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JEFFREY ELLENBERG, D.M.D., P.A.

Company Details

Entity Name: JEFFREY ELLENBERG, D.M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 25 Mar 1998 (27 years ago)
Date of dissolution: 22 Sep 1998 (26 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 22 Sep 1998 (26 years ago)
Document Number: P98000027812
Address: 1430 BELCHER ROAD SOUTH, CLEARWATER, FL, 34624
Mail Address: 1430 BELCHER ROAD SOUTH, CLEARWATER, FL, 34624
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JEFFREY ELLENBERG, D.M.D., P.A. 401(K) PROFIT SHARING PLAN AND T 2023 592285092 2024-09-05 JEFFREY ELLENBERG, D.M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 7275317751
Plan sponsor’s address 1430 S. BELCHER ROAD, CLEARWATER, FL, 33764

Signature of
Role Plan administrator
Date 2024-09-05
Name of individual signing SHIRLEY HORNER
Valid signature Filed with authorized/valid electronic signature
JEFFREY ELLENBERG, D.M.D., P.A. 401(K) PROFIT SHARING PLAN AND T 2022 592285092 2023-09-14 JEFFREY ELLENBERG, D.M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 7275317751
Plan sponsor’s address 1430 S. BELCHER ROAD, CLEARWATER, FL, 33764

Signature of
Role Plan administrator
Date 2023-09-14
Name of individual signing SHIRLEY HORNER
Valid signature Filed with authorized/valid electronic signature
JEFFREY ELLENBERG, D.M.D., P.A. 401(K) PROFIT SHARING PLAN AND T 2021 592285092 2022-08-23 JEFFREY ELLENBERG, D.M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 7275317751
Plan sponsor’s address 1430 S. BELCHER ROAD, CLEARWATER, FL, 33764

Signature of
Role Plan administrator
Date 2022-08-23
Name of individual signing NICK RICE
Valid signature Filed with authorized/valid electronic signature
JEFFREY ELLENBERG, D.M.D., P.A. 401(K) PROFIT SHARING PLAN AND T 2019 592285092 2020-10-09 JEFFREY ELLENBERG, D.M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 7275317751
Plan sponsor’s address 1430 S. BELCHER ROAD, CLEARWATER, FL, 33764

Signature of
Role Plan administrator
Date 2020-10-09
Name of individual signing JEFFREY ELLENBERG
Valid signature Filed with authorized/valid electronic signature
JEFFREY ELLENBERG, D.M.D., P.A. 401(K) PROFIT SHARING PLAN 2010 592285092 2011-10-06 JEFFREY ELLENBERG, D.M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 7275317751
Plan sponsor’s address 1430 SOUTH BELCHER ROAD, CLEARWATER, FL, 337642876

Plan administrator’s name and address
Administrator’s EIN 592285092
Plan administrator’s name JEFFREY ELLENBERG, D.M.D., P.A.
Plan administrator’s address 1430 SOUTH BELCHER ROAD, CLEARWATER, FL, 337642876
Administrator’s telephone number 7275317751

Signature of
Role Plan administrator
Date 2011-10-06
Name of individual signing JEFFREY ELLENBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
JEFFREY ELLENBERG, D.M.D., P.A., 401(K) PROFIT SHARING PLAN 2010 592285092 2011-11-14 JEFFREY ELLENBERG, D.M.D., P.A. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 7275317751
Plan sponsor’s address 1430 BELCHER ROAD SOUTH, CLEARWATER, FL, 337642876

Plan administrator’s name and address
Administrator’s EIN 592285092
Plan administrator’s name JEFFREY ELLENBERG, D.M.D., P.A.
Plan administrator’s address 1430 BELCHER ROAD SOUTH, CLEARWATER, FL, 337642876
Administrator’s telephone number 7275317751

Signature of
Role Plan administrator
Date 2011-11-14
Name of individual signing JEFFREY ELLENBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature
JEFFREY ELLENBERG, D.M.D., P.A., 401(K) PROFIT SHARING PLAN 2010 592285092 2011-11-14 JEFFREY ELLENBERG, D.M.D., P.A. 0
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 7275317751
Plan sponsor’s address 1430 BELCHER ROAD SOUTH, CLEARWATER, FL, 337642876

Plan administrator’s name and address
Administrator’s EIN 592285092
Plan administrator’s name JEFFREY ELLENBERG, D.M.D., P.A.
Plan administrator’s address 1430 BELCHER ROAD SOUTH, CLEARWATER, FL, 337642876
Administrator’s telephone number 7275317751

Signature of
Role Plan administrator
Date 2011-11-14
Name of individual signing JEFFREY ELLENBERG, D.M.D.
Valid signature Filed with incorrect/unrecognized electronic signature
JEFFREY ELLENBERG, D.M.D., P.A. 401(K) PROFIT SHARING PLAN 2009 592285092 2010-10-15 JEFFREY ELLENBERG, D.M.D., P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621210
Sponsor’s telephone number 7275317751
Plan sponsor’s address 1430 SOUTH BELCHER ROAD, CLEARWATER, FL, 337642876

Plan administrator’s name and address
Administrator’s EIN 592285092
Plan administrator’s name JEFFREY ELLENBERG, D.M.D., P.A.
Plan administrator’s address 1430 SOUTH BELCHER ROAD, CLEARWATER, FL, 337642876
Administrator’s telephone number 7275317751

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing JEFFREY ELLENBERG, D.M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LOVELACE WILLIAM K Agent 2310 WEST BAY DRIVE, LARGO, FL, 33770

Director

Name Role Address
ELLENBERG JEFFREY Director 1430 BELCHER ROAD SOUTH, CLEARWATER, FL, 34624

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 1998-09-22 No data No data

Documents

Name Date
Voluntary Dissolution 1998-09-22
Domestic Profit 1998-03-25

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Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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