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  5. H. Russell Cook, P.C.

H. Russell Cook, P.C.

Details

Name: H. Russell Cook, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 14 Dec 1988 (36 years ago)
Date of dissolution: 09 Dec 2016
Entity Number: 000-127-802
Register Number: 000127802
ZIP code: 36330
County: Coffee
Place of Formation: Coffee County
Registered Office Street Address: 207 EAST WATTS ST SUITE 220 BLDG BENTERPRISE, AL 36330
Authorized Capital: $1,200
Paid Share Capital: $1,200

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1710322987 2013-05-01 2015-12-09 PO BOX 310210, ENTERPRISE, AL, 363310210, US 207 E WATTS ST, SUITE 220, ENTERPRISE, AL, 363301801, US

Contacts
Phone +1 334-393-1056
Fax 3343936187

Authorized person
Name DR. H. RUSSELL COOK
Role OWNER
Phone 3343931056

Taxonomy
Taxonomy Code 261QP2300X - Primary Care Clinic/Center
License Number DO126
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 000014819
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RUSSELL COOK DO PROFIT SHARING PLAN 2015 621375301 2016-08-22 H. RUSSELL COOK, P.C. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-12-15
Business code 621111
Sponsor’s telephone number 3343931056
Plan sponsor’s address P O BOX 210, ENTERPRISE, AL, 36331
RUSSELL COOK DO PROFIT SHARING PLAN 2014 621375301 2015-08-13 H. RUSSELL COOK, P.C. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-12-15
Business code 621111
Sponsor’s telephone number 3343931056
Plan sponsor’s address P O BOX 210, ENTERPRISE, AL, 36331
RUSSELL COOK DO PROFIT SHARING PLAN 2013 621375301 2014-09-12 H. RUSSELL COOK, P.C. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-12-15
Business code 621111
Sponsor’s telephone number 3343931056
Plan sponsor’s address P O BOX 210, ENTERPRISE, AL, 36331
RUSSELL COOK DO PROFIT SHARING PLAN 2012 621375301 2013-08-14 H. RUSSELL COOK, P.C. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-12-15
Business code 621111
Sponsor’s telephone number 3343931056
Plan sponsor’s address P O BOX 210, ENTERPRISE, AL, 36331

Signature of
Role Plan administrator
Date 2013-08-14
Name of individual signing H.RUSSELL COOK
RUSSELL COOK DO PROFIT SHARING PLAN 2011 621375301 2012-09-24 H. RUSSELL COOK, P.C. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-12-15
Business code 621111
Sponsor’s telephone number 3343931056
Plan sponsor’s address P O BOX 210, ENTERPRISE, AL, 36331

Plan administrator’s name and address
Administrator’s EIN 621375301
Plan administrator’s name H. RUSSELL COOK, P.C.
Plan administrator’s address P O BOX 210, ENTERPRISE, AL, 36331
Administrator’s telephone number 3343931056

Signature of
Role Plan administrator
Date 2012-09-21
Name of individual signing H.RUSSELL COOK
RUSSELL COOK DO PROFIT SHARING PLAN 2010 621375301 2011-09-02 H. RUSSELL COOK, P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-12-15
Business code 621111
Sponsor’s telephone number 3343931056
Plan sponsor’s address P O BOX 210, ENTERPRISE, AL, 36331

Plan administrator’s name and address
Administrator’s EIN 621375301
Plan administrator’s name H. RUSSELL COOK, P.C.
Plan administrator’s address P O BOX 210, ENTERPRISE, AL, 36331
Administrator’s telephone number 3343931056

Signature of
Role Plan administrator
Date 2011-09-01
Name of individual signing H.RUSSELL COOK
RUSSELL COOK DO PROFIT SHARING PLAN 2009 621375301 2010-07-09 H. RUSSELL COOK, P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1989-12-15
Business code 621111
Sponsor’s telephone number 3343931056
Plan sponsor’s mailing address P O BOX 210, ENTERPRISE, AL, 36331
Plan sponsor’s address 207 EAST WATTS ST, ENTERPRISE, AL, 36330

Plan administrator’s name and address
Administrator’s EIN 621375301
Plan administrator’s name H. RUSSELL COOK, P.C.
Plan administrator’s address P O BOX 210, ENTERPRISE, AL, 36331
Administrator’s telephone number 3343931056

Number of participants as of the end of the plan year
Active participants 3
Other retired or separated participants entitled to future benefits 1
Number of participants with account balances as of the end of the plan year 4

Signature of
Role Plan administrator
Date 2010-07-09
Name of individual signing H.RUSSELL COOK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
COOK, H RUSSELL Agent

Incorporator

Name Role
COOK, H RUSSELL Incorporator

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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