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  5. JONATHAN D. FORMAN, M.D., P.A.

JONATHAN D. FORMAN, M.D., P.A.

Company Details

Entity Name: JONATHAN D. FORMAN, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 21 Aug 2007 (18 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 02 Oct 2017 (7 years ago)
Document Number: P07000093519
FEI/EIN Number 412250118
Address: 508 South Habana Avenue, 170, TAMPA, FL, 33609, US
Mail Address: 4931 W Melrose Avenue North, TAMPA, FL, 33629, US
ZIP code: 33609
County: Hillsborough
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2022 412250118 2024-02-14 JONATHAN D. FORMAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2021 412250118 2023-02-15 JONATHAN D. FORMAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2020 412250118 2021-10-12 JONATHAN D. FORMAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2019 412250118 2020-12-10 JONATHAN D. FORMAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2018 412250118 2019-10-15 JONATHAN D. FORMAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2017 412250118 2018-10-11 JONATHAN D. FORMAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2016 412250118 2017-10-12 JONATHAN D. FORMAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2015 412250118 2016-10-11 JONATHAN D. FORMAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2014 412250118 2015-10-06 JONATHAN D. FORMAN, M.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100

Signature of
Role Plan administrator
Date 2015-10-06
Name of individual signing JONATHAN D. FORMAN, M.D.
Valid signature Filed with authorized/valid electronic signature
JONATHAN D. FORMAN, M.D., P.A. 401(K) PROFIT SHARING PLAN AND TRUST 2013 412250118 2014-10-14 JONATHAN D. FORMAN, M.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 8138773100
Plan sponsor’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629

Plan administrator’s name and address
Administrator’s EIN 412250118
Plan administrator’s name JONATHAN D. FORMAN, M.D., P.A.
Plan administrator’s address 3225 S. MACDILL AVENUE #129-175, TAMPA, FL, 33629
Administrator’s telephone number 8138773100

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing JONATHAN D. FORMAN, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
FORMAN JONATHAN DDr. Agent 508 SOUTH HABANA AVENUE, TAMPA, FL, 33609

President

Name Role Address
FORMAN JONATHAN D President 508 SOUTH HABANA AVENUE, SUITE #170, TAMPA, FL, 33609

Director

Name Role Address
FORMAN JONATHAN D Director 508 SOUTH HABANA AVENUE, SUITE #170, TAMPA, FL, 33609

Events

Event Type Filed Date Value Description
REINSTATEMENT 2017-10-02 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2017-09-22 No data No data
CHANGE OF MAILING ADDRESS 2015-10-26 508 South Habana Avenue, 170, TAMPA, FL 33609 No data
REINSTATEMENT 2015-10-26 No data No data
REGISTERED AGENT NAME CHANGED 2015-10-26 FORMAN, JONATHAN D, Dr. No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2015-09-25 No data No data
CHANGE OF PRINCIPAL ADDRESS 2013-05-01 508 South Habana Avenue, 170, TAMPA, FL 33609 No data
REGISTERED AGENT ADDRESS CHANGED 2012-09-28 508 SOUTH HABANA AVENUE, SUITE 170, TAMPA, FL 33609 No data
REINSTATEMENT 2010-08-11 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2009-09-25 No data No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J22000020000 TERMINATED 1000000911422 HILLSBOROU 2021-12-28 2032-01-12 $ 839.44 STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236

Documents

Name Date
ANNUAL REPORT 2024-04-30
ANNUAL REPORT 2023-09-18
ANNUAL REPORT 2022-09-02
ANNUAL REPORT 2021-05-31
ANNUAL REPORT 2020-06-30
ANNUAL REPORT 2019-05-30
ANNUAL REPORT 2018-09-07
REINSTATEMENT 2017-10-02
ANNUAL REPORT 2016-08-31
REINSTATEMENT 2015-10-26

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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