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  5. THOMAS J. DERBES, M.D., P.A.

THOMAS J. DERBES, M.D., P.A.

Company Details

Entity Name: THOMAS J. DERBES, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 23 Dec 2002 (22 years ago)
Date of dissolution: 26 Sep 2014 (10 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 26 Sep 2014 (10 years ago)
Document Number: P02000133847
FEI/EIN Number 562307388
Address: 3731 BAYTREE RD, LYNN HAVEN, FL, 32444, US
Mail Address: 3731 BAYTREE RD, LYNN HAVEN, FL, 32444, US
ZIP code: 32444
County: Bay
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
THOMAS J. DERBES, M.D., P.A. CASH BALANCE PLAN 2010 562307388 2011-06-14 THOMAS J. DERBES, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8509138996
Plan sponsor’s address 2103 JENKS AVENUE, PANAMA CITY, FL, 32405

Plan administrator’s name and address
Administrator’s EIN 562307388
Plan administrator’s name THOMAS J. DERBES, M.D., P.A.
Plan administrator’s address 2103 JENKS AVENUE, PANAMA CITY, FL, 32405
Administrator’s telephone number 8509138996

Signature of
Role Plan administrator
Date 2011-06-14
Name of individual signing THOMAS J. DERBES, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-14
Name of individual signing THOMAS J. DERBES, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS J. DERBES, M.D., P.A. 401(K) PSP 2010 562307388 2011-07-05 THOMAS J. DERBES, M.D., P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8509138996
Plan sponsor’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405

Plan administrator’s name and address
Administrator’s EIN 562307388
Plan administrator’s name THOMAS J. DERBES, M.D., P.A.
Plan administrator’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405
Administrator’s telephone number 8509138996

Signature of
Role Plan administrator
Date 2011-07-05
Name of individual signing JULIE BOSS
Valid signature Filed with authorized/valid electronic signature
THOMAS J. DERBES, M.D., P.A. 401(K) PSP 2009 562307388 2010-11-01 THOMAS J. DERBES, M.D., P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8509138996
Plan sponsor’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405

Plan administrator’s name and address
Administrator’s EIN 562307388
Plan administrator’s name THOMAS J. DERBES, M.D., P.A.
Plan administrator’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405
Administrator’s telephone number 8509138996

Signature of
Role Plan administrator
Date 2010-11-01
Name of individual signing JULIE BOSS
Valid signature Filed with authorized/valid electronic signature
THOMAS J. DERBES, M.D., P.A. CASH BALANCE PLAN 2009 562307388 2010-10-14 THOMAS J. DERBES, M.D., P.A. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8509138996
Plan sponsor’s address 2103 JENKS AVENUE, PANAMA CITY, FL, 32405

Plan administrator’s name and address
Administrator’s EIN 562307388
Plan administrator’s name THOMAS J. DERBES, M.D., P.A.
Plan administrator’s address 2103 JENKS AVENUE, PANAMA CITY, FL, 32405
Administrator’s telephone number 8509138996

Signature of
Role Plan administrator
Date 2010-10-13
Name of individual signing THOMAS J. DERBES, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-13
Name of individual signing THOMAS J. DERBES, M.D.
Valid signature Filed with authorized/valid electronic signature
THOMAS J. DERBES, M.D., P.A. 401(K) PSP 2009 562307388 2010-09-17 THOMAS J. DERBES, M.D., P.A. 9
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8509138996
Plan sponsor’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405

Plan administrator’s name and address
Administrator’s EIN 562307388
Plan administrator’s name THOMAS J. DERBES, M.D., P.A.
Plan administrator’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405
Administrator’s telephone number 8509138996

Signature of
Role Employer/plan sponsor
Date 2010-09-16
Name of individual signing THOMAS DERBES
Valid signature Filed with authorized/valid electronic signature
THOMAS J. DERBES, M.D., P.A. 401(K) PSP 2009 562307388 2010-09-15 THOMAS J. DERBES, M.D., P.A. 9
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8509138996
Plan sponsor’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405

Plan administrator’s name and address
Administrator’s EIN 562307388
Plan administrator’s name THOMAS J. DERBES, M.D., P.A.
Plan administrator’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405
Administrator’s telephone number 8509138996

Signature of
Role Employer/plan sponsor
Date 2010-09-15
Name of individual signing THOMAS DERBES
Valid signature Filed with authorized/valid electronic signature
THOMAS J. DERBES, M.D., P.A. 401(K) PSP 2009 562307388 2010-04-29 THOMAS J. DERBES, M.D., P.A. 9
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 8509138996
Plan sponsor’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405

Plan administrator’s name and address
Administrator’s EIN 562307388
Plan administrator’s name THOMAS J. DERBES, M.D., P.A.
Plan administrator’s address 2103 JANKS AVENUE, PANAMA CITY, FL, 32405
Administrator’s telephone number 8509138996

Signature of
Role Plan administrator
Date 2010-04-29
Name of individual signing THOMAS DERBES
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DERBES THOMAS J Agent 3731 BAYTREE RD, LYNN HAVEN, FL, 32444

Director

Name Role Address
DERBES THOMAS J Director 3731 BAYTREE RD, LYNN HAVEN, FL, 32444

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 No data No data
CHANGE OF PRINCIPAL ADDRESS 2013-02-25 3731 BAYTREE RD, LYNN HAVEN, FL 32444 No data
CHANGE OF MAILING ADDRESS 2013-02-25 3731 BAYTREE RD, LYNN HAVEN, FL 32444 No data
REGISTERED AGENT ADDRESS CHANGED 2013-02-25 3731 BAYTREE RD, LYNN HAVEN, FL 32444 No data

Documents

Name Date
ANNUAL REPORT 2013-02-25
ANNUAL REPORT 2012-01-09
ANNUAL REPORT 2011-01-19
ANNUAL REPORT 2010-01-06
ANNUAL REPORT 2009-03-23
ANNUAL REPORT 2008-01-25
ANNUAL REPORT 2007-01-04
ANNUAL REPORT 2006-01-03
ANNUAL REPORT 2005-02-16
ANNUAL REPORT 2004-03-09

Related by officers

No related officers

Related by address

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Date of last update: 02 Feb 2025

Sources: Florida Department of State

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