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  5. PBS INSURANCE UNDERWRITING CORP.

PBS INSURANCE UNDERWRITING CORP.

Company Details

Name: PBS INSURANCE UNDERWRITING CORP.
Legal type: Kentucky Corporation
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 04 Oct 1991 (34 years ago)
Organization Date: 04 Oct 1991 (34 years ago)
Last Annual Report: 24 Aug 2016 (9 years ago)
Organization Number: 0291563
ZIP code: 40243
City: Louisville, Douglass Hills, Douglass Hls, Middletown...
Primary County: Jefferson County
Principal Office: 303 MIDDLETOWN PARK PLACE, STE F, LOUISVILLE, KY 40243
Place of Formation: KENTUCKY
Common No Par Shares: 2000

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PBS INSURANCE UNDERWRITING CORP. 401(K) PROFIT SHARING PLAN 2014 611209402 2015-09-15 PBS INSURANCE UNDERWRITING CORP. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 524210
Sponsor’s telephone number 5022441056
Plan sponsor’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243

Signature of
Role Plan administrator
Date 2015-09-15
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
PBS INSURANCE UNDERWRITING CORP. 401(K) PROFIT SHARING PLAN 2014 611209402 2015-09-01 PBS INSURANCE UNDERWRITING CORP. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 524210
Sponsor’s telephone number 5022441056
Plan sponsor’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243

Signature of
Role Plan administrator
Date 2015-09-01
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
PBS INSURANCE UNDERWRITING CORP. 401(K) PROFIT SHARING PLAN 2013 611209402 2014-07-08 PBS INSURANCE UNDERWRITING CORP. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 524210
Sponsor’s telephone number 5022441056
Plan sponsor’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243

Signature of
Role Plan administrator
Date 2014-07-08
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-08
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
PBS INSURANCE UNDERWRITING CORP. 401(K) PROFIT SHARING PLAN 2012 611209402 2013-05-22 PBS INSURANCE UNDERWRITING CORP. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 524210
Sponsor’s telephone number 5022441056
Plan sponsor’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243

Signature of
Role Plan administrator
Date 2013-05-22
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-22
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
PBS INSURANCE UNDERWRITING CORP. 401(K) PROFIT SHARING PLAN 2011 611209402 2012-09-19 PBS INSURANCE UNDERWRITING CORP. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 524210
Sponsor’s telephone number 5022441056
Plan sponsor’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611209402
Plan administrator’s name PBS INSURANCE UNDERWRITING CORP.
Plan administrator’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243
Administrator’s telephone number 5022441056

Signature of
Role Plan administrator
Date 2012-09-19
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-09-19
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
PBS INSURANCE UNDERWRITING CORP. 401(K) PROFIT SHARING PLAN 2011 611209402 2012-06-19 PBS INSURANCE UNDERWRITING CORP. 5
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 524210
Sponsor’s telephone number 5022441056
Plan sponsor’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611209402
Plan administrator’s name PBS INSURANCE UNDERWRITING CORP.
Plan administrator’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243
Administrator’s telephone number 5022441056

Signature of
Role Plan administrator
Date 2012-06-19
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-19
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
PBS INSURANCE UNDERWRITING CORP. 401(K) PROFIT SHARING PLAN 2010 611209402 2011-06-22 PBS INSURANCE UNDERWRITING CORP. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 524210
Sponsor’s telephone number 5022441056
Plan sponsor’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611209402
Plan administrator’s name PBS INSURANCE UNDERWRITING CORP.
Plan administrator’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243
Administrator’s telephone number 5022441056

Signature of
Role Plan administrator
Date 2011-06-22
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-22
Name of individual signing JACK W. SMITH
Valid signature Filed with authorized/valid electronic signature
PBS INSURANCE UNDERWRITING CORP. 401(K) PROFIT SHARING PLAN 2009 611209402 2010-08-19 PBS INSURANCE UNDERWRITING CORP. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 524210
Sponsor’s telephone number 5022441056
Plan sponsor’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611209402
Plan administrator’s name PBS INSURANCE UNDERWRITING CORP.
Plan administrator’s address 303 MIDDLETOWN PARK PLACE, SUITE F, LOUISVILLE, KY, 40243
Administrator’s telephone number 5022441056

Signature of
Role Plan administrator
Date 2010-08-19
Name of individual signing FRANK HARRISON
Valid signature Filed with authorized/valid electronic signature

Incorporator

Name Role
JACK W. SMITH Incorporator

Sole Officer

Name Role
Jack W Smith Sole Officer

Director

Name Role
Jack W. Smith Director

Registered Agent

Name Role
JACK W. SMITH Registered Agent

Licenses

Department License Number License Type / Line of Authority Status Issue Date Effective Date Inactive Date Expiry Date Address
Department of Insurance DOI ID 401286 Surplus Lines Broker - Not Applicable Inactive 2006-06-29 - 2016-02-01 - -
Department of Insurance DOI ID 401286 Agent - Property Inactive 2000-08-15 - 2016-03-31 - -
Department of Insurance DOI ID 401286 Agent - Casualty Inactive 2000-08-04 - 2016-03-31 - -
Department of Insurance DOI ID 401286 Administrator - Not Applicable Inactive 1999-03-25 - 2016-01-11 - -
Department of Insurance DOI ID 401286 Agent - General Lines Inactive 1992-02-04 - 2000-08-15 - -

Former Company Names

Name Action
PROFESSIONAL BENEFIT SPECIALISTS, INC. Old Name

Filings

Name File Date
Administrative Dissolution Return 2017-10-31
Administrative Dissolution 2017-10-09
Annual Report 2016-08-24
Annual Report 2015-05-22
Annual Report 2014-02-10
Annual Report 2013-02-08
Annual Report 2012-02-21
Annual Report 2011-05-19
Annual Report 2010-03-26
Annual Report 2009-06-17

Related by officers

JACK W. SMITH

SMITH AND TALLEY INCORPORATED THE MIDWESTERN ASSOCIATION OF OBSTETRICIANS & GYNECOLOGISTS, INC. MID AMERICA ASSOCIATION OF PHYSICIANS & SURGEONS, INC. COSMETIC SURGEONS OF AMERICA ASSOCIATION, INC. SUPERIOR RISK PURCHASING GROUP, INC. GIBRALTAR RISK PURCHASING GROUP, INC. AMERICAN ENVIRONMENTAL KENTUCKY LLC

Jack W Smith

THE MIDWESTERN ASSOCIATION OF OBSTETRICIANS & GYNECOLOGISTS, INC. MID AMERICA ASSOCIATION OF PHYSICIANS & SURGEONS, INC. GLOBAL ANESTHESIOLOGIST SPECIALTY SERVICE RISK PURCHASING GROUP, INC. PELICAN RPG, INC. SUPERIOR RISK PURCHASING GROUP, INC. TEXAS ORGANIZATION OF PHYSICIANS & SURGEONS RISK PURCHASING GROUP, INC. PHYSICIANS OUTPATIENT EMERGENCY NETWORK INSURANCE EXCHANGE RISK PURCHASING GROUP, INC.

Jack W. Smith

GLOBAL ANESTHESIOLOGIST SPECIALTY SERVICE RISK PURCHASING GROUP, INC. SUPERIOR RISK PURCHASING GROUP, INC. TEXAS ORGANIZATION OF PHYSICIANS & SURGEONS RISK PURCHASING GROUP, INC. PHYSICIANS OUTPATIENT EMERGENCY NETWORK INSURANCE EXCHANGE RISK PURCHASING GROUP, INC. PBS PREMIUM FINANCING CORPORATION

Related by address

No related companies by address

Sources: Kentucky Secretary of State

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