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Covenant Pain Therapies Center, Inc.

Details

Name: Covenant Pain Therapies Center, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Dissolved
Date of registration: 08 Nov 2016 (8 years ago)
Date of dissolution: 13 Mar 2023
Entity Number: 000-375-989
Register Number: 000375989
Historical Names: Covenant Pain Therapies Center, LLC
County: Madison
Place of Formation: Jefferson County
Registered Office Street Address: 3007 MEMORIAL PARKWAY SW SUITE CHUNTSVILLE, AL 35801
Registered Office Street Address ZIP Code: 35801
Authorized Capital: 100 @ $1.00 PV

Activities PROVIDE MEDICAL/RELATED SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1235671231 2016-11-08 2021-07-13 PO BOX 18084, HUNTSVILLE, AL, 358048084, US 3007 MEMORIAL PKWY SW, HUNTSVILLE, AL, 358015393, US

Contacts
Phone +1 256-882-2003
Fax 2567054630

Authorized person
Name CHERYL ANN GOURD
Role SOLE MEMBER
Phone 2567054406

Taxonomy
Taxonomy Code 208VP0014X - Interventional Pain Medicine Physician
License Number 12320
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COVENANT PAIN CENTER 401(K) PLAN 2023 814362899 2024-04-15 COVENANT PAIN THERAPIES CENTER, INC. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 2567054406
Plan sponsor’s address 3007 MEMORIAL PKWY SW, SUITE C, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 823719843
Plan administrator’s name FUTUREPLAN FIDUCIARY SERVICES LLC
Plan administrator’s address PO BOX 55757, BOSTON, MA, 02205
Administrator’s telephone number 8557115283

Signature of
Role Plan administrator
Date 2024-04-15
Name of individual signing ERIC QUELLA
COVENANT PAIN CENTER 401(K) PLAN 2022 814362899 2023-05-25 COVENANT PAIN THERAPIES CENTER, INC. 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 2567054406
Plan sponsor’s address 3007 MEMORIAL PKWY SW, SUITE C, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 823719843
Plan administrator’s name FUTUREPLAN FIDUCIARY SERVICES LLC
Plan administrator’s address PO BOX 55757, BOSTON, MA, 02205
Administrator’s telephone number 6174546797

Signature of
Role Plan administrator
Date 2023-05-25
Name of individual signing TIFFANY CHENARD
COVENANT PAIN CENTER 401(K) PLAN 2021 814362899 2022-10-05 COVENANT PAIN THERAPIES CENTER, INC. 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 2567054406
Plan sponsor’s address 3007 MEMORIAL PKWY SW, SUITE C, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 823719843
Plan administrator’s name ASCENSUS HOLDINGS, INC.
Plan administrator’s address 113 SEABOARD LANE, SUITE B150, FRANKLIN, TN, 37067
Administrator’s telephone number 6154677090

Signature of
Role Plan administrator
Date 2022-10-05
Name of individual signing ERIC QUELLA
COVENANT PAIN CENTER 401(K) PLAN 2021 814362899 2022-10-05 COVENANT PAIN THERAPIES CENTER, INC. 48
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 2567054406
Plan sponsor’s address 3007 MEMORIAL PKWY SW, SUITE C, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 823719843
Plan administrator’s name ASCENSUS HOLDINGS, INC.
Plan administrator’s address 113 SEABOARD LANE, SUITE B150, FRANKLIN, TN, 37067
Administrator’s telephone number 6154677090

Signature of
Role Plan administrator
Date 2022-10-05
Name of individual signing ERIC QUELLA
COVENANT PAIN CENTER 401(K) PLAN 2020 814362899 2021-10-13 COVENANT PAIN THERAPIES CENTER, INC. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 2567054406
Plan sponsor’s address 3007 MEMORIAL PKWY SW, SUITE C, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 823719843
Plan administrator’s name ASCENSUS HOLDINGS, INC.
Plan administrator’s address 113 SEABOARD LANE, SUITE B150, FRANKLIN, TN, 37067
Administrator’s telephone number 6154677090

Signature of
Role Plan administrator
Date 2021-10-13
Name of individual signing CHRISTINA OWEN
COVENANT PAIN CENTER 401(K) PLAN 2019 814362899 2020-10-12 COVENANT PAIN THERAPIES CENTER, INC. 52
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 2567054406
Plan sponsor’s address 3007 MEMORIAL PKWY SW, SUITE C, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 823719843
Plan administrator’s name ASCENSUS HOLDINGS, INC.
Plan administrator’s address 113 SEABOARD LANE, SUITE B150, FRANKLIN, TN, 37067
Administrator’s telephone number 6154677090

Signature of
Role Plan administrator
Date 2020-10-12
Name of individual signing CHRISTINA OWEN
COVENANT PAIN CENTER 401(K) PLAN 2019 814362899 2020-10-30 COVENANT PAIN THERAPIES CENTER, INC. 52
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 2567054406
Plan sponsor’s address 3007 MEMORIAL PKWY SW, SUITE C, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 823719843
Plan administrator’s name ASCENSUS HOLDINGS, INC.
Plan administrator’s address 113 SEABOARD LANE, SUITE B150, FRANKLIN, TN, 37067
Administrator’s telephone number 6154677090

Signature of
Role Plan administrator
Date 2020-10-30
Name of individual signing CHRISTINA OWEN
COVENANT PAIN CENTER 401(K) PLAN 2018 814362899 2019-10-14 COVENANT PAIN THERAPIES CENTER, INC. 56
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 2567054406
Plan sponsor’s address 3007 MEMORIAL PKWY SW, SUITE C, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 823719843
Plan administrator’s name ASCENSUS HOLDINGS, INC.
Plan administrator’s address 113 SEABOARD LANE, SUITE B150, FRANKLIN, TN, 37067
Administrator’s telephone number 6154677090

Signature of
Role Plan administrator
Date 2019-10-14
Name of individual signing CHRISTINA OWEN
COVENANT PAIN CENTER 401(K) PLAN 2017 814362899 2018-10-05 COVENANT PAIN THERAPIES CENTER, LLC 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-03-01
Business code 621111
Sponsor’s telephone number 2567054406
Plan sponsor’s address 3007 MEMORIAL PKWY SW, SUITE C, HUNTSVILLE, AL, 35801

Plan administrator’s name and address
Administrator’s EIN 823719843
Plan administrator’s name ASCENSUS HOLDINGS, INC.
Plan administrator’s address 113 SEABOARD LANE, SUITE B150, FRANKLIN, TN, 37067
Administrator’s telephone number 6154677090

Signature of
Role Plan administrator
Date 2018-10-05
Name of individual signing VERONICA FRANKS

Director

Name Role Address
RAINS, THOMAS Director 3007 MEMORIAL PARKWAY SW SUITE CHUNTSVILLE, AL 35801

Agent

Name Role Address
RAINS, THOMAS Agent 3007 MEMORIAL PARKWAY SW SUITE CHUNTSVILLE, AL 35801

Incorporator

Name Role Address
THOMPSON, CHRIS Incorporator 1901 SIXTH AVE N STE 1400BIRMINGHAM, AL 35203

Events

Event Date Event Type Old Value New Value
2018-02-21 Name Change Covenant Pain Therapies Center, LLC Covenant Pain Therapies Center, Inc.

Related by officers

THOMPSON, CHRIS

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Related by address

No related companies by address

Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State

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