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  5. SOUTHERN IMAGE EMBROIDERY, INC.

SOUTHERN IMAGE EMBROIDERY, INC.

Company Details

Entity Name: SOUTHERN IMAGE EMBROIDERY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 06 Nov 1995 (29 years ago)
Document Number: P95000085619
FEI/EIN Number 593346447
Address: 4861 Park Street North, St. Petersburg, FL, 33709, US
Mail Address: 4861 Park Street North, St.Petersburg, FL, 33709, US
ZIP code: 33709
County: Pinellas
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHERN IMAGE EMBROIDERY INC 401(K) PROFIT SHARING PLAN & TRUST 2023 593346447 2024-07-01 SOUTHERN IMAGE EMBROIDERY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 323100
Sponsor’s telephone number 7275442700
Plan sponsor’s address 4861 PARK STREET NORTH, SAINT PETERSBURG, FL, 33709

Signature of
Role Plan administrator
Date 2024-07-01
Name of individual signing JEFFERY K LEWIS
Valid signature Filed with authorized/valid electronic signature
SOUTHERN IMAGE EMBROIDERY INC 401(K) PROFIT SHARING PLAN & TRUST 2022 593346447 2023-06-23 SOUTHERN IMAGE EMBROIDERY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 323100
Sponsor’s telephone number 7275442700
Plan sponsor’s address 4861 PARK STREET NORTH, SAINT PETERSBURG, FL, 33709

Signature of
Role Plan administrator
Date 2023-06-23
Name of individual signing JEFFERY K LEWIS
Valid signature Filed with authorized/valid electronic signature
SOUTHERN IMAGE EMBROIDERY INC 401(K) PROFIT SHARING PLAN & TRUST 2021 593346447 2022-07-15 SOUTHERN IMAGE EMBROIDERY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 323100
Sponsor’s telephone number 7275442700
Plan sponsor’s address 4861 PARK STREET NORTH, SAINT PETERSBURG, FL, 33709

Signature of
Role Plan administrator
Date 2022-07-15
Name of individual signing JEFFERY LEWIS
Valid signature Filed with authorized/valid electronic signature
SOUTHERN IMAGE EMBROIDERY INC 401(K) PROFIT SHARING PLAN & TRUST 2020 593346447 2021-06-18 SOUTHERN IMAGE EMBROIDERY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 323100
Sponsor’s telephone number 7275442700
Plan sponsor’s address 4861 PARK STREET NORTH, SAINT PETERSBURG, FL, 33709

Signature of
Role Plan administrator
Date 2021-06-18
Name of individual signing JEFFERY K LEWIS
Valid signature Filed with authorized/valid electronic signature
SOUTHERN IMAGE EMBROIDERY INC 401(K) PROFIT SHARING PLAN & TRUST 2019 593346447 2020-07-02 SOUTHERN IMAGE EMBROIDERY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 323100
Sponsor’s telephone number 7275442700
Plan sponsor’s address 4861 PARK STREET NORTH, SAINT PETERSBURG, FL, 33709

Signature of
Role Plan administrator
Date 2020-07-02
Name of individual signing JEFFERY K LEWIS
Valid signature Filed with authorized/valid electronic signature
SOUTHERN IMAGE EMBROIDERY INC 401 K PROFIT SHARING PLAN TRUST 2018 593346447 2019-07-17 SOUTHERN IMAGE EMBROIDERY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 323100
Sponsor’s telephone number 7275442700
Plan sponsor’s address 4861 PARK STREET NORTH, SAINT PETERSBURG, FL, 33709

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing JEFFERY K LEWIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LEWIS JEFFERY K Agent 4861 Park Street North, St. Petersburg, FL, 33709

President

Name Role Address
LEWIS JEFFERY K President 5696 ORANGE RD, SEMINOLE, FL, 33772

Secretary

Name Role Address
LAROSE TERRY A Secretary 5696 ORANGE RD, SEMINOLE, FL, 33772

Vice President

Name Role Address
Anderson Megan J Vice President 1937 76th Ave N., St petersburg, FL, 33702

Manager

Name Role Address
LaRose Joseph Manager 343 37th Ave NE, St petersburg, FL, 33704

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2016-03-28 LEWIS, JEFFERY K No data
CHANGE OF PRINCIPAL ADDRESS 2013-04-10 4861 Park Street North, St. Petersburg, FL 33709 No data
CHANGE OF MAILING ADDRESS 2013-04-10 4861 Park Street North, St. Petersburg, FL 33709 No data
REGISTERED AGENT ADDRESS CHANGED 2013-04-10 4861 Park Street North, St. Petersburg, FL 33709 No data

Documents

Name Date
ANNUAL REPORT 2024-03-08
ANNUAL REPORT 2023-04-10
ANNUAL REPORT 2022-03-04
ANNUAL REPORT 2021-03-22
ANNUAL REPORT 2020-03-24
ANNUAL REPORT 2019-04-16
ANNUAL REPORT 2018-03-27
ANNUAL REPORT 2017-04-03
ANNUAL REPORT 2016-03-28
ANNUAL REPORT 2015-04-08

Related by officers

LEWIS JEFFERY K

SOUTHERN IMAGE SPECIALITIES, INC.

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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