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  5. COOPER FAMILY MEDICAL, PLLC

COOPER FAMILY MEDICAL, PLLC

Company Details

Entity Name: COOPER FAMILY MEDICAL, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 11 Jun 2004 (21 years ago)
Document Number: L04000044464
FEI/EIN Number 201251028
Address: 5123 4TH AVE CIRCLE EAST, BRADENTON, FL, 34208, US
Mail Address: 5123 4TH AVE CIRCLE EAST, BRADENTON, FL, 34208, US
ZIP code: 34208
County: Manatee
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1871513192 2006-07-20 2024-07-24 5123 4TH AVENUE CIR E, BRADENTON, FL, 342085620, US 5123 4TH AVENUE CIR E, BRADENTON, FL, 342085620, US

Contacts
Phone +1 941-744-5510
Fax 9417445166

Authorized person
Name DR. CATHERINE COOPER
Role PHYSICIAN
Phone 9417445510

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS BLUE SHIELD
Number 74797
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COOPER FAMILY MEDICAL PLLC 401(K) PLAN 2023 201251028 2024-10-03 COOPER FAMILY MEDICAL PLLC 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 9417445510
Plan sponsor’s address 5123 4TH AVENUE CIR E, BRADENTON, FL, 342085620

Signature of
Role Plan administrator
Date 2024-10-03
Name of individual signing ANDREW CLARK
Valid signature Filed with authorized/valid electronic signature
COOPER FAMILY MEDICAL 401K PLAN 2022 201251028 2023-09-19 COOPER FAMILY MEDICAL PLLC 51
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 9417181476
Plan sponsor’s address 5123 4TH AVENUE CIR E, BRADENTON, FL, 342085620

Signature of
Role Plan administrator
Date 2023-09-19
Name of individual signing PLAN SPONSOR
Valid signature Filed with authorized/valid electronic signature
COOPER FAMILY MEDICAL PLLC 401(K) PLAN 2021 201251028 2022-09-27 COOPER FAMILY MEDICAL PLLC 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-08-01
Business code 621111
Sponsor’s telephone number 9417181476
Plan sponsor’s address 5123 FOURTH AVENUE CIRCLE EAST, BRADENTON, FL, 34208

Signature of
Role Plan administrator
Date 2022-09-27
Name of individual signing ANDREW R. CLARK, D.O.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-09-27
Name of individual signing ANDREW R.CLARK, D.O.
Valid signature Filed with authorized/valid electronic signature
COOPER FAMILY MEDICAL PLLC 401(K) PLAN 2020 201251028 2021-06-23 COOPER FAMILY MEDICAL PLLC 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-08-01
Business code 621111
Sponsor’s telephone number 9417181476
Plan sponsor’s address 5123 FOURTH AVENUE CIRCLE EAST, BRADENTON, FL, 34208

Signature of
Role Plan administrator
Date 2021-06-23
Name of individual signing ANDREW R. CLARK, D.O.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-23
Name of individual signing ANDREW R. CLARK, D.O.
Valid signature Filed with authorized/valid electronic signature
COOPER FAMILY MEDICAL PLLC 401(K) PLAN 2019 201251028 2020-09-10 COOPER FAMILY MEDICAL PLLC 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-08-01
Business code 621111
Sponsor’s telephone number 9417181476
Plan sponsor’s address 5123 4TH AVENUE CIR E, BRADENTON, FL, 34208

Signature of
Role Plan administrator
Date 2020-09-10
Name of individual signing BONNIE ROSSI
Valid signature Filed with authorized/valid electronic signature
COOPER FAMILY MEDICAL PLLC 401(K) PLAN 2018 201251028 2019-07-08 COOPER FAMILY MEDICAL PLLC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-08-01
Business code 621111
Sponsor’s telephone number 9417181476
Plan sponsor’s address 5123 FOURTH AVENUE CIRCLE EAST, BRADENTON, FL, 34208

Signature of
Role Plan administrator
Date 2019-07-08
Name of individual signing ANDREW R. CLARK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-08
Name of individual signing ANDREW R. CLARK
Valid signature Filed with authorized/valid electronic signature
COOPER FAMILY MEDICAL PLLC 401(K) PLAN 2017 201251028 2018-06-29 COOPER FAMILY MEDICAL PLLC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-08-01
Business code 621111
Sponsor’s telephone number 9417181476
Plan sponsor’s address 5123 FOURTH AVENUE CIRCLE EAST, BRADENTON, FL, 34208

Signature of
Role Plan administrator
Date 2018-06-29
Name of individual signing ANDREW R. CLARK, D.O.
Valid signature Filed with authorized/valid electronic signature
COOPER FAMILY MEDICAL 401K PLAN 2016 201251028 2017-06-14 COOPER FAMILY MEDICAL PLLC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-08-01
Business code 621111
Sponsor’s telephone number 9417181476
Plan sponsor’s address 5123 4TH AVENUE CIR E, BRADENTON, FL, 34208

Signature of
Role Plan administrator
Date 2017-06-14
Name of individual signing ANDREW ROBERT CLARK, D.O.
Valid signature Filed with authorized/valid electronic signature
COOPER FAMILY MEDICAL 401K PLAN 2015 201251028 2016-06-21 COOPER FAMILY MEDICAL PLLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-08-01
Business code 621111
Sponsor’s telephone number 9417181476
Plan sponsor’s address 5123 4TH AVENUE CIR E, BRADENTON, FL, 34208

Signature of
Role Plan administrator
Date 2016-06-21
Name of individual signing ANDREW ROBERT CLARK ,D.O.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BLALOCK, WALTERS, HELD & JOHNSON, P.A. Agent 802 11TH STREET WEST, BRADENTON, FL, 34205

Chief Financial Officer

Name Role Address
COOPER CATHERINE M Chief Financial Officer 5123 4TH AVENUE CIRCLE EAST, BRADENTON, FL, 34208

Chief Executive Officer

Name Role Address
COOPER CHRISTOPHER M Chief Executive Officer 5123 4TH AVE CIR EAST, BRADENTON, FL, 34208

Chief Operating Officer

Name Role Address
CLARK ANDREW R Chief Operating Officer 5123 4TH AVE CIR EAST, BRADENTON, FL, 34208

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2013-03-12 5123 4TH AVE CIRCLE EAST, BRADENTON, FL 34208 No data
CHANGE OF MAILING ADDRESS 2013-03-12 5123 4TH AVE CIRCLE EAST, BRADENTON, FL 34208 No data

Documents

Name Date
ANNUAL REPORT 2024-02-04
ANNUAL REPORT 2023-02-14
ANNUAL REPORT 2022-02-01
ANNUAL REPORT 2021-01-15
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-03-19
ANNUAL REPORT 2018-02-05
ANNUAL REPORT 2017-01-25
ANNUAL REPORT 2016-02-22
ANNUAL REPORT 2015-03-16

Related by officers

COOPER CATHERINE M

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COOPER CHRISTOPHER M

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CLARK ANDREW R

TRIPLE SEA INVESTMENTS, L.L.C. ARCANDSRF LLC CIRRUS ENVIRONMENTAL LLC ZEUS ELECTRIC LLC CLARK FENCING L.L.C.

BLALOCK, WALTERS, HELD & JOHNSON, P.A.

AGELESS BUSINESS CONSULTING, INC. AN HARVESTING, INC BATH LLC CHINESE DRYWALL REMEDIATION, LLC RIVERWALK RECOVERY OF MANATEE LLC AGELESS REGENERATIVE INSTITUTE, INC. AGELESS REGENERATIVE CENTER, PA JR GONZALES HARVESTING, INC. FLORIDA PREMIER TURF FARMS, LLC MANATEE MEDICAL RESEARCH INSTITUTE, LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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