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  5. FAMILY MEDICAL CARE OF MOUNT DORA, INC.

FAMILY MEDICAL CARE OF MOUNT DORA, INC. - Florida Company Profile

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Company Details

Entity Name: FAMILY MEDICAL CARE OF MOUNT DORA, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 26 Dec 2012 (13 years ago)
Last Event: AMENDMENT
Event Date Filed: 22 May 2017 (8 years ago)
Document Number: P12000103591
FEI/EIN Number 46-1785485
Address: 1502 N. Donnelly Street, MOUNT DORA, FL, 32757, US
Mail Address: 1502 N. Donnelly Street, MOUNT DORA, FL, 32757, US
ZIP code: 32757
City: Mount Dora
County: Lake
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
HALL-INGALLS GINA President 1502 N. Donnelly Street, MOUNT DORA, FL, 32757
HALL-INGALLS GINA Agent 1502 N. Donnelly Street, MOUNT DORA, FL, 32757

National Provider Identifier

NPI Number:
1265844757
Link:
View on NPI website

Authorized Person:

Name:
JOHN N BOUCHER
Role:
CEO
Phone:
4078347800

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Phone:
+1 352-383-8200

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2018-03-26 1502 N. Donnelly Street, Suite 107, MOUNT DORA, FL 32757 -
CHANGE OF MAILING ADDRESS 2018-03-26 1502 N. Donnelly Street, Suite 107, MOUNT DORA, FL 32757 -
REGISTERED AGENT ADDRESS CHANGED 2018-03-26 1502 N. Donnelly Street, Suite 107, MOUNT DORA, FL 32757 -
AMENDMENT 2017-05-22 - -
REGISTERED AGENT NAME CHANGED 2017-05-22 HALL-INGALLS, GINA -
AMENDMENT 2013-02-20 - -

Documents

Name Date
ANNUAL REPORT 2024-05-01
ANNUAL REPORT 2023-04-28
ANNUAL REPORT 2022-03-08
ANNUAL REPORT 2021-01-29
ANNUAL REPORT 2020-04-03
ANNUAL REPORT 2019-04-26
ANNUAL REPORT 2018-03-26
Amendment 2017-05-22
ANNUAL REPORT 2017-02-01
ANNUAL REPORT 2016-01-21

USAspending Awards / Financial Assistance

Date:
2021-01-27
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
17500.00
Total Face Value Of Loan:
17500.00
Date:
2020-05-02
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
4000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-05-02
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
18052.00
Total Face Value Of Loan:
18052.00
Date:
2020-05-02
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
18052.00
Total Face Value Of Loan:
18052.00
Date:
2020-05-02
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
4000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Paycheck Protection Program

Jobs Reported:
4
Initial Approval Amount:
$17,500
Date Approved:
2021-01-27
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$17,500
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$17,618.62
Servicing Lender:
JPMorgan Chase Bank, National Association
Use of Proceeds:
Payroll: $17,498
Utilities: $1
Jobs Reported:
4
Initial Approval Amount:
$18,052
Date Approved:
2020-05-01
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$18,052
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$18,215.64
Servicing Lender:
JPMorgan Chase Bank, National Association
Use of Proceeds:
Payroll: $14,442
Rent: $3,610

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CHAMPION WEALTH ADVISORS, LLC
Florida Limited Liability Co.
CHAMPION WEALTH ADVISORS, LLC, which currently Inactive, had registered address 1502 N. Donnelly Street, MOUNT DORA, FL, 32757, US.
CHAMPION WEALTH ADVISORS, LLC
Florida Limited Liability Co.
CHAMPION WEALTH ADVISORS, LLC, which currently Inactive, had registered address 1502 N. Donnelly Street, MOUNT DORA, FL, 32757, US.
KIP 1, LLC
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KIP 1, LLC, which currently Inactive, had registered address 1502 N. Donnelly Street, MOUNT DORA, FL, 32757, US.
KIP 1, LLC
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KIP 1, LLC, which currently Inactive, had registered address 1502 N. Donnelly Street, MOUNT DORA, FL, 32757, US.

Date of last update: 01 Aug 2025

Sources: Florida Department of State

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