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  5. FAMILY PHYSICIAN ASSOCIATES, P.S.C.

FAMILY PHYSICIAN ASSOCIATES, P.S.C.

Company Details

Name: FAMILY PHYSICIAN ASSOCIATES, P.S.C.
Jurisdiction: Kentucky
Profit or Non-Profit: Profit
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Bad
File Date: 19 Jun 1960 (65 years ago)
Organization Date: 19 Jun 1960 (65 years ago)
Last Annual Report: 29 Jun 2012 (13 years ago)
Organization Number: 0183067
ZIP code: 40065
Primary County: Shelby
Principal Office: 515 HOSPITAL DR., SHELBYVILLE, KY 40065
Place of Formation: KENTUCKY
Authorized Shares: 2000

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FAMILY PHYSICIAN ASSOCIATES, P.S.C 401(K) PLAN 2013 611035885 2014-10-31 FAMILY PHYSICIAN ASSOCIATES, P.S.C. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-30
Business code 621111
Sponsor’s telephone number 5026333525
Plan sponsor’s address 515 HOSPITAL DRIVE, SUITE 1, SHELBYVILLE, KY, 40065
FAMILY PHYSICIAN ASSOCIATES, P.S.C 401(K) PLAN 2013 611035885 2014-10-06 FAMILY PHYSICIAN ASSOCIATES, P.S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-30
Business code 621111
Sponsor’s telephone number 5026333525
Plan sponsor’s address 515 HOSPITAL DRIVE, SUITE 1, SHELBYVILLE, KY, 40065
FAMILY PHYSICIAN ASSOCIATES, P.S.C 401(K) PLAN 2012 611035885 2013-07-30 FAMILY PHYSICIAN ASSOCIATES, P.S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-30
Business code 621111
Sponsor’s telephone number 5026333525
Plan sponsor’s address 515 HOSPITAL DRIVE, SUITE 1, SHELBYVILLE, KY, 40065

Signature of
Role Plan administrator
Date 2013-07-30
Name of individual signing DAVID W. WALLACE, MD
Valid signature Filed with authorized/valid electronic signature
FAMILY PHYSICIAN ASSOCIATES, P.S.C 401(K) PLAN 2011 611035885 2012-10-11 FAMILY PHYSICIAN ASSOCIATES, P.S.C. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-30
Business code 621111
Sponsor’s telephone number 5026333525
Plan sponsor’s address 515 HOSPITAL DRIVE, SUITE 1, SHELBYVILLE, KY, 40065

Plan administrator’s name and address
Administrator’s EIN 611035885
Plan administrator’s name FAMILY PHYSICIAN ASSOCIATES, P.S.C.
Plan administrator’s address 515 HOSPITAL DRIVE, SUITE 1, SHELBYVILLE, KY, 40065
Administrator’s telephone number 5026333525

Signature of
Role Plan administrator
Date 2012-10-10
Name of individual signing DAVID W. WALLACE, MD
Valid signature Filed with authorized/valid electronic signature
FAMILY PHYSICIAN ASSOCIATES, P.S.C 401(K) PLAN 2010 611035885 2011-10-04 FAMILY PHYSICIAN ASSOCIATES, P.S.C. 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-30
Business code 621111
Sponsor’s telephone number 5026333525
Plan sponsor’s address 515 HOSPITAL DRIVE, SUITE 1, SHELBYVILLE, KY, 40065

Plan administrator’s name and address
Administrator’s EIN 611035885
Plan administrator’s name FAMILY PHYSICIAN ASSOCIATES, P.S.C.
Plan administrator’s address 515 HOSPITAL DRIVE, SUITE 1, SHELBYVILLE, KY, 40065
Administrator’s telephone number 5026333525

Signature of
Role Plan administrator
Date 2011-10-03
Name of individual signing DAVID W. WALLACE, MD
Valid signature Filed with authorized/valid electronic signature
FAMILY PHYSICIAN ASSOCIATES, P.S.C 401(K) PLAN 2009 611035885 2010-10-13 FAMILY PHYSICIAN ASSOCIATES, P.S.C. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1971-06-30
Business code 621111
Sponsor’s telephone number 5026333525
Plan sponsor’s address 515 HOSPITAL DRIVE, SUITE 1, SHELBYVILLE, KY, 40065

Plan administrator’s name and address
Administrator’s EIN 611035885
Plan administrator’s name FAMILY PHYSICIAN ASSOCIATES, P.S.C.
Plan administrator’s address 515 HOSPITAL DRIVE, SUITE 1, SHELBYVILLE, KY, 40065
Administrator’s telephone number 5026333525

Signature of
Role Plan administrator
Date 2010-10-12
Name of individual signing DAVID W. WALLACE, MD
Valid signature Filed with authorized/valid electronic signature

President

Name Role
James R Smith President

Secretary

Name Role
Edward L Sames Secretary

Vice President

Name Role
David A Jones Vice President

Director

Name Role
David W Wallace Director
Edward L Sames Director
David A Jones Director
James R Smith Director

Shareholder

Name Role
DAVID W WALLACE Shareholder
James R Smith Shareholder
David A Jones Shareholder
Kenneth A Gardner Shareholder
EDWARD L SAMES Shareholder

Incorporator

Name Role
DONALD CHATHAM, M. D. Incorporator

Registered Agent

Name Role
JAMES R. SMITH, M.D. Registered Agent

Former Company Names

Name Action
DONALD CHATHAM, P. S. C. Old Name

Filings

Name File Date
Administrative Dissolution 2013-09-28
Annual Report 2012-06-29
Annual Report 2011-06-30
Reinstatement Certificate of Existence 2010-12-02
Reinstatement 2010-12-02
Reinstatement Approval Letter UI 2010-12-02
Reinstatement Approval Letter Revenue 2010-12-02
Administrative Dissolution 2010-11-02
Annual Report 2009-06-24
Annual Report 2008-07-28

Related by officers

James R Smith

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David A Jones

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David W Wallace

FAMILY PHYSICIAN ENTERPRISES, LLC

DAVID W WALLACE

DELTA V CONSULTING, LLC FAMILY PHYSICIAN ENTERPRISES

Kenneth A Gardner

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JAMES R. SMITH, M.D.

LEE TAYLOR ENTERPRISES FAMILY PHYSICIANS ENTERPRISES FAMILY PHYSICIAN ENTERPRISES, LLC

Related by address

No related companies by address

Date of last update: 08 Jan 2025

Sources: Kentucky Secretary of State

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