| Name: | Brookwood OB-GYN, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 19 Jul 2001 (23 years ago) (Companies founded in July 2001) |
| Date of dissolution: | 29 Dec 2011 |
| Entity Number: | 000-217-887 |
| Register Number: | 000217887 |
| ZIP code: | 35209 (Companies in Jefferson, 35209) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 2006 BROOKWOOD MEDICAL CENTER DR, STE 202BIRMINGHAM, AL 35209 |
| Authorized Capital: | $1,000 |
Activities
OBSTETRICS/GYNECOLOGY SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164590352 | 2006-12-04 | 2020-08-22 | 2006 BROOKWOOD MEDICAL CTR DR, SUITE 202, WMP, BIRMINGHAM, AL, 352096899, US | 2006 BROOKWOOD MEDICAL CTR DR, SUITE 202, WMP, BIRMINGHAM, AL, 352096899, US | |||||||||||||||||
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| Phone | +1 205-877-2850 |
| Fax | 2058772858 |
Authorized person
| Name | DR. JACK B FREEMAN |
| Role | PRESIDENT |
| Phone | 2058772850 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| State | AL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BROOKWOOD OB-GYN, P.C. 401(K) PROFIT SHARING PLAN | 2011 | 631279525 | 2012-05-30 | BROOKWOOD OB-GYN, P.C. | 23 | |||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 631279525 |
| Plan administrator’s name | BROOKWOOD OB-GYN, P.C. |
| Plan administrator’s address | 2006 BROOKWOOD MED CTR DR STE 202, BIRMINGHAM, AL, 352096823 |
| Administrator’s telephone number | 2058772853 |
Signature of
| Role | Plan administrator |
| Date | 2012-05-30 |
| Name of individual signing | JACK B. FREEMAN, M.D. |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2001-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2058772853 |
| Plan sponsor’s address | 2006 BROOKWOOD MEDICAL CENTER DRIVE, SUITE 202, BIRMINGHAM, AL, 352096823 |
Plan administrator’s name and address
| Administrator’s EIN | 631279525 |
| Plan administrator’s name | BROOKWOOD OB-GYN, P.C. |
| Plan administrator’s address | 2006 BROOKWOOD MEDICAL CENTER DRIVE, SUITE 202, BIRMINGHAM, AL, 352096823 |
| Administrator’s telephone number | 2058772853 |
Signature of
| Role | Plan administrator |
| Date | 2011-10-13 |
| Name of individual signing | JACK B. FREEMAN, M.D. |
| Role | Employer/plan sponsor |
| Date | 2011-10-13 |
| Name of individual signing | JACK B. FREEMAN, M.D. |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2001-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2058772853 |
| Plan sponsor’s address | 2006 BROOKWOOD MEDICAL CENTER DRIVE, SUITE 202, BIRMINGHAM, AL, 352096823 |
Plan administrator’s name and address
| Administrator’s EIN | 631279525 |
| Plan administrator’s name | BROOKWOOD OB-GYN, P.C. |
| Plan administrator’s address | 2006 BROOKWOOD MEDICAL CENTER DRIVE, SUITE 202, BIRMINGHAM, AL, 352096823 |
| Administrator’s telephone number | 2058772853 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-12 |
| Name of individual signing | JACK B. FREEMAN, M.D. |
| Role | Employer/plan sponsor |
| Date | 2010-10-12 |
| Name of individual signing | JACK B. FREEMAN, M.D. |
| Name | Role | Address |
|---|---|---|
| CHRISTIAN, EDWARD R | Incorporator | 420 20TH ST N STE 3400BIRMINGHAM, AL 35203 |
| Name | Role |
|---|---|
| FREEEMAN, JACK B | Agent |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
