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  5. BRUCE D. SHEPHARD, M.D., P.A.

BRUCE D. SHEPHARD, M.D., P.A.

Company Details

Entity Name: BRUCE D. SHEPHARD, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 01 Mar 1994 (31 years ago)
Date of dissolution: 12 Jan 2018 (7 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 12 Jan 2018 (7 years ago)
Document Number: P94000016419
FEI/EIN Number 593226151
Address: 13014 N. Dale Mabry Hwy, #208, TAMPA, FL, 33618, US
Mail Address: 13014 N. Dale Mabry Hwy, #208, TAMPA, FL, 33618, US
ZIP code: 33618
County: Hillsborough
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BRUCE D. SHEPHARD, M.D., P.A. PROFIT SHARING PLAN 2016 593226151 2017-07-11 BRUCE D. SHEPHARD, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8139285276
Plan sponsor’s address 13014 N. DALE MABRY, #208, TAMPA, FL, 33618

Signature of
Role Plan administrator
Date 2017-07-11
Name of individual signing BRUCE D. SHEPHARD
Valid signature Filed with authorized/valid electronic signature
BRUCE D. SHEPHARD, M.D., P.A. PROFIT SHARING PLAN 2015 593226151 2016-03-07 BRUCE D. SHEPHARD, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8138740720
Plan sponsor’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368

Plan administrator’s name and address
Administrator’s EIN 593226151
Plan administrator’s name BRUCE D. SHEPHARD, M.D., P.A.
Plan administrator’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368
Administrator’s telephone number 8138740720

Signature of
Role Plan administrator
Date 2016-03-07
Name of individual signing BRUCE D. SHEPHARD
Valid signature Filed with authorized/valid electronic signature
BRUCE D. SHEPHARD, M.D., P.A. PROFIT SHARING PLAN 2014 593226151 2015-03-13 BRUCE D. SHEPHARD, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8138740720
Plan sponsor’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368

Plan administrator’s name and address
Administrator’s EIN 593226151
Plan administrator’s name BRUCE D. SHEPHARD, M.D., P.A.
Plan administrator’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368
Administrator’s telephone number 8138740720

Signature of
Role Plan administrator
Date 2015-03-13
Name of individual signing BRUCE D. SHEPHARD
Valid signature Filed with authorized/valid electronic signature
BRUCE D. SHEPHARD, M.D., P.A. PROFIT SHARING PLAN 2013 593226151 2014-03-03 BRUCE D. SHEPHARD, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8138740720
Plan sponsor’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368

Plan administrator’s name and address
Administrator’s EIN 593226151
Plan administrator’s name BRUCE D. SHEPHARD, M.D., P.A.
Plan administrator’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368
Administrator’s telephone number 8138740720

Signature of
Role Plan administrator
Date 2014-03-03
Name of individual signing BRUCE D. SHEPHARD
Valid signature Filed with authorized/valid electronic signature
BRUCE D. SHEPHARD, M.D., P.A. PROFIT SHARING PLAN 2012 593226151 2013-02-28 BRUCE D. SHEPHARD, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8138740720
Plan sponsor’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368

Plan administrator’s name and address
Administrator’s EIN 593226151
Plan administrator’s name BRUCE D. SHEPHARD, M.D., P.A.
Plan administrator’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368
Administrator’s telephone number 8138740720

Signature of
Role Plan administrator
Date 2013-02-28
Name of individual signing BRUCE D. SHEPHARD
Valid signature Filed with authorized/valid electronic signature
BRUCE D. SHEPHARD, M.D., P.A. PROFIT SHARING PLAN 2011 593226151 2012-03-11 BRUCE D. SHEPHARD, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8138740720
Plan sponsor’s DBA name P.A.
Plan sponsor’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368

Plan administrator’s name and address
Administrator’s EIN 593226151
Plan administrator’s name BRUCE D. SHEPHARD, M.D., P.A.
Plan administrator’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368
Administrator’s telephone number 8138762496

Signature of
Role Plan administrator
Date 2012-03-11
Name of individual signing BRUCE D. SHEPHARD
Valid signature Filed with authorized/valid electronic signature
BRUCE D. SHEPHARD, M.D., P.A. PROFIT SHARING PLAN 2010 593226151 2011-04-27 BRUCE D. SHEPHARD, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8138740720
Plan sponsor’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368

Plan administrator’s name and address
Administrator’s EIN 593226151
Plan administrator’s name BRUCE D. SHEPHARD, M.D., P.A.
Plan administrator’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368
Administrator’s telephone number 8138762496

Signature of
Role Plan administrator
Date 2011-04-27
Name of individual signing BRUCE D. SHEPHARD
Valid signature Filed with authorized/valid electronic signature
BRUCE D. SHEPHARD, M.D., P.A. PROFIT SHARING PLAN 2009 593226151 2010-06-01 BRUCE D. SHEPHARD, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621111
Sponsor’s telephone number 8138762496
Plan sponsor’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368

Plan administrator’s name and address
Administrator’s EIN 593226151
Plan administrator’s name BRUCE D. SHEPHARD, M.D., P.A.
Plan administrator’s address 4302 N HABANA AVE STE 300, TAMPA, FL, 336076368
Administrator’s telephone number 8138762496

Signature of
Role Plan administrator
Date 2010-06-01
Name of individual signing BRUCE D. SHEPHARD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SHEPHARD BRUCE D Agent 13014 N. Dale Mabry Hwy, TAMPA, FL, 33618

Manager

Name Role Address
SHEPHARD BRUCE D Manager 13014 N. Dale Mabry Hwy, TAMPA, FL, 33618

Director

Name Role Address
SHEPHARD BRUCE D Director 13014 N. Dale Mabry Hwy, TAMPA, FL, 33618

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2018-01-12 No data No data
CHANGE OF PRINCIPAL ADDRESS 2017-02-13 13014 N. Dale Mabry Hwy, #208, TAMPA, FL 33618 No data
CHANGE OF MAILING ADDRESS 2017-02-13 13014 N. Dale Mabry Hwy, #208, TAMPA, FL 33618 No data
REGISTERED AGENT ADDRESS CHANGED 2017-02-13 13014 N. Dale Mabry Hwy, #208, TAMPA, FL 33618 No data
CANCEL ADM DISS/REV 2004-10-25 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2004-10-01 No data No data
REGISTERED AGENT NAME CHANGED 1995-03-06 SHEPHARD, BRUCE D No data

Documents

Name Date
ANNUAL REPORT 2017-02-13
ANNUAL REPORT 2016-01-25
ANNUAL REPORT 2015-01-13
ANNUAL REPORT 2014-01-19
ANNUAL REPORT 2013-01-27
ANNUAL REPORT 2012-01-07
ANNUAL REPORT 2011-01-31
ANNUAL REPORT 2010-01-26
ANNUAL REPORT 2009-03-31
ANNUAL REPORT 2008-01-11

Related by officers

No related officers

Related by address

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Date of last update: 03 Feb 2025

Sources: Florida Department of State

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