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  5. ADULT MEDICINE OF LAKE COUNTY, INC.

ADULT MEDICINE OF LAKE COUNTY, INC. - Florida Company Profile

Company Details

Entity Name: ADULT MEDICINE OF LAKE COUNTY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

ADULT MEDICINE OF LAKE COUNTY, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act.
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 15 Dec 1997 (27 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 29 Oct 2019 (5 years ago)
Document Number: P97000105435
FEI/EIN Number 593483343

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 3619 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757
Mail Address: 3619 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757
ZIP code: 32757
County: Lake
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1851450209 2006-12-08 2024-11-04 3619 LAKE CENTER DR, MOUNT DORA, FL, 327572364, US 3619 LAKE CENTER DR, MOUNT DORA, FL, 327572364, US

Contacts
Phone +1 352-383-8222
Fax 3523831420

Authorized person
Name SHIRLEY NAGEL
Role PRESIDENT
Phone 3523838222

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ADULT MEDICINE OF LAKE COUNTY 401(K) PROFIT SHARING PLAN AND TRUST 2023 593483343 2024-08-08 ADULT MEDICINE OF LAKE COUNTY INC. 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3523838222
Plan sponsor’s address 3619 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757

Signature of
Role Plan administrator
Date 2024-08-08
Name of individual signing MARILYN DOYLE
Valid signature Filed with authorized/valid electronic signature
ADULT MEDICINE OF LAKE COUNTY 401(K) PROFIT SHARING PLAN AND TRUST 2022 593483343 2023-09-29 ADULT MEDICINE OF LAKE COUNTY INC. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3523838222
Plan sponsor’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 327572364

Signature of
Role Plan administrator
Date 2023-09-29
Name of individual signing MARILYN DOYLE
Valid signature Filed with authorized/valid electronic signature
ADULT MEDICINE OF LAKE COUNTY 401 K PROFIT SHARING PLAN TRUST 2014 593483343 2015-07-31 ADULT MEDICINE OF LAKE COUNTY 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3523839057
Plan sponsor’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 327572364

Signature of
Role Plan administrator
Date 2015-07-31
Name of individual signing ANN PIKE
Valid signature Filed with authorized/valid electronic signature
ADULT MEDICINE OF LAKE COUNTY 401 K PROFIT SHARING PLAN TRUST 2014 593483343 2015-07-31 ADULT MEDICINE OF LAKE COUNTY 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3523839057
Plan sponsor’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 327572364

Signature of
Role Plan administrator
Date 2015-07-31
Name of individual signing ANN PIKE
Valid signature Filed with authorized/valid electronic signature
ADULT MEDICINE OF LAKE COUNTY 401 K PROFIT SHARING PLAN TRUST 2013 593483343 2014-06-20 ADULT MEDICINE OF LAKE COUNTY 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3523839057
Plan sponsor’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 327572364

Signature of
Role Plan administrator
Date 2014-06-20
Name of individual signing ANN M PIKE
Valid signature Filed with authorized/valid electronic signature
ADULT MEDICINE OF LAKE COUNTY 401 K PROFIT SHARING PLAN TRUST 2012 593483343 2013-06-20 ADULT MEDICINE OF LAKE COUNTY 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3523839057
Plan sponsor’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 327572364

Signature of
Role Plan administrator
Date 2013-06-20
Name of individual signing ADULT MEDICINE OF LAKE COUNTY
Valid signature Filed with authorized/valid electronic signature
ADULT MEDICINE OF LAKE COUNTY 401 K PROFIT SHARING PLAN TRUST 2011 593483343 2012-10-04 ADULT MEDICINE OF LAKE COUNTY 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3523839057
Plan sponsor’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 327572364

Plan administrator’s name and address
Administrator’s EIN 593483343
Plan administrator’s name ADULT MEDICINE OF LAKE COUNTY
Plan administrator’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 327572364
Administrator’s telephone number 3523839057

Signature of
Role Plan administrator
Date 2012-10-04
Name of individual signing ADULT MEDICINE OF LAKE COUNTY
Valid signature Filed with authorized/valid electronic signature
ADULT MEDICINE OF LAKE COUNTY 401 K PROFIT SHARING PLAN TRUST 2010 593483343 2012-10-04 ADULT MEDICINE OF LAKE COUNTY 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3523839057
Plan sponsor’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 32757

Plan administrator’s name and address
Administrator’s EIN 593483343
Plan administrator’s name ADULT MEDICINE OF LAKE COUNTY
Plan administrator’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 32757
Administrator’s telephone number 3523839057

Signature of
Role Plan administrator
Date 2012-10-04
Name of individual signing ADULT MEDICINE OF LAKE COUNTY
Valid signature Filed with authorized/valid electronic signature
ADULT MEDICINE OF LAKE COUNTY 2009 593483343 2010-08-02 ADULT MEDICINE OF LAKE COUNTY 21
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3523839057
Plan sponsor’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 32757

Plan administrator’s name and address
Administrator’s EIN 593483343
Plan administrator’s name ADULT MEDICINE OF LAKE COUNTY
Plan administrator’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 32757
Administrator’s telephone number 3523839057

Signature of
Role Plan administrator
Date 2010-08-02
Name of individual signing ADULT MEDICINE OF LAKE COUNTY
Valid signature Filed with incorrect/unrecognized electronic signature
ADULT MEDICINE OF LAKE COUNTY 2009 593483343 2010-08-03 ADULT MEDICINE OF LAKE COUNTY 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3523839057
Plan sponsor’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 32757

Plan administrator’s name and address
Administrator’s EIN 593483343
Plan administrator’s name ADULT MEDICINE OF LAKE COUNTY
Plan administrator’s address 3619 LAKE CENTER DR, MOUNT DORA, FL, 32757
Administrator’s telephone number 3523839057

Signature of
Role Plan administrator
Date 2010-08-03
Name of individual signing ADULT MEDICINE OF LAKE COUNTY
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
NAGEL SHIRLEY M Director 3619 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757
DAVINA ELEANOR Director 3619 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757
NAGEL SHIRLEY M Agent 3619 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G20000092831 MED SPA MOUNT DORA ACTIVE 2020-07-31 2025-12-31 - 3587 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757

Events

Event Type Filed Date Value Description
REINSTATEMENT 2019-10-29 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 - -
REGISTERED AGENT NAME CHANGED 2018-10-31 NAGEL, SHIRLEY MD -
REINSTATEMENT 2018-10-31 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 - -
REGISTERED AGENT ADDRESS CHANGED 2008-01-15 3619 LAKE CENTER DRIVE, MOUNT DORA, FL 32757 -
CHANGE OF PRINCIPAL ADDRESS 2008-01-15 3619 LAKE CENTER DRIVE, MOUNT DORA, FL 32757 -
CHANGE OF MAILING ADDRESS 2008-01-15 3619 LAKE CENTER DRIVE, MOUNT DORA, FL 32757 -

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J22000027005 ACTIVE 35-2021-CA-001989-AXXX-XX CIRCUIT COURT, LAKE COUNTY 2021-10-15 2027-01-18 $168,974.29 BALBOA CAPITAL CORPORATION, 575 ANTON BLVD, 12TH FLOOR, COSTA MESA, CA 92626

Documents

Name Date
ANNUAL REPORT 2025-01-22
ANNUAL REPORT 2024-02-09
ANNUAL REPORT 2023-02-24
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-05-19
ANNUAL REPORT 2020-06-12
REINSTATEMENT 2019-10-29
REINSTATEMENT 2018-10-31
ANNUAL REPORT 2017-02-13
ANNUAL REPORT 2016-03-03

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2746757209 2020-04-16 0491 PPP 3619 LAKE CENTER DR, MOUNT DORA, FL, 32757
Loan Status Date 2022-02-18
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 325000
Loan Approval Amount (current) 325000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 48270
Servicing Lender Name JPMorgan Chase Bank, National Association
Servicing Lender Address 1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address MOUNT DORA, LAKE, FL, 32757-0001
Project Congressional District FL-11
Number of Employees 46
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Hispanic or Latino
Business Type Subchapter S Corporation
Originating Lender ID 194093
Originating Lender Name JPMorgan Chase Bank, National Association
Originating Lender Address CHICAGO, IL
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 330556.06
Forgiveness Paid Date 2022-01-06

Companies related by officers

DAVINA ELEANOR

MEDSPA OF MOUNT DORA INC. - Active
Domestic Profit (2021 )
WELLCARE PROPERTIES, L.L.C. - Active
Florida Limited Liability Co. (2006 )
CLINICAL RESEARCH OF ADULT MEDICINE LLC - Active
Florida Limited Liability Co. (2023 )
KALEIDOSCOPE MARKETING CONCEPTS, LLC - Active
Florida Limited Liability Co. (2023 )

Companies related by address

3619 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757

MOUNT DORA CENTER FOR WELLNESS AND VITALITY, INC. BODY BY US LLC CLINICAL RESEARCH OF ADULT MEDICINE LLC KALEIDOSCOPE MARKETING CONCEPTS, LLC

3619 LAKE CENTER DRIVE, MOUNT DORA, FL, 32757

MOUNT DORA CENTER FOR WELLNESS AND VITALITY, INC. BODY BY US LLC CLINICAL RESEARCH OF ADULT MEDICINE LLC KALEIDOSCOPE MARKETING CONCEPTS, LLC

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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