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  5. VALRICO BRANDON MEDICAL GROUP, INC.

VALRICO BRANDON MEDICAL GROUP, INC.

Company Details

Entity Name: VALRICO BRANDON MEDICAL GROUP, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 06 May 1999 (26 years ago)
Date of dissolution: 12 Aug 2019 (5 years ago)
Last Event: VOLUNTARY DISS W/ NOTICE
Event Date Filed: 12 Aug 2019 (5 years ago)
Document Number: P99000041171
FEI/EIN Number 593574830
Address: 2237 LITHIA CENTER LN., VALRICO, FL, 33596, US
Mail Address: 2237 LITHIA CENTER LN., VALRICO, FL, 33596, US
ZIP code: 33596
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1972554673 2006-05-15 2008-02-20 2237 LITHIA CENTER LN, VALRICO, FL, 335945676, US 2237 LITHIA CENTER LN, VALRICO, FL, 335945676, US

Contacts
Phone +1 813-662-0123
Fax 8136629422

Authorized person
Name FRED BEARISON
Role MEDICAL DIRECTOR
Phone 8136620123

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

Other Provider Identifiers
Issuer BC/BS
Number 97072

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN - FINAL 2018 593574830 2019-06-05 VALRICO BRANDON MEDICAL GROUP, INC. 0
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN - FINAL 2018 593574830 2019-06-05 VALRICO BRANDON MEDICAL GROUP, INC. 0
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN - FINAL 2018 593574830 2019-09-26 VALRICO BRANDON MEDICAL GROUP, INC. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN 2018 593574830 2019-06-05 VALRICO BRANDON MEDICAL GROUP, INC. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN 2017 593574830 2018-03-05 VALRICO BRANDON MEDICAL GROUP, INC. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596

Signature of
Role Plan administrator
Date 2018-03-05
Name of individual signing FRED BEARISON
Valid signature Filed with authorized/valid electronic signature
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN 2016 593574830 2017-06-06 VALRICO BRANDON MEDICAL GROUP, INC. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN 2015 593574830 2016-06-17 VALRICO BRANDON MEDICAL GROUP, INC. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN 2014 593574830 2015-04-20 VALRICO BRANDON MEDICAL GROUP, INC. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596

Signature of
Role Plan administrator
Date 2015-04-20
Name of individual signing FRED BEARISON
Valid signature Filed with authorized/valid electronic signature
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN 2013 593574830 2014-05-02 VALRICO BRANDON MEDICAL GROUP, INC. 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596

Signature of
Role Plan administrator
Date 2014-05-02
Name of individual signing FRED BEARISON
Valid signature Filed with authorized/valid electronic signature
VALRICO BRANDON MEDICAL GROUP, INC. 401(K) PLAN 2012 593574830 2013-05-13 VALRICO BRANDON MEDICAL GROUP, INC. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-01
Business code 621111
Sponsor’s telephone number 8136620123
Plan sponsor’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596

Plan administrator’s name and address
Administrator’s EIN 593574830
Plan administrator’s name VALRICO BRANDON MEDICAL GROUP, INC.
Plan administrator’s address 2237 LITHIA CENTER LANE, VALRICO, FL, 33596
Administrator’s telephone number 8136620123

Signature of
Role Plan administrator
Date 2013-05-13
Name of individual signing FRED BEARISON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BEARISON FRED Agent 2237 LITHIA CENTER LN., VALRICO, FL, 33596

Director

Name Role Address
BEARISON FRED Director 2237 LITHA CENTER LN., VALRICO, FL, 33596

President

Name Role Address
BEARISON FRED President 2237 LITHA CENTER LN., VALRICO, FL, 33596

Secretary

Name Role Address
BEARISON FRED Secretary 2237 LITHA CENTER LN., VALRICO, FL, 33596

Treasurer

Name Role Address
BEARISON FRED Treasurer 2237 LITHA CENTER LN., VALRICO, FL, 33596

Events

Event Type Filed Date Value Description
VOLUNTARY DISS W/ NOTICE 2019-08-12 No data No data
CHANGE OF PRINCIPAL ADDRESS 2011-01-12 2237 LITHIA CENTER LN., VALRICO, FL 33596 No data
CHANGE OF MAILING ADDRESS 2011-01-12 2237 LITHIA CENTER LN., VALRICO, FL 33596 No data
REGISTERED AGENT ADDRESS CHANGED 2008-02-15 2237 LITHIA CENTER LN., VALRICO, FL 33596 No data

Documents

Name Date
CORAPVDWN 2019-08-12
ANNUAL REPORT 2018-01-31
ANNUAL REPORT 2017-02-02
ANNUAL REPORT 2016-02-03
ANNUAL REPORT 2015-02-02
ANNUAL REPORT 2014-03-17
ANNUAL REPORT 2013-01-31
ANNUAL REPORT 2012-03-19
ANNUAL REPORT 2011-01-12
ANNUAL REPORT 2010-02-19

Related by officers

BEARISON FRED

PARKS BEARISON, INC.

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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