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  5. SANTA ROSA GASTROENTEROLOGY INC.

SANTA ROSA GASTROENTEROLOGY INC.

Company Details

Entity Name: SANTA ROSA GASTROENTEROLOGY INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 02 Jun 2003 (22 years ago)
Document Number: P03000060431
FEI/EIN Number 200009224
Address: 3117 Merion Dr, Miramar Beach, FL, 32550, US
Mail Address: 3117 MERION DR, MIRAMAR BEACH, FL, 32550, US
ZIP code: 32550
County: Walton
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1790956472 2008-03-20 2010-12-20 5992 BERRYHILL RD, SUITE 201, MILTON, FL, 325701013, US 5992 BERRYHILL RD, SUITE 201, MILTON, FL, 325701013, US

Contacts
Phone +1 850-626-9626
Fax 8506269606

Authorized person
Name KERI A RUSYNYK
Role OFFICE MANAGER
Phone 8507484420

Taxonomy
Taxonomy Code 207RG0100X - Gastroenterology Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2023 200009224 2024-07-09 SANTA ROSA GASTROENTEROLOGY, INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8507484420
Plan sponsor’s address 3117 MERION DRIVE, MIRAMAR BEACH, FL, 32550

Signature of
Role Plan administrator
Date 2024-07-09
Name of individual signing KERI RUSYNYK
Valid signature Filed with authorized/valid electronic signature
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2022 200009224 2023-09-19 SANTA ROSA GASTROENTEROLOGY, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8507484420
Plan sponsor’s address 3117 MERION DRIVE, MIRAMAR BEACH, FL, 32550

Signature of
Role Plan administrator
Date 2023-09-19
Name of individual signing KERI RUSYNYK
Valid signature Filed with authorized/valid electronic signature
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2021 200009224 2022-10-17 SANTA ROSA GASTROENTEROLOGY, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8507484420
Plan sponsor’s address 3117 MERION DRIVE, MIRAMAR BEACH, FL, 32550
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2020 200009224 2021-10-12 SANTA ROSA GASTROENTEROLOGY, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8507484420
Plan sponsor’s address 3117 MERION DRIVE, MIRAMAR BEACH, FL, 32550
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2019 200009224 2020-10-10 SANTA ROSA GASTROENTEROLOGY, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8506269626
Plan sponsor’s address 102 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL, 32459
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2018 200009224 2019-08-12 SANTA ROSA GASTROENTEROLOGY, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8506269626
Plan sponsor’s address 102 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL, 32459
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2017 200009224 2018-09-13 SANTA ROSA GASTROENTEROLOGY, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8506269626
Plan sponsor’s address 102 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL, 32459
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2016 200009224 2017-10-16 SANTA ROSA GASTROENTEROLOGY, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8506269626
Plan sponsor’s address 102 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL, 32459
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2015 200009224 2016-10-11 SANTA ROSA GASTROENTEROLOGY, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8506269626
Plan sponsor’s address 102 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL, 32459
SANTA ROSA GASTROENTEROLOGY, INC. 401(K) PLAN 2014 200009224 2015-09-28 SANTA ROSA GASTROENTEROLOGY, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8506269626
Plan sponsor’s address 102 MACK BAYOU LOOP, SUITE 102, SANTA ROSA BEACH, FL, 32459

Agent

Name Role Address
RUSYNYK RAPHAEL A Agent 3117 MERION DR, MIRAMAR BEACH, FL, 32550

President

Name Role Address
RUSYNYK RAPHAEL ADr. President 3117 MERION DR, MIRAMAR BEACH, FL, 32550

Vice President

Name Role Address
RUSYNYK KERI A Vice President 3117 MERION DR, MIRAMAR BEACH, FL, 32550

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2021-04-29 3117 Merion Dr, Miramar Beach, FL 32550 No data
CHANGE OF MAILING ADDRESS 2013-06-20 3117 Merion Dr, Miramar Beach, FL 32550 No data
REGISTERED AGENT ADDRESS CHANGED 2013-06-20 3117 MERION DR, MIRAMAR BEACH, FL 32550 No data

Documents

Name Date
ANNUAL REPORT 2024-04-29
ANNUAL REPORT 2023-04-27
ANNUAL REPORT 2022-04-29
ANNUAL REPORT 2021-04-29
ANNUAL REPORT 2020-04-02
ANNUAL REPORT 2019-04-09
ANNUAL REPORT 2018-04-23
ANNUAL REPORT 2017-04-27
ANNUAL REPORT 2016-02-23
ANNUAL REPORT 2015-04-28

Related by officers

RUSYNYK KERI A

ALEX AND KERI RUSYNYK, LLC

Related by address

3117 MERION DR, MIRAMAR BEACH, FL, 32550, US

ALEX AND KERI RUSYNYK, LLC

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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