Diana M. Mancuso, M.D., P.A.

Details

Name:	Diana M. Mancuso, M.D., P.A.
Jurisdiction:	Alabama
Legal type:	Domestic Professional Association
Status:	Exists
Date of registration:	26 Jun 1981 (43 years ago)
Entity Number:	000-064-499
Register Number:	000064499
County:	Mobile
Place of Formation:	Houston County
Principal Address:	3226 W MAIN STREET STE #2DOTHAN, AL 36603
Principal Address ZIP Code:	36603

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

DIANA M MANCUSO, M.D, P.A PROFIT SHARING PLAN

2023

630809802

2024-06-11

DIANA M. MANCUSO, M.D., P.A.

7

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1981-01-01
Business code	621111
Sponsor’s telephone number	3347934120
Plan sponsor’s address	4300 WEST MAIN STREET, SUITE 16, DOTHAN, AL, 36305

Signature of

Role	Plan administrator
Date	2024-06-11
Name of individual signing	DIANA MANCUSO

DIANA M MANCUSO, M.D, P.A PROFIT SHARING PLAN

2022

630809802

2023-09-04

DIANA M. MANCUSO, M.D., P.A.

5

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1981-01-01
Business code	621111
Sponsor’s telephone number	3347934120
Plan sponsor’s address	4300 WEST MAIN STREET, SUITE 16, DOTHAN, AL, 36305

Signature of

Role	Plan administrator
Date	2023-09-04
Name of individual signing	DIANA M MANCUSO

DIANA M MANCUSO, M.D, P.A PROFIT SHARING PLAN

2021

630809802

2022-06-09

DIANA M. MANCUSO, M.D., P.A.

6

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1981-01-01
Business code	621111
Sponsor’s telephone number	3347934120
Plan sponsor’s address	4300 WEST MAIN STREET, SUITE 16, DOTHAN, AL, 36305

Signature of

Role	Plan administrator
Date	2022-06-09
Name of individual signing	DIANA M MANCUSO

DIANA M MANCUSO, M.D, P.A PROFIT SHARING PLAN

2020

630809802

2021-09-02

DIANA M. MANCUSO, M.D., P.A.

7

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1981-01-01
Business code	621111
Sponsor’s telephone number	3347934120
Plan sponsor’s address	4300 WEST MAIN STREET, SUITE 16, DOTHAN, AL, 36305

Signature of

Role	Plan administrator
Date	2021-09-02
Name of individual signing	DIANA M MANCUSO

DIANA M MANCUSO, M.D, P.A PROFIT SHARING PLAN

2019

630809802

2020-06-16

DIANA M. MANCUSO, M.D., P.A.

7

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1981-01-01
Business code	621111
Sponsor’s telephone number	3347934120
Plan sponsor’s address	4300 WEST MAIN STREET, SUITE 16, DOTHAN, AL, 36305

Signature of

Role	Plan administrator
Date	2020-06-16
Name of individual signing	DIANA M MANCUSO

DIANA M MANCUSO, MD PA PROFIT SHARING PLAN

2018

630809802

2019-07-25

DIANA M. MANCUSO, M.D., P.A.

7

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1981-01-01
Business code	621111
Sponsor’s telephone number	3347934120
Plan sponsor’s address	4300 WEST MAIN STREET, SUITE 16, DOTHAN, AL, 36305

Signature of

Role	Plan administrator
Date	2019-07-25
Name of individual signing	DIANA M MANCUSO

Role	Employer/plan sponsor
Date	2019-07-25
Name of individual signing	DIANA M MANCUSO

DIANA M MANCUSO, MD PA PROFIT SHARING PLAN

2017

630809802

2018-10-02

DIANA M. MANCUSO, M.D., P.A.

7

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1981-01-01
Business code	621111
Sponsor’s telephone number	3347934120
Plan sponsor’s address	4300 WEST MAIN STREET, SUITE 16, DOTHAN, AL, 36305

Signature of

Role	Plan administrator
Date	2018-10-02
Name of individual signing	DIANA M MANCUSO

Role	Employer/plan sponsor
Date	2018-10-02
Name of individual signing	DIANA M MANCUSO

Member

Name	Role
MANCUSO, DIANA M	Member
GREENBERG, ALLAN H	Member

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State