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Simon-Williamson Clinic, P.C.

Details

Name: Simon-Williamson Clinic, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 01 Jul 1975 (49 years ago) (Companies founded in July 1975)
Entity Number: 000-038-691
Register Number: 000038691
Historical Names: Simon-Williamson Clinic, P.A.
ZIP code: 35211 (Companies in Jefferson, 35211)
County: Jefferson
Place of Formation: Jefferson County
Principal Address: BIRMINGHAM, AL
Registered Office Street Address: 832 PRINCETON AVENUE SWBIRMINGHAM, AL 35211
Authorized Capital: $25,000
Paid Share Capital: -----

Activities PRACTICE OF MEDICINE

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
D215UTPF7KV7 2022-06-09 832 PRINCETON AVE SW, BIRMINGHAM, AL, 35211, 1320, USA 832 PRINCETON AVENUE, S.W., BIRMINGHAM, AL, 35211, USA

Business Information
Doing Business As (AFF: PRINCETON BAPTIST MEDICAL CENTER)
Division Name SIMON-WILLIAMSON CLINIC, P.C.
Division Number SIMON-WILL
Congressional District 07
State/Country of Incorporation AL, USA
Activation Date 2021-05-20
Initial Registration Date 2021-03-10
Entity Start Date 1935-01-01
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 621111

Points of Contacts
Electronic Business
Title PRIMARY POC
Name HEATHER UNDERWOOD
Address 832 PRINCETON AVENUE SW, BIRMINGHAM, AL, 35211, USA
Government Business
Title PRIMARY POC
Name KRISTINE LEDLOW
Address 832 PRINCETON AVENUE, SW, BIRMINGHAM, AL, 35211, USA
Past Performance Information not Available

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1497702344 2006-05-27 2022-03-17 832 PRINCETON AVE SW, BIRMINGHAM, AL, 352111320, US 832 PRINCETON AVE SW, BIRMINGHAM, AL, 352111323, US

Contacts
Phone +1 205-780-7053
Fax 2053974989

Authorized person
Name WILLIAM E. KIRBY III
Role PRESIDENT OF SWC
Phone 2053978907

Taxonomy
Taxonomy Code 133V00000X - Registered Dietitian
Is Primary No
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary No
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes
Taxonomy Code 207RH0003X - Hematology & Oncology Physician
Is Primary No
Taxonomy Code 207RR0500X - Rheumatology Physician
State AL
Is Primary No
Taxonomy Code 207U00000X - Nuclear Medicine Physician
Is Primary No
Taxonomy Code 207V00000X - Obstetrics & Gynecology Physician
Is Primary No
Taxonomy Code 207W00000X - Ophthalmology Physician
Is Primary No
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary No
Taxonomy Code 213ES0131X - Foot Surgery Podiatrist
Is Primary No
Taxonomy Code 2471M1202X - Magnetic Resonance Imaging Radiologic Technologist
Is Primary No
Taxonomy Code 363LF0000X - Family Nurse Practitioner
Is Primary No
Taxonomy Code 363LP2300X - Primary Care Nurse Practitioner
Is Primary No
Taxonomy Code 367A00000X - Advanced Practice Midwife
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 000060006
State AL
Issuer MEDICARE
Number D436
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SIMON WILLIAMSON CLINIC, P. C. 401(K) PROFIT SHARING PLAN 2023 630693892 2024-10-15 SIMON WILLIAMSON CLINIC, P.C. 65
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1999-09-01
Business code 621111
Sponsor’s telephone number 2052068435
Plan sponsor’s address 832 PRINCETON SW AVE, BIRMINGHAM, AL, 352111323

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing SCOTTIE HUGHES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-15
Name of individual signing SCOTTIE HUGHES
Valid signature Filed with authorized/valid electronic signature
SIMON WILLIAMSON CLINIC SUPPLEMENTAL MEDICAL HEALTH PLAN 2017 630693892 2019-03-29 SIMON WILLIAMSON CLINIC, P.C. 153
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2017-09-01
Business code 621111
Sponsor’s telephone number 2057807053
Plan sponsor’s mailing address 832 PRINCETON AVE SW, BIRMINGHAM, AL, 352111320
Plan sponsor’s address 832 PRINCETON AVE SW, BIRMINGHAM, AL, 352111320

Plan administrator’s name and address
Administrator’s EIN 582015573
Plan administrator’s name COVENANT ADMINISTRATORS INC
Plan administrator’s address 2810 PREMIERE PKWY STE 400, DULUTH, GA, 300978908
Administrator’s telephone number 6782588200

Number of participants as of the end of the plan year
Active participants 142

Signature of
Role Plan administrator
Date 2019-03-29
Name of individual signing THERESA WALDEN
Valid signature Filed with authorized/valid electronic signature
SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2011 630693892 2012-10-15 SIMON-WILLIAMSON CLINIC, P.C. 210
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 2052068253
Plan sponsor’s mailing address 832 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Plan sponsor’s address 832 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211

Plan administrator’s name and address
Administrator’s EIN 630693892
Plan administrator’s name SIMON-WILLIAMSON CLINIC, P.C.
Plan administrator’s address 832 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Administrator’s telephone number 2052068253

Number of participants as of the end of the plan year
Active participants 220
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing ELLOUISE COTTON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-15
Name of individual signing ELLOUISE COTTON
Valid signature Filed with authorized/valid electronic signature
SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2010 630693892 2011-10-17 SIMON-WILLIAMSON CLINIC, P.C. 206
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 2052068253
Plan sponsor’s mailing address 832 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Plan sponsor’s address 832 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211

Plan administrator’s name and address
Administrator’s EIN 630693892
Plan administrator’s name SIMON-WILLIAMSON CLINIC, P.C.
Plan administrator’s address 832 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Administrator’s telephone number 2052068253

Number of participants as of the end of the plan year
Active participants 206
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing LEE BREWER
Valid signature Filed with authorized/valid electronic signature
SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2009 630693892 2010-07-29 SIMON-WILLIAMSON CLINIC, P.C. 163
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 2052068435
Plan sponsor’s mailing address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Plan sponsor’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211

Plan administrator’s name and address
Administrator’s EIN 630693892
Plan administrator’s name SIMON-WILLIAMSON CLINIC, P.C.
Plan administrator’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Administrator’s telephone number 2052068435

Number of participants as of the end of the plan year
Active participants 163
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing JESSICA KUBAT
Valid signature Filed with authorized/valid electronic signature
SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2009 630693892 2010-07-29 SIMON-WILLIAMSON CLINIC, P.C. 253
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 2052068435
Plan sponsor’s mailing address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Plan sponsor’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211

Plan administrator’s name and address
Administrator’s EIN 630693892
Plan administrator’s name SIMON-WILLIAMSON CLINIC, P.C.
Plan administrator’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Administrator’s telephone number 2052068435

Number of participants as of the end of the plan year
Active participants 253
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing JESSICA KUBAT
Valid signature Filed with authorized/valid electronic signature
SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2009 630693892 2010-07-29 SIMON-WILLIAMSON CLINIC, P.C. 172
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 2052068435
Plan sponsor’s mailing address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Plan sponsor’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211

Plan administrator’s name and address
Administrator’s EIN 630693892
Plan administrator’s name SIMON-WILLIAMSON CLINIC, P.C.
Plan administrator’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Administrator’s telephone number 2052068435

Number of participants as of the end of the plan year
Active participants 172
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing JESSICA KUBAT
Valid signature Filed with authorized/valid electronic signature
SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2009 630693892 2010-07-29 SIMON-WILLIAMSON CLINIC, P.C. 159
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 2052068435
Plan sponsor’s mailing address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Plan sponsor’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211

Plan administrator’s name and address
Administrator’s EIN 630693892
Plan administrator’s name SIMON-WILLIAMSON CLINIC, P.C.
Plan administrator’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Administrator’s telephone number 2052068435

Number of participants as of the end of the plan year
Active participants 159
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing JESSICA KUBAT
Valid signature Filed with authorized/valid electronic signature
SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2009 630693892 2010-07-29 SIMON-WILLIAMSON CLINIC, P.C. 145
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 2052068435
Plan sponsor’s mailing address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Plan sponsor’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211

Plan administrator’s name and address
Administrator’s EIN 630693892
Plan administrator’s name SIMON-WILLIAMSON CLINIC, P.C.
Plan administrator’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Administrator’s telephone number 2052068435

Number of participants as of the end of the plan year
Active participants 145
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing JESSICA KUBAT
Valid signature Filed with authorized/valid electronic signature
SIMON-WILLIAMSON CLINIC, P.C. GROUP HEALTH AND WELFARE BENEFITS PLAN 2009 630693892 2010-07-29 SIMON-WILLIAMSON CLINIC, P.C. 143
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1990-01-01
Business code 621111
Sponsor’s telephone number 2052068435
Plan sponsor’s mailing address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Plan sponsor’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211

Plan administrator’s name and address
Administrator’s EIN 630693892
Plan administrator’s name SIMON-WILLIAMSON CLINIC, P.C.
Plan administrator’s address 833 PRINCETON AVENUE, SW, 3RD FLOOR, BIRMINGHAM, AL, 35211
Administrator’s telephone number 2052068435

Number of participants as of the end of the plan year
Active participants 143
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing JESSICA KUBAT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
MONTGOMERY, RIAN L Agent

Incorporator

Name Role
NAVARI, RUDOLPH M MD Incorporator
BEARDEN, WINFORD E MD Incorporator

Events

Event Date Event Type Old Value New Value
1997-03-11 Capital Change $10,000 Authorized ----- Paid In $25,000 Authorized ----- Paid In
1992-09-30 Name Change Simon-Williamson Clinic, P.A. Simon-Williamson Clinic, P.C.

Related by officers

No related officers

Related by address

BIRMINGHAM, AL

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832 PRINCETON AVENUE SWBIRMINGHAM, AL 35211

SWC Princeton II, LLC

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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