| Entity Name: | LAKE UROLOGY ADMINISTRATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 28 Dec 1992 (32 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 29 Nov 2018 (6 years ago) |
| Document Number: | P92000015255 |
| FEI/EIN Number | 59-3155729 |
| Address: | LAKE UROLOGY CLINIC, 12109 COUNTY ROAD 103, OXFORD, FL 34484 |
| Mail Address: | LAKE UROLOGY CLINIC, 12109 COUNTY ROAD 103, OXFORD, FL 34484 |
| ZIP code: | 34484 |
| County: | Sumter |
| Place of Formation: | FLORIDA |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE UROLOGY ADMINISTRATION INC. 401(K) PLAN | 2010 | 593155729 | 2012-12-21 | LAKE UROLOGY ADMINISTRATION INC | 24 | |||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 593155729 |
| Plan administrator’s name | LAKE UROLOGY ADMINISTRATION INC |
| Plan administrator’s address | 616 N. PALMETTO ST., LEESBURG, FL, 34748 |
| Administrator’s telephone number | 3527874567 |
Signature of
| Role | Plan administrator |
| Date | 2012-12-21 |
| Name of individual signing | DAVID BRUNETTI |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2000-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3527874567 |
| Plan sponsor’s address | 616 N. PALMETTO ST., LEESBURG, FL, 34748 |
Plan administrator’s name and address
| Administrator’s EIN | 593155729 |
| Plan administrator’s name | LAKE UROLOGY ADMINISTRATION INC |
| Plan administrator’s address | 616 N. PALMETTO ST., LEESBURG, FL, 34748 |
| Administrator’s telephone number | 3527874567 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-06 |
| Name of individual signing | DAVID BRUNETTI |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| LAKE UROLOGY CLINIC | Agent | 12109 COUNTY ROAD 103, OXFORD, FL 34484 |
| Name | Role | Address |
|---|---|---|
| SHER, ANDREW B | Director | 12109 COUNTY ROAD 103, OXFORD, FL 34484 |
| ROACH, RICHARD | Director | 12109 COUNTY ROAD 103, OXFORD, FL 34484 |
| GORDON, CAROLE | Director | 12109 COUNTY ROAD 103, OXFORD, FL 34484 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2018-11-29 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-11-29 | LAKE UROLOGY CLINIC, 12109 COUNTY ROAD 103, OXFORD, FL 34484 | No data |
| CHANGE OF MAILING ADDRESS | 2018-11-29 | LAKE UROLOGY CLINIC, 12109 COUNTY ROAD 103, OXFORD, FL 34484 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-11-29 | LAKE UROLOGY CLINIC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-11-29 | 12109 COUNTY ROAD 103, OXFORD, FL 34484 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-02-26 |
| REINSTATEMENT | 2018-11-29 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-13 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
