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  5. CUSTOM ANESTHESIA SERVICES, INC.

CUSTOM ANESTHESIA SERVICES, INC.

Company Details

Entity Name: CUSTOM ANESTHESIA SERVICES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 24 May 1995 (30 years ago)
Document Number: P95000041011
FEI/EIN Number 650586710
Address: 15342 BRIAR RIDGE CR., FORT MYERS, FL, 33912
Mail Address: 15342 BRIAR RIDGE CR., FORT MYERS, FL, 33912
ZIP code: 33912
County: Lee
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CUSTOM ANESTHESIA SERVICES, INC. PROFIT SHARING PLAN 2014 650586710 2015-07-17 CUSTOM ANESTHESIA SERVICES, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2395437209
Plan sponsor’s mailing address 15342 BRIAR RIDGE CIRCLE, FORT MYERS, FL, 33912
Plan sponsor’s address 15342 BRIAR RIDGE CIRCLE, FT. MYERS, FL, 33912

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2015-07-17
Name of individual signing DAVID OBRIEN
Valid signature Filed with authorized/valid electronic signature
CUSTOM ANESTHESIA SERVICES, INC. PROFIT SHARING PLAN 2013 650586710 2014-08-13 CUSTOM ANESTHESIA SERVICES, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2395437209
Plan sponsor’s mailing address 15342 BRIAR RIDGE CIRCLE, FORT MYERS, FL, 33912
Plan sponsor’s address 15342 BRIAR RIDGE CIRCLE, FT. MYERS, FL, 33912

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2014-08-13
Name of individual signing DAVID OBRIEN
Valid signature Filed with authorized/valid electronic signature
CUSTOM ANESTHESIA SERVICES, INC. PROFIT SHARING PLAN 2012 650586710 2013-09-04 CUSTOM ANESTHESIA SERVICES, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2395437209
Plan sponsor’s mailing address 15342 BRIAR RIDGE CIRCLE, FORT MYERS, FL, 33912
Plan sponsor’s address 15342 BRIAR RIDGE CIRCLE, FT. MYERS, FL, 33912

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2013-09-04
Name of individual signing DAVID OBRIEN
Valid signature Filed with authorized/valid electronic signature
CUSTOM ANESTHESIA SERVICES, INC. PROFIT SHARING PLAN 2011 650586710 2012-08-13 CUSTOM ANESTHESIA SERVICES, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2395437209
Plan sponsor’s mailing address 15342 BRIAR RIDGE CIRCLE, FORT MYERS, FL, 33912
Plan sponsor’s address 15342 BRIAR RIDGE CIRCLE, FT. MYERS, FL, 33912

Plan administrator’s name and address
Administrator’s EIN 650586710
Plan administrator’s name CUSTOM ANESTHESIA SERVICES, INC.
Plan administrator’s address 15342 BRIAR RIDGE CIRCLE, FORT MYERS, FL, 33912
Administrator’s telephone number 2395437209

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-08-10
Name of individual signing DAVID OBRIEN
Valid signature Filed with authorized/valid electronic signature
CUSTOM ANESTHESIA SERVICES, INC. PROFIT SHARING PLAN 2010 650586710 2011-06-02 CUSTOM ANESTHESIA SERVICES, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2395437209
Plan sponsor’s mailing address 15342 BRIAR RIDGE CIRCLE, FORT MYERS, FL, 33912
Plan sponsor’s address 15342 BRIAR RIDGE CIRCLE, FT. MYERS, FL, 33912

Plan administrator’s name and address
Administrator’s EIN 650586710
Plan administrator’s name CUSTOM ANESTHESIA SERVICES, INC.
Plan administrator’s address 15342 BRIAR RIDGE CIRCLE, FORT MYERS, FL, 33912
Administrator’s telephone number 2395437209

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-06-01
Name of individual signing DAVID OBRIEN
Valid signature Filed with authorized/valid electronic signature
CUSTOM ANESTHESIA SERVICES, INC. PROFIT SHARING PLAN 2009 650586710 2010-09-20 CUSTOM ANESTHESIA SERVICES, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 2395437209
Plan sponsor’s mailing address 15342 BRIAR RIDGE CIRCLE, FORT MYERS, FL, 33912
Plan sponsor’s address 15342 BRIAR RIDGE CIRCLE, FT. MYERS, FL, 33912

Plan administrator’s name and address
Administrator’s EIN 650586710
Plan administrator’s name CUSTOM ANESTHESIA SERVICES, INC.
Plan administrator’s address 15342 BRIAR RIDGE CIRCLE, FORT MYERS, FL, 33912
Administrator’s telephone number 2395437209

Number of participants as of the end of the plan year
Active participants 4
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-09-20
Name of individual signing DAVID OBRIEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SHIELDS CHRISTOPHER J Agent 1833 HENDRY STREET, FORT MYERS, FL, 33901

Secretary

Name Role Address
JONES KEVIN D Secretary 15342 BRIAR RIDGE CIRCLE, FT. MYERS, FL

Treasurer

Name Role Address
JONES KEVIN D Treasurer 15342 BRIAR RIDGE CIRCLE, FT. MYERS, FL

Director

Name Role Address
JONES KEVIN D Director 15342 BRIAR RIDGE CIRCLE, FT. MYERS, FL
O'BRIEN DAVID F Director 16051 BRIAR CLIFF LANE, FT. MYERS, FL

Vice President

Name Role Address
O'BRIEN DAVID F Vice President 16051 BRIAR CLIFF LANE, FT. MYERS, FL

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Related by address

No related companies by address

Date of last update: 01 Jan 2025

Sources: Florida Department of State

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