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Randolph Medical Associates, P.C.

Details

Name: Randolph Medical Associates, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 29 Oct 1999 (25 years ago) (Companies founded in October 1999)
Entity Number: 000-206-016
Register Number: 000206016
Place of Formation: Randolph County
Principal Address: ROANOKE, AL
Registered Office Street Address: 469 PRICE STROANOKE, AL 36274-2131
Authorized Capital: $100,000
Paid Share Capital: $10,000

Activities PROFESSIONAL MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1104003987 2008-01-24 2008-01-24 PO BOX 625, ROANOKE, AL, 362740625, US 965 US HWY 431, ROANOKE, AL, 36274, US

Contacts
Phone +1 334-863-2150
Fax 3348638733

Authorized person
Name DR. RUSSELL DOAK PETERSON
Role OWNER
Phone 3348632150

Taxonomy
Taxonomy Code 246XS1301X - Sonography Specialist/Technologist
License Number D0436
State AL
Is Primary Yes

Other Provider Identifiers
Issuer BCBS
Number 51091244
State AL
Issuer UPIN
Number E26656
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RANDOLPH MEDICAL ASSOCIATES 401(K) PLAN 2018 631236074 2019-10-18 RANDOLPH MEDICAL ASSOCIATES, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3348632141
Plan sponsor’s address 965 HIGHWAY 431, ROANOKE, AL, 36274

Signature of
Role Plan administrator
Date 2019-10-18
Name of individual signing D'ANN HEARD
RANDOLPH MEDICAL ASSOCIATES 401(K) PLAN 2018 631236074 2019-08-06 RANDOLPH MEDICAL ASSOCIATES, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 3348632141
Plan sponsor’s address 965 HIGHWAY 431, ROANOKE, AL, 36274

Signature of
Role Plan administrator
Date 2019-08-06
Name of individual signing D'ANN HEARD
RANDOLPH MEDICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2011 631236074 2012-08-27 RANDOLPH MEDICAL ASSOCIATES, P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3348632141
Plan sponsor’s mailing address P. O. BOX 625, ROANOKE, AL, 36274
Plan sponsor’s address 965 HWY 431, ROANOKE, AL, 36274

Plan administrator’s name and address
Administrator’s EIN 631236074
Plan administrator’s name RANDOLPH MEDICAL ASSOCIATES, P.C.
Plan administrator’s address P. O. BOX 625, ROANOKE, AL, 36274
Administrator’s telephone number 3348632141

Number of participants as of the end of the plan year
Active participants 0
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
Number of participants with account balances as of the end of the plan year 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 2012-08-27
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
RANDOLPH MEDICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2010 631236074 2011-10-10 RANDOLPH MEDICAL ASSOCIATES, P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3348632141
Plan sponsor’s mailing address P. O. BOX 625, ROANOKE, AL, 36274
Plan sponsor’s address 965 HWY 431, ROANOKE, AL, 36274

Plan administrator’s name and address
Administrator’s EIN 631236074
Plan administrator’s name RANDOLPH MEDICAL ASSOCIATES, P.C.
Plan administrator’s address P. O. BOX 625, ROANOKE, AL, 36274
Administrator’s telephone number 3348632141

Number of participants as of the end of the plan year
Active participants 9
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 10
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 2011-10-10
Name of individual signing MARY PETERSON
Valid signature Filed with authorized/valid electronic signature
RANDOLPH MEDICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2009 631236074 2010-09-21 RANDOLPH MEDICAL ASSOCIATES, P.C. 9
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3348632141
Plan sponsor’s mailing address P. O. BOX 625, ROANOKE, AL, 36274
Plan sponsor’s address 965 HWY 431, ROANOKE, AL, 36274

Plan administrator’s name and address
Administrator’s EIN 631236074
Plan administrator’s name RANDOLPH MEDICAL ASSOCIATES, P.C.
Plan administrator’s address P. O. BOX 625, ROANOKE, AL, 36274
Administrator’s telephone number 3348632141

Number of participants as of the end of the plan year
Active participants 9
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 1
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 10
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 1

Signature of
Role Employer/plan sponsor
Date 2010-09-21
Name of individual signing MARY PETERSON
Valid signature Filed with authorized/valid electronic signature
RANDOLPH MEDICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2009 631236074 2010-09-23 RANDOLPH MEDICAL ASSOCIATES, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3348632141
Plan sponsor’s mailing address P. O. BOX 625, ROANOKE, AL, 36274
Plan sponsor’s address 965 HWY 431, ROANOKE, AL, 36274

Plan administrator’s name and address
Administrator’s EIN 631236074
Plan administrator’s name RANDOLPH MEDICAL ASSOCIATES, P.C.
Plan administrator’s address P. O. BOX 625, ROANOKE, AL, 36274
Administrator’s telephone number 3348632141

Number of participants as of the end of the plan year
Active participants 9
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 1
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 10
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 1

Signature of
Role Plan administrator
Date 2010-09-23
Name of individual signing MARY PETERSON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PETERSON, RUSSELL D Agent 965 HIGHWAY 431ROANOKE, AL 36274

Incorporator

Name Role Address
PETERSON, RUSSELL D Incorporator 965 HIGHWAY 431ROANOKE, AL 36274

Related by officers

PETERSON, RUSSELL D

Rhino Enterprises, LLC Regional Wellness Centers, P.C. d/b/a Randolph Medical Associates, P.C.

Related by address

ROANOKE, AL

Better-Vision Cable Co., Inc. Handley Textiles, Inc. Jack Kitchens Enterprises, Inc. Phillips Brothers Hardware, Inc. Phillips Milling Company Randolph County Livestock Association, Inc. Randolph Memory Gardens, Inc. Webbpak, Inc. Roanoke Furniture Company, Inc. Roanoke Telephone Company, Inc.

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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