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  5. GREGORIO N. MEDALLE, M.D., P.A.

GREGORIO N. MEDALLE, M.D., P.A.

Company Details

Entity Name: GREGORIO N. MEDALLE, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 27 Aug 1986 (38 years ago)
Document Number: J30579
FEI/EIN Number 411419893
Address: 2822 CHATSWORTH LANE, LAKELAND, FL, 33812, US
Mail Address: 1110 HUSS ROAD, WAUCHULA, FL, 33873, US
ZIP code: 33812
County: Polk
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GREGORIO N. MEDALLE, M.D., P.A. PROFIT SHARING PLAN 2016 411419893 2017-08-31 GREGORIO N. MEDALLE, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 8637733773
Plan sponsor’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358
GREGORIO N. MEDALLE, M.D., P.A. PROFIT SHARING PLAN 2015 411419893 2016-06-28 GREGORIO N. MEDALLE, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 8637733773
Plan sponsor’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358
GREGORIO N. MEDALLE, M.D., P.A. PROFIT SHARING PLAN 2014 411419893 2015-10-02 GREGORIO N. MEDALLE, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 8637733773
Plan sponsor’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358
GREGORIO N. MEDALLE, M.D., P.A. PROFIT SHARING PLAN 2013 411419893 2014-09-05 GREGORIO N. MEDALLE, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 8637733773
Plan sponsor’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358
GREGORIO N. MEDALLE, M.D., P.A. PROFIT SHARING PLAN 2012 411419893 2013-10-15 GREGORIO N. MEDALLE, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 8637733773
Plan sponsor’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing GREGORIO N MEDALLE MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-15
Name of individual signing GREGORIO N MEDALLE MD
Valid signature Filed with authorized/valid electronic signature
GREGORIO N. MEDALLE, M.D., P.A. PROFIT SHARING PLAN 2011 411419893 2012-06-25 GREGORIO N. MEDALLE, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 8637733773
Plan sponsor’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358

Plan administrator’s name and address
Administrator’s EIN 411419893
Plan administrator’s name GREGORIO N. MEDALLE, M.D., P.A.
Plan administrator’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358
Administrator’s telephone number 8637733773

Signature of
Role Plan administrator
Date 2012-06-25
Name of individual signing GREGORIO N MEDALLE MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-25
Name of individual signing GREGORIO N MEDALLE MD
Valid signature Filed with authorized/valid electronic signature
GREGORIO N. MEDALLE, M.D., P.A. PROFIT SHARING PLAN 2010 411419893 2011-09-19 GREGORIO N. MEDALLE, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 8637733773
Plan sponsor’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358

Plan administrator’s name and address
Administrator’s EIN 411419893
Plan administrator’s name GREGORIO N. MEDALLE, M.D., P.A.
Plan administrator’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358
Administrator’s telephone number 8637733773

Signature of
Role Plan administrator
Date 2011-09-19
Name of individual signing GREGORIO N MEDALLE MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-19
Name of individual signing GREGORIO N MEDALLE MD
Valid signature Filed with authorized/valid electronic signature
GREGORIO N. MEDALLE, M.D., P.A. PROFIT SHARING PLAN 2009 411419893 2010-10-13 GREGORIO N. MEDALLE, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 8637733773
Plan sponsor’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358

Plan administrator’s name and address
Administrator’s EIN 411419893
Plan administrator’s name GREGORIO N. MEDALLE, M.D., P.A.
Plan administrator’s address 1052 DOWNING CIRCLE, WAUCHULA, FL, 338733358
Administrator’s telephone number 8637733773

Signature of
Role Plan administrator
Date 2010-10-13
Name of individual signing GREGORIO N MEDALLE MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-13
Name of individual signing GREGORIO N MEDALLE MD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MEDALLE GREGORIO N Agent 2822 CHATSWORTH LANE, LAKELAND, FL, 33812

President

Name Role Address
MEDALLE GREGORIO N President 2822 CHATSWORTH LANE, LAKELAND, FL, 33812

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2018-09-28 No data No data

Related by officers

MEDALLE GREGORIO N

MEDALLE FAMILY, LLC

Related by address

1110 HUSS ROAD, WAUCHULA, FL, 33873, US

BEULAHLAND, INC.

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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