROUT 401(K) PLAN 2021 800855560 2022-05-19 BEAN SPROUT, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 9043723260
Plan sponsor’s address 2008 RIVERSIDE AVENUE, SUITE 101, JACKSONVILLE, FL, 32204

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2022-05-19
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
BEAN SPROUT 401(K) PLAN 2020 800855560 2021-04-27 BEAN SPROUT, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 9043723260
Plan sponsor’s address 2008 RIVERSIDE AVENUE, SUITE 101, JACKSONVILLE, FL, 32204

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-04-27
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
BEAN SPROUT 401(K) PLAN 2019 800855560 2020-07-01 BEAN SPROUT, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 9043723260
Plan sponsor’s address 2008 RIVERSIDE AVENUE, SUITE 101, JACKSONVILLE, FL, 32204

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-07-01
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
BEAN SPROUT 401(K) PLAN 2018 800855560 2019-07-17 BEAN SPROUT, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 9043723260
Plan sponsor’s address 2008 RIVERSIDE AVENUE, SUITE 101, JACKSONVILLE, FL, 32204

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
BEAN SPROUT 401(K) PLAN 2017 800855560 2018-07-25 BEAN SPROUT, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 9043723260
Plan sponsor’s address 2008 RIVERSIDE AVENUE, SUITE 101, JACKSONVILLE, FL, 32204

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2018-07-25
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Farah Law Agent 6550 St. Augustine Road, JACKSONVILLE, FL, 32217

President

Name Role Address
MASON JODI D President 2008 Riverside Avenue, JACKSONVILLE, FL, 32204

Treasurer

Name Role Address
Mason Arlo Treasurer 2008 Riverside Avenue, JACKSONVILLE, FL, 32204

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000062508 BEAN TREE PEDIATRIC DENTISTRY ACTIVE 2023-05-18 2028-12-31 No data 2008 RIVERSIDE AVENUE, SUITE 101, JACKSONVILLE, FL, 32204
G12000101797 BEAN TREE PEDIATRIC DENTISTRY EXPIRED 2012-10-18 2017-12-31 No data 5045 TOPROYAL LANE, JACKSONVILLE, FL, 32277

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2020-03-17 Farah Law No data
REGISTERED AGENT ADDRESS CHANGED 2014-02-03 6550 St. Augustine Road, Suite 103, JACKSONVILLE, FL 32217 No data
CHANGE OF PRINCIPAL ADDRESS 2013-03-25 2008 Riverside Avenue, Suite 1, JACKSONVILLE, FL 32204 No data

Documents

Name Date
ANNUAL REPORT 2024-02-12
ANNUAL REPORT 2023-01-23
ANNUAL REPORT 2022-03-10
ANNUAL REPORT 2021-02-23
ANNUAL REPORT 2020-03-17
ANNUAL REPORT 2019-02-07
ANNUAL REPORT 2018-03-20
ANNUAL REPORT 2017-04-10
ANNUAL REPORT 2016-04-23
ANNUAL REPORT 2015-02-21

Related by officers

Farah Law

SNIPS LAWN & TREE SERVICE, INC. ELIAS FAMILY PARTNERS, LLC COLLIER INVESTMENTS II, LLC PANTHEON REALTY GROUP, INC. HEALTH POINTE JACKSONVILLE, LLC NEUROSPINE FLORIDA, PA ATI2, INC ADMIRALS INSURANCE CORP COLLIER MEDIA, LLC ACCELERATED DELIVERY, 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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