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  5. RAFAEL BELTRAN, M.D., P.A.

RAFAEL BELTRAN, M.D., P.A.

Company Details

Entity Name: RAFAEL BELTRAN, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 12 May 2003 (22 years ago)
Document Number: P03000051880
FEI/EIN Number 16-1663774
Address: 3637 4TH ST NORTH, 480, ST. PETERSBURG, FL, 33704
Mail Address: 4777 ROYAL PALM CIRCLE, SAINT PETERSBURG, FL, 33703, US
ZIP code: 33704
County: Pinellas
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RAFAEL BELTRAN M D P A 401(K) PROFIT SHARING PLAN & TRUST 2023 161663774 2024-07-29 RAFAEL BELTRAN M D P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2024-07-29
Name of individual signing JANICE VOSLER BELTRAN
Valid signature Filed with authorized/valid electronic signature
RAFAEL BELTRAN M D P A 401(K) PROFIT SHARING PLAN & TRUST 2022 161663774 2023-09-14 RAFAEL BELTRAN M D P A 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2023-09-14
Name of individual signing JANICE VOSLER BELTRAN
Valid signature Filed with authorized/valid electronic signature
RAFAEL BELTRAN M D P A 401(K) PROFIT SHARING PLAN & TRUST 2021 161663774 2022-07-12 RAFAEL BELTRAN M D P A 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2022-07-12
Name of individual signing JANICE. VOSLER BELTRAN
Valid signature Filed with authorized/valid electronic signature
RAFAEL BELTRAN M D P A 401(K) PROFIT SHARING PLAN & TRUST 2020 161663774 2021-07-26 RAFAEL BELTRAN M D P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 541990
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2021-07-26
Name of individual signing JANICE VOSLER BELTRAN
Valid signature Filed with authorized/valid electronic signature
RAFAEL BELTRAN M D P A 401(K) PROFIT SHARING PLAN & TRUST 2019 161663774 2020-07-06 RAFAEL BELTRAN M D P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 541990
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2020-07-06
Name of individual signing JANICE VOSLER-BELTRAN
Valid signature Filed with authorized/valid electronic signature
RAFAEL BELTRAN M D P A 401 K PROFIT SHARING PLAN TRUST 2018 161663774 2019-07-26 RAFAEL BELTRAN M D P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 541990
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2019-07-26
Name of individual signing JANICE VOSLER BELTRAN
Valid signature Filed with authorized/valid electronic signature
RAFAEL BELTRAN M D P A 401 K PROFIT SHARING PLAN TRUST 2017 161663774 2018-07-06 RAFAEL BELTRAN M D P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 541990
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2018-07-06
Name of individual signing JANICE VOSLER BELTRAN
Valid signature Filed with authorized/valid electronic signature
RAFAEL BELTRAN M D P A 401 K PROFIT SHARING PLAN TRUST 2016 161663774 2017-07-06 RAFAEL BELTRAN M D P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 541990
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2017-07-06
Name of individual signing JANICE VOSLER
Valid signature Filed with authorized/valid electronic signature
RAFAEL BELTRAN M D P A 401 K PROFIT SHARING PLAN TRUST 2015 161663774 2016-06-24 RAFAEL BELTRAN M D P A 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 541990
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2016-06-24
Name of individual signing JANICE VOSLER BELTRAN
Valid signature Filed with authorized/valid electronic signature
RAFAEL BELTRAN M D P A 401 K PROFIT SHARING PLAN TRUST 2014 161663774 2015-07-16 RAFAEL BELTRAN M D P A 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 541990
Sponsor’s telephone number 7272043274
Plan sponsor’s address 4777 ROYAL PALM CIR NE, SAINT PETERSBURG, FL, 337033139

Signature of
Role Plan administrator
Date 2015-07-16
Name of individual signing JANICE VOSLER BELTRAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BELTRAN RAFAEL M Agent 4777 ROYAL PALM CIRCLE, SAINT PETERSBURG, FL, 33703

Manager

Name Role Address
BELTRAN RAFAEL M Manager 4777 ROYAL PALM CIRCLE, SAINT PETERSBURG, FL, 33703

Director

Name Role Address
BELTRAN RAFAEL M Director 4777 ROYAL PALM CIRCLE, SAINT PETERSBURG, FL, 33703

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2018-03-12 3637 4TH ST NORTH, 480, ST. PETERSBURG, FL 33704 No data
REGISTERED AGENT NAME CHANGED 2012-03-22 BELTRAN, RAFAEL MD No data
CHANGE OF PRINCIPAL ADDRESS 2010-03-21 3637 4TH ST NORTH, 480, ST. PETERSBURG, FL 33704 No data
REGISTERED AGENT ADDRESS CHANGED 2004-07-21 4777 ROYAL PALM CIRCLE, SAINT PETERSBURG, FL 33703 No data

Documents

Name Date
ANNUAL REPORT 2024-03-04
ANNUAL REPORT 2023-03-19
ANNUAL REPORT 2022-03-14
ANNUAL REPORT 2021-04-26
ANNUAL REPORT 2020-01-22
ANNUAL REPORT 2019-01-28
ANNUAL REPORT 2018-03-12
ANNUAL REPORT 2017-02-16
ANNUAL REPORT 2016-04-26
ANNUAL REPORT 2015-06-08

Related by officers

No related officers

Related by address

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Date of last update: 01 Feb 2025

Sources: Florida Department of State

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