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DAVID B. SOUTHREN, M.D., P.C.

Company Details

Name: DAVID B. SOUTHREN, M.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 15 Nov 1990 (34 years ago) (Companies founded in November 1990)
Entity Number: 1489019
ZIP code: 10994 (Companies in Rockland, 10994)
County: Rockland
Place of Formation: New York
Address: 2 MEDICAL PARK DR, STE 3, WEST NYACK, NY, United States, 10994

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DAVID B. SOUTHREN, M.D., P.C. 401(K) PROFIT SHARING PLAN & TRUST 2010 133592840 2011-09-20 DAVID B. SOUTHREN, M.D., P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-03-01
Business code 111100
Sponsor’s telephone number 8452689880
Plan sponsor’s address 206 ROUTE 303, VALLEY COTTAGE, NY, 10989

Plan administrator’s name and address
Administrator’s EIN 133592840
Plan administrator’s name DAVID B. SOUTHREN, M.D., P.C.
Plan administrator’s address 206 ROUTE 303, VALLEY COTTAGE, NY, 10989
Administrator’s telephone number 8452689880

Signature of
Role Plan administrator
Date 2011-09-20
Name of individual signing DAVID B. SOUTHREN, M.D.
DAVID B. SOUTHREN, M.D., P.C. PROFIT SHARING PLAN 2010 133592840 2011-09-20 DAVID B. SOUTHREN, M.D., P.C. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 8452680880
Plan sponsor’s address 206 ROUTE 303, VALLEY COTTAGE, NY, 10989

Plan administrator’s name and address
Administrator’s EIN 133592840
Plan administrator’s name DAVID B. SOUTHREN, M.D., P.C.
Plan administrator’s address 206 ROUTE 303, VALLEY COTTAGE, NY, 10989
Administrator’s telephone number 8452680880

Signature of
Role Plan administrator
Date 2011-09-20
Name of individual signing DAVID B. SOUTHREN, M.D.
DAVID B. SOUTHREN, M.D., P.C. PROFIT SHARING PLAN 2009 133592840 2010-10-04 DAVID B. SOUTHREN, M.D., P.C. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8452680880
Plan sponsor’s address 206 ROUTE 303, ADDRESS LINE 2, VALLEY COTTAGE, NY, 10989

Plan administrator’s name and address
Administrator’s EIN 133592840
Plan administrator’s name DAVID B. SOUTHREN, M.D., P.C.
Plan administrator’s address 206 ROUTE 303, ADDRESS LINE 2, VALLEY COTTAGE, NY, 10989
Administrator’s telephone number 8452680880

Signature of
Role Plan administrator
Date 2010-10-04
Name of individual signing DAVID B. SOUTHREN, M.D.
DAVID B. SOUTHREN, M.D., P.C. 401(K) PROFIT SHARING PLAN & TRUST 2009 133592840 2010-10-04 DAVID B. SOUTHREN, M.D., P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-03-01
Business code 111100
Sponsor’s telephone number 8452689880
Plan sponsor’s address 206 ROUTE 303, ADDRESS LINE 2, VALLEY COTTAGE, NY, 10989

Plan administrator’s name and address
Administrator’s EIN 133592840
Plan administrator’s name DAVID B. SOUTHREN, M.D., P.C.
Plan administrator’s address 206 ROUTE 303, ADDRESS LINE 2, VALLEY COTTAGE, NY, 10989
Administrator’s telephone number 8452689880

Signature of
Role Plan administrator
Date 2010-10-04
Name of individual signing DAVID B. SOUTHREN, M.D.

Chief Executive Officer

Name Role Address
DAVID B. SOUTHREN M.D., P.C. Chief Executive Officer 2 MEDICAL PARK DR, STE 3, WEST NY, NY, United States, 10994

DOS Process Agent

Name Role Address
DAVID B. SOUTHREN, M.D., P.C. DOS Process Agent 2 MEDICAL PARK DR, STE 3, WEST NYACK, NY, United States, 10994

History

Start date End date Type Value
2024-11-01 2024-11-01 Address 206 RTE 303, VALLEY COTTAGE, NY, 10989, USA (Type of address: Chief Executive Officer)
2024-11-01 2024-11-01 Address 2 MEDICAL PARK DR, STE 3, WEST NY, NY, 10994, USA (Type of address: Chief Executive Officer)
2023-12-28 2024-11-01 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2023-12-28 2024-11-01 Address 206 RTE 303, VALLEY COTTAGE, NY, 10989, USA (Type of address: Service of Process)
2023-12-28 2023-12-28 Address 206 RTE 303, VALLEY COTTAGE, NY, 10989, USA (Type of address: Chief Executive Officer)
2023-12-28 2024-11-01 Address 206 RTE 303, VALLEY COTTAGE, NY, 10989, USA (Type of address: Chief Executive Officer)
2004-08-17 2023-12-28 Address 206 ROUTE 303, VALLEY COTTAGE, NY, 10989, USA (Type of address: Service of Process)
2003-03-28 2004-08-17 Address 206 ROUTE 303, VALLEY COTTAGE, NY, 10989, USA (Type of address: Service of Process)
1996-11-14 2003-03-28 Address 206 RTE 303, VALLEY COTTAGE, NY, 10989, USA (Type of address: Service of Process)
1996-11-14 2023-12-28 Address 206 RTE 303, VALLEY COTTAGE, NY, 10989, USA (Type of address: Chief Executive Officer)

Filings

Filing Number Date Filed Type Effective Date
241101039177 2024-11-01 BIENNIAL STATEMENT 2024-11-01
231228001548 2023-12-28 BIENNIAL STATEMENT 2023-12-28
201210060617 2020-12-10 BIENNIAL STATEMENT 2020-11-01
110214002882 2011-02-14 BIENNIAL STATEMENT 2010-11-01
081215002260 2008-12-15 BIENNIAL STATEMENT 2008-11-01
061212002485 2006-12-12 BIENNIAL STATEMENT 2006-11-01
050111002028 2005-01-11 BIENNIAL STATEMENT 2004-11-01
040817000419 2004-08-17 CERTIFICATE OF AMENDMENT 2004-08-17
030630002579 2003-06-30 BIENNIAL STATEMENT 2002-11-01
030328000604 2003-03-28 CERTIFICATE OF CHANGE 2003-03-28

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 14 Nov 2024

Sources: New York Secretary of State

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