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  5. CLINICAL & FORENSIC INSTITUTE, INC.

CLINICAL & FORENSIC INSTITUTE, INC.

Company Details

Entity Name: CLINICAL & FORENSIC INSTITUTE, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 05 Jun 1992 (33 years ago)
Last Event: AMENDMENT
Event Date Filed: 22 Aug 2005 (19 years ago)
Document Number: V41897
FEI/EIN Number 65-0338493
Address: 1900 N UNIVERSITY DRIVE, SUITE 210, PEMBROKE PINES, FL 33024
Mail Address: 1900 N University Drive, Suite 210, Pembroke Pines, FL 33024
ZIP code: 33024
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1386860856 2007-04-17 2009-01-22 4801 S UNIVERSITY DR, SUITE 301-EAST, DAVIE, FL, 333283839, US 4801 S UNIVERSITY DR, SUITE 301-EAST, DAVIE, FL, 333283839, US

Contacts
Phone +1 954-434-8006
Fax 9544340147

Authorized person
Name DR. LORI JANE BUTTS
Role PRESIDENT
Phone 9544348006

Taxonomy
Taxonomy Code 103TC0700X - Clinical Psychologist
License Number PY0006490
State FL
Is Primary No
Taxonomy Code 103TF0200X - Forensic Psychologist
License Number PY0006490
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CLINICAL & FORENSIC INSTITUTE 401K PROFIT SHARING PLAN 2023 650338493 2024-05-26 CLINICAL & FORENSIC INSTITUTE 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 9544348006
Plan sponsor’s address 2101 S. ANDREWS AVE., SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2024-05-26
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature
CLINICAL & FORENSIC INSTITUTE 401K PROFIT SHARING PLAN 2022 650338493 2023-05-30 CLINICAL & FORENSIC INSTITUTE 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 9544348006
Plan sponsor’s address 2101 S. ANDREWS AVE., SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2023-05-30
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature
CLINICAL & FORENSIC INSTITUTE 401K PROFIT SHARING PLAN 2021 650338493 2022-07-13 CLINICAL & FORENSIC INSTITUTE 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 9544348006
Plan sponsor’s address 2101 S. ANDREWS AVE., SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2022-07-13
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature
CLINICAL & FORENSIC INSTITUTE 401K PROFIT SHARING PLAN 2020 650338493 2021-06-09 CLINICAL & FORENSIC INSTITUTE 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 9544348006
Plan sponsor’s address 2101 S. ANDREWS AVE., SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2021-06-09
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature
CLINICAL & FORENSIC INSTITUTE 401K PROFIT SHARING PLAN 2019 650338493 2020-07-16 CLINICAL & FORENSIC INSTITUTE 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 7865473235
Plan sponsor’s address 2101 S. ANDREWS AVE., SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2020-07-16
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature
CLINICAL & FORENSIC INSTITUTE 401K PROFIT SHARING PLAN 2018 650338493 2019-06-26 CLINICAL & FORENSIC INSTITUTE 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 7865473235
Plan sponsor’s address 2101 S. ANDREWS AVE., SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2019-06-26
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature
CLINICAL & FORENSIC INSTITUTE 401K PROFIT SHARING PLAN 2017 650338493 2018-05-26 CLINICAL & FORENSIC INSTITUTE 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 7865473235
Plan sponsor’s address 2101 S. ANDREWS AVE., SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2018-05-26
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature
CLINICAL & FORENSIC INSTITUTE 401K PROFIT SHARING PLAN 2016 650338493 2017-05-19 CLINICAL & FORENSIC INSTITUTE 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 7865473235
Plan sponsor’s address 2101 S. ANDREWS AVE., SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2017-05-19
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature
CLINICAL & FORENSIC INSTITUTE 401K PROFIT SHARING PLAN 2015 650338493 2016-06-04 CLINICAL & FORENSIC INSTITUTE 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 7865473235
Plan sponsor’s address 2101 S. ANDREWS AVE., SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2016-06-04
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature
CLINICAL FORENSIC INSTITUTE 401 K PROFIT SHARING PLAN TRUST 2014 650338493 2015-06-04 CLINICAL & FORENSIC INSTITUTE 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621330
Sponsor’s telephone number 9544348006
Plan sponsor’s address 2101 S. ANDREWS AVE, SUITE 103, FT. LAUDERDALE, FL, 33316

Signature of
Role Plan administrator
Date 2015-06-04
Name of individual signing LORI BUTTS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BUTTS, LORI J Agent 1900 N UNIVERSITY DRIVE, SUITE 210, PEMBROKE PINES, FL 33024

PRESIDENT

Name Role Address
BUTTS, LORI J PRESIDENT 1900 N UNIVERSITY DRIVE, SUITE 210 PEMBROKE PINES, FL 33024

Vice President

Name Role Address
FERNANDEZ, VANESSA Vice President 1900 N UNIVERSITY DRIVE, SUITE 210 PEMBROKE PINES, FL 33024

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G09000127810 THE R.E.A.C.H. PROGRAM EXPIRED 2009-06-26 2014-12-31 No data 4801 SOUTH UNIVERSITY DRIVE, SUITE 301-EAST, DAVIE, FL, 33328

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-11-08 1900 N UNIVERSITY DRIVE, SUITE 210, PEMBROKE PINES, FL 33024 No data
REGISTERED AGENT ADDRESS CHANGED 2024-11-08 1900 N UNIVERSITY DRIVE, SUITE 210, PEMBROKE PINES, FL 33024 No data
CHANGE OF MAILING ADDRESS 2024-11-04 1900 N UNIVERSITY DRIVE, SUITE 210, PEMBROKE PINES, FL 33024 No data
AMENDMENT 2005-08-22 No data No data
REGISTERED AGENT NAME CHANGED 2005-08-22 BUTTS, LORI J No data

Documents

Name Date
Reg. Agent Change 2024-11-08
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-01-25
AMENDED ANNUAL REPORT 2022-05-09
ANNUAL REPORT 2022-01-19
ANNUAL REPORT 2021-01-27
ANNUAL REPORT 2020-01-20
ANNUAL REPORT 2019-02-12
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-10

Related by officers

FERNANDEZ, VANESSA

ROLY FERNANDEZ INVESTMENTS, INC.

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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