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  5. HAROLD W BLEVINS MD PSC

HAROLD W BLEVINS MD PSC

Company Details

Name: HAROLD W BLEVINS MD PSC
Legal type: Kentucky Professional Services Corp
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 03 Nov 1975 (49 years ago)
Organization Date: 03 Nov 1975 (49 years ago)
Last Annual Report: 04 Feb 2025 (3 months ago)
Organization Number: 0051345
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 40207
City: Louisville, Bellewood, Brownsboro Village, Brwnsboro...
Primary County: Jefferson County
Principal Office: 3999 DUTCHMANS LN 3A, LOUISVILLE, KY 40207-4747
Place of Formation: KENTUCKY
Authorized Shares: 1000

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING 401(K) PLAN AND TRUST AGREEMENT 2023 610889380 2024-07-16 HAROLD W. BLEVINS P.S.C. 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 0
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING 401(K) PLAN AND TRUST AGREEMENT 2023 610889380 2024-02-25 HAROLD W. BLEVINS P.S.C. 9
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 0
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING 401(K) PLAN AND TRUST AGREEMENT 2022 610889380 2023-07-05 HAROLD W. BLEVINS P.S.C. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 9
Other retired or separated participants entitled to future benefits 2
Number of participants with account balances as of the end of the plan year 9
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING 401(K) PLAN AND TRUST AGREEMENT 2021 610889380 2022-03-19 HAROLD W. BLEVINS P.S.C. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 9
Other retired or separated participants entitled to future benefits 1
Number of participants with account balances as of the end of the plan year 10
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING 401(K) PLAN AND TRUST AGREEMENT 2020 610889380 2021-03-31 HAROLD W. BLEVINS P.S.C. 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 9
Other retired or separated participants entitled to future benefits 1
Number of participants with account balances as of the end of the plan year 10
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 1
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING 401(K) PLAN AND TRUST AGREEMENT 2019 610889380 2020-04-21 HAROLD W. BLEVINS P.S.C. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 9
Other retired or separated participants entitled to future benefits 1
Number of participants with account balances as of the end of the plan year 9
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING 401(K) PLAN AND TRUST AGREEMENT 2018 610889380 2019-05-14 HAROLD W. BLEVINS P.S.C. 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 10
Number of participants with account balances as of the end of the plan year 10
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING 401(K) PLAN AND TRUST AGREEMENT 2017 610889380 2018-05-08 HAROLD W. BLEVINS P.S.C. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 10
Number of participants with account balances as of the end of the plan year 9
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING PLAN 2016 610889380 2017-05-12 HAROLD W. BLEVINS P.S.C. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 10
Number of participants with account balances as of the end of the plan year 10
HAROLD W. BLEVINS, P.S.C. PROFIT SHARING PLAN 2015 610889380 2016-05-20 HAROLD W. BLEVINS P.S.C. 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 10
Number of participants with account balances as of the end of the plan year 10
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/03/17/20150317064215P030003177241001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 10
Number of participants with account balances as of the end of the plan year 10
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/02/20140602090641P030427816161005.pdf
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 10
Other retired or separated participants entitled to future benefits 1
Number of participants with account balances as of the end of the plan year 11
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 1
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/07/20130507141713P030201801155004.pdf
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 402074734

Number of participants as of the end of the plan year
Active participants 14
Other retired or separated participants entitled to future benefits 2
Number of participants with account balances as of the end of the plan year 16

Signature of
Role Plan administrator
Date 2013-04-24
Name of individual signing JEFFREY NAU
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/05/07/20120507081222P040008915842001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Plan sponsor’s address 4001 DUTCHMANS LANE SUITE 2E, LOUISVILLE, KY, 402074734

Plan administrator’s name and address
Administrator’s EIN 610889380
Plan administrator’s name HAROLD W. BLEVINS P.S.C.
Plan administrator’s address 3999 DUTCHMANS LANE SUITE 3A, LOUISVILLE, KY, 40207
Administrator’s telephone number 5028977300

Number of participants as of the end of the plan year
Active participants 14
Other retired or separated participants entitled to future benefits 1
Number of participants with account balances as of the end of the plan year 15
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 1

Signature of
Role Plan administrator
Date 2012-04-27
Name of individual signing HAROLD BLEVINS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/06/20110606124413P040073272673004.pdf
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 4001 DUTCHMANS LANE SUITE 2E, LOUISVILLE, KY, 402074734
Plan sponsor’s address 4001 DUTCHMANS LANE SUITE 2E, LOUISVILLE, KY, 402074734

Plan administrator’s name and address
Administrator’s EIN 610889380
Plan administrator’s name HAROLD W. BLEVINS P.S.C.
Plan administrator’s address 4001 DUTCHMANS LANE SUITE 2E, LOUISVILLE, KY, 402074734
Administrator’s telephone number 5028977300

Number of participants as of the end of the plan year
Active participants 15
Other retired or separated participants entitled to future benefits 1
Number of participants with account balances as of the end of the plan year 15

Signature of
Role Plan administrator
Date 2011-06-06
Name of individual signing HAROLD BLEVINS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-06
Name of individual signing HAROLD BLEVINS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/05/04/20100504154427P040238656545003.pdf
Three-digit plan number (PN) 002
Effective date of plan 1976-09-01
Business code 621111
Sponsor’s telephone number 5028977300
Plan sponsor’s mailing address 4001 DUTCHMANS LANE SUITE 2E, LOUISVILLE, KY, 402074734
Plan sponsor’s address 4001 DUTCHMANS LANE SUITE 2E, LOUISVILLE, KY, 402074734

Plan administrator’s name and address
Administrator’s EIN 610889380
Plan administrator’s name HAROLD W. BLEVINS P.S.C.
Plan administrator’s address 4001 DUTCHMANS LANE SUITE 2E, LOUISVILLE, KY, 402074734
Administrator’s telephone number 5028977300

Number of participants as of the end of the plan year
Active participants 13
Other retired or separated participants entitled to future benefits 1
Number of participants with account balances as of the end of the plan year 14

Signature of
Role Plan administrator
Date 2010-05-04
Name of individual signing HAROLD BLEVINS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-05-04
Name of individual signing HAROLD BLEVINS
Valid signature Filed with authorized/valid electronic signature

Director

Name Role
JEFFREY C NAU Director
HAROLD W. BLEVINS Director
MICHAEL J BROWN Director

Vice President

Name Role
JEFFREY C NAU Vice President

Incorporator

Name Role
HAROLD W. BLEVINS Incorporator

Shareholder

Name Role
MICHAEL J BROWN Shareholder
JEFFREY C NAU Shareholder

Registered Agent

Name Role
MICHAEL J. BROWN, M.D. Registered Agent

President

Name Role
MICHAEL J BROWN President

Former Company Names

Name Action
HAROLD W. BLEVINS, P. S. C. Old Name

Assumed Names

Name Status Expiration Date
ENT ASSOCIATES Expiring 2025-08-21

Filings

Name File Date
Annual Report 2025-02-04
Annual Report 2024-05-15
Annual Report 2023-03-15
Annual Report 2022-04-22
Annual Report 2021-02-09
Annual Report 2020-04-23
Principal Office Address Change 2020-04-23
Name Renewal 2020-02-20
Amendment 2019-12-20
Annual Report 2019-04-19

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
9121137006 2020-04-09 0457 PPP 3999 DUTCHMANS LN STE 3A, LOUISVILLE, KY, 40207-4701
Loan Status Date 2021-05-15
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 132100
Loan Approval Amount (current) 132100
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27542
Servicing Lender Name Republic Bank & Trust Company
Servicing Lender Address 601 W Market St Republic Corporate Center, LOUISVILLE, KY, 40202
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address LOUISVILLE, JEFFERSON, KY, 40207-4701
Project Congressional District KY-03
Number of Employees 10
NAICS code 621111
Borrower Race White
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 27542
Originating Lender Name Republic Bank & Trust Company
Originating Lender Address LOUISVILLE, KY
Gender Male Owned
Veteran Unanswered
Forgiveness Amount 133395.31
Forgiveness Paid Date 2021-04-08

Related by officers

MICHAEL J BROWN

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Related by address

No related companies by address

Sources: Kentucky Secretary of State

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