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  5. MEDICAL CENTER ON THE GULF, LLC

MEDICAL CENTER ON THE GULF, LLC

Company Details

Entity Name: MEDICAL CENTER ON THE GULF, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 25 Sep 2002 (22 years ago)
Document Number: L02000025198
FEI/EIN Number 320034881
Address: 915 Cypress Cove Way, Tarpon Springs, FL, 34688, US
Mail Address: 915 Cypress Cove Way, Tarpon Springs, FL, 34688, US
ZIP code: 34688
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1497720700 2006-02-21 2015-07-13 PO BOX 1921, DUNEDIN, FL, 346971921, US 30522 US 19 N STE 109, PALM HARBOR, FL, 346844436, US

Contacts
Phone +1 727-738-0220
Fax 7277347072

Authorized person
Name ANANDA SOM
Role CHAIRMAN
Phone 7277380220

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

Other Provider Identifiers
Issuer RAILROAD MEDICARE
Number 110239219
Issuer GRP #
Number K8814
Issuer OXFORD HEALTH INSURANCE
Number P2746142
Issuer AVMED
Number 244046
Issuer MEDICAID
Number 254433400
State FL
Issuer TUFTS HEALTH PLAN
Number 410972
Issuer AETNA
Number 5306646
Issuer FIRST HEALTH
Number 1627837
Issuer AMERIGROUP
Number 213422
Issuer CIGNA
Number 3087332
Issuer BLUE CROSS BLUE SHIELD
Number 43705
Issuer UNITED HEALTHCARE
Number 0407698

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEDICAL CENTER ON THE GULF, LLC CASH BALANCE PLAN 2022 320034881 2023-10-06 MEDICAL CENTER ON THE GULF, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2023-10-06
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-06
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
MEDICAL CENTER ON THE GULF, LLC 401(K) PLAN 2022 320034881 2023-10-06 MEDICAL CENTER ON THE GULF, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-06-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2023-10-06
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
MEDICAL CENTER ON THE GULF, LLC 401(K) PLAN 2021 320034881 2022-10-17 MEDICAL CENTER ON THE GULF, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-06-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
MEDICAL CENTER ON THE GULF, LLC CASH BALANCE PLAN 2021 320034881 2022-10-17 MEDICAL CENTER ON THE GULF, LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
MEDICAL CENTER ON THE GULF, LLC 401(K) PLAN 2020 320034881 2021-10-14 MEDICAL CENTER ON THE GULF, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-06-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
MEDICAL CENTER ON THE GULF, LLC CASH BALANCE PLAN 2020 320034881 2021-10-14 MEDICAL CENTER ON THE GULF, LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
MEDICAL CENTER ON THE GULF, LLC 401(K) PLAN 2019 320034881 2020-10-09 MEDICAL CENTER ON THE GULF, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-06-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2020-10-09
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
MEDICAL CENTER ON THE GULF, LLC CASH BALANCE PLAN 2019 320034881 2020-10-09 MEDICAL CENTER ON THE GULF, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2020-10-09
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-10-09
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
MEDICAL CENTER ON THE GULF, LLC 401(K) PLAN 2018 320034881 2019-10-09 MEDICAL CENTER ON THE GULF, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-06-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2019-10-09
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
MEDICAL CENTER ON THE GULF, LLC CASH BALANCE PLAN 2018 320034881 2019-10-09 MEDICAL CENTER ON THE GULF, LLC 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 7277380220
Plan sponsor’s address 30522 US 19 N, SUITE 109, PALM HARBOR, FL, 34684

Signature of
Role Plan administrator
Date 2019-10-08
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-08
Name of individual signing SUDIPA SOM
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SOM SUDIPA Agent 915 CYPRESS COVE WAY, TARPON SPRINGS, FL, 34688

Manager

Name Role Address
SOM ANANDA Manager 915 CYPRESS COVE WAY, TARPON SPRINGS, FL, 34698

Administrator

Name Role Address
SOM SUDIPA Administrator 915 Cypress Cove Way, Tarpon Springs, FL, 34688

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-02-24 915 Cypress Cove Way, Tarpon Springs, FL 34688 No data
CHANGE OF MAILING ADDRESS 2024-02-24 915 Cypress Cove Way, Tarpon Springs, FL 34688 No data
REGISTERED AGENT ADDRESS CHANGED 2005-05-02 915 CYPRESS COVE WAY, TARPON SPRINGS, FL 34688 No data

Documents

Name Date
ANNUAL REPORT 2024-02-24
ANNUAL REPORT 2023-01-30
ANNUAL REPORT 2022-01-29
ANNUAL REPORT 2021-01-11
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-02-07
ANNUAL REPORT 2018-01-12
ANNUAL REPORT 2017-01-07
ANNUAL REPORT 2016-03-07
ANNUAL REPORT 2015-01-06

Related by officers

SOM ANANDA

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SOM SUDIPA

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Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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