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Performance Anesthesia, Inc.

Details

Name: Performance Anesthesia, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Dissolved
Date of registration: 31 Dec 2008 (16 years ago)
Date of dissolution: 01 Oct 2015
Entity Number: 000-259-589
Register Number: 000259589
County: Limestone
Place of Formation: Limestone County
Principal Address: ATHENS, AL
Registered Office Street Address: 17174 LEATHERWOOD DRATHENS, AL 35611
Registered Office Street Address ZIP Code: 35611
Authorized Capital: $50,000
Paid Share Capital: $2,000

Activities ANESTHESIA SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1700135720 2012-09-05 2012-09-05 PO BOX 660257, BIRMINGHAM, AL, 352660257, US 202 HOSPITAL ST, MOULTON, AL, 356501218, US

Contacts
Phone +1 205-979-5882
Fax 2059791248
Phone +1 256-974-2200
Fax 2562161982

Authorized person
Name RANDALL J WILSON
Role OWNER
Phone 2059795882

Taxonomy
Taxonomy Code 367500000X - Certified Registered Nurse Anesthetist
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PERFORMANCE ANESTHESIA, INC. 401K PROFIT SHARING PLAN 2013 263901620 2014-07-02 PERFORMANCE ANESTHESIA, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 2566421344
Plan sponsor’s address 17174 LEATHERWOOD DR, ATHENS, AL, 35611
PERFORMANCE ANESTHESIA, INC. 401K PROFIT SHARING PLAN 2012 263901620 2013-10-14 PERFORMANCE ANESTHESIA, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 2566421344
Plan sponsor’s address 17174 LEATHERWOOD DR, ATHENS, AL, 35611

Signature of
Role Plan administrator
Date 2013-10-14
Name of individual signing J FASSE, TPA
PERFORMANCE ANESTHESIA,INC. 401K PLAN 2011 263901620 2012-07-31 PERFORMANCE ANESTHESIA,INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 2566421344
Plan sponsor’s address 17174 LEATHERWOOD DRIVE, ATHENS, AL, 35611

Plan administrator’s name and address
Administrator’s EIN 263901620
Plan administrator’s name PERFORMANCE ANESTHESIA,INC.
Plan administrator’s address 17174 LEATHERWOOD DRIVE, ATHENS, AL, 35611
Administrator’s telephone number 2566421344

Signature of
Role Plan administrator
Date 2012-07-31
Name of individual signing RANDALL WILSON
Role Employer/plan sponsor
Date 2012-07-31
Name of individual signing RANDALL WILSON
PERFORMANCE ANESTHESIA,INC. 401K PLAN 2010 263901620 2011-10-14 PERFORMANCE ANESTHESIA,INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 2566421344
Plan sponsor’s address 17174 LEATHERWOOD DRIVE, ATHENS, AL, 35611

Plan administrator’s name and address
Administrator’s EIN 263901620
Plan administrator’s name PERFORMANCE ANESTHESIA,INC.
Plan administrator’s address 17174 LEATHERWOOD DRIVE, ATHENS, AL, 35611
Administrator’s telephone number 2566421344

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing RANDALL WILSON
Role Employer/plan sponsor
Date 2011-10-14
Name of individual signing RANDALL WILSON
PERFORMANCE ANESTHESIA,INC. 401K PLAN 2009 263901620 2010-10-12 PERFORMANCE ANESTHESIA,INC. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 2566421344
Plan sponsor’s address 17174 LEATHERWOOD DRIVE, ATHENS, AL, 35611

Plan administrator’s name and address
Administrator’s EIN 263901620
Plan administrator’s name PERFORMANCE ANESTHESIA,INC.
Plan administrator’s address 17174 LEATHERWOOD DRIVE, ATHENS, AL, 35611
Administrator’s telephone number 2566421344

Signature of
Role Plan administrator
Date 2010-10-12
Name of individual signing RANDALL WILSON
Role Employer/plan sponsor
Date 2010-10-12
Name of individual signing RANDALL WILSON
PERFORMANCE ANESTHESIA,INC. 401K PLAN 2009 263901620 2010-10-12 PERFORMANCE ANESTHESIA,INC. 0
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621399
Sponsor’s telephone number 2566421344
Plan sponsor’s address 17174 LEATHERWOOD DRIVE, ATHENS, AL, 35611

Plan administrator’s name and address
Administrator’s EIN 263901620
Plan administrator’s name PERFORMANCE ANESTHESIA,INC.
Plan administrator’s address 17174 LEATHERWOOD DRIVE, ATHENS, AL, 35611
Administrator’s telephone number 2566421344

Signature of
Role Plan administrator
Date 2010-10-12
Name of individual signing RANDALL WILSON
Role Employer/plan sponsor
Date 2010-10-12
Name of individual signing RANDALL WILSON

Agent

Name Role
GRAHAM, DOYLE W Agent

Incorporator

Name Role
GRAHAM, DOYLE W Incorporator
WILSON, RANDALL J Incorporator

Related by officers

No related officers

Related by address

ATHENS, AL

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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