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  5. DAVID M. BLAKE, M.D., P.S.C.

DAVID M. BLAKE, M.D., P.S.C.

Company Details

Name: DAVID M. BLAKE, M.D., P.S.C.
Jurisdiction: Kentucky
Profit or Non-Profit: Profit
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Good
File Date: 06 Aug 1999 (25 years ago)
Organization Date: 06 Aug 1999 (25 years ago)
Last Annual Report: 05 Jul 2016 (9 years ago)
Organization Number: 0478355
ZIP code: 40504
Primary County: Fayette
Principal Office: 1451 HARRODSBURG RD. BLD-D-302, LEXINGTON, KY 40504
Place of Formation: KENTUCKY
Authorized Shares: 100

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2016 611352070 2017-04-27 DAVID M. BLAKE, M.D., P.S.C. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Signature of
Role Plan administrator
Date 2017-04-27
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2015 611352070 2016-02-10 DAVID M. BLAKE, M.D., P.S.C. 14
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Signature of
Role Plan administrator
Date 2016-02-10
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2015 611352070 2016-02-23 DAVID M. BLAKE, M.D., P.S.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Signature of
Role Plan administrator
Date 2016-02-23
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2014 611352070 2015-06-10 DAVID M. BLAKE, M.D., P.S.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Signature of
Role Plan administrator
Date 2015-06-10
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2013 611352070 2014-06-23 DAVID M. BLAKE, M.D., P.S.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Signature of
Role Plan administrator
Date 2014-06-23
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2012 611352070 2013-07-09 DAVID M. BLAKE, M.D., P.S.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Signature of
Role Plan administrator
Date 2013-07-09
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2011 611352070 2012-07-11 DAVID M. BLAKE, M.D., P.S.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Plan administrator’s name and address
Administrator’s EIN 611352070
Plan administrator’s name DAVID M. BLAKE, M.D., P.S.C.
Plan administrator’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504
Administrator’s telephone number 8592601273

Signature of
Role Plan administrator
Date 2012-07-11
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2010 611352070 2011-07-13 DAVID M. BLAKE, M.D., P.S.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Plan administrator’s name and address
Administrator’s EIN 611352070
Plan administrator’s name DAVID M. BLAKE, M.D., P.S.C.
Plan administrator’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504
Administrator’s telephone number 8592601273

Signature of
Role Plan administrator
Date 2011-07-13
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2010 611352070 2011-07-07 DAVID M. BLAKE, M.D., P.S.C. 11
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Plan administrator’s name and address
Administrator’s EIN 611352070
Plan administrator’s name DAVID M. BLAKE, M.D., P.S.C.
Plan administrator’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504
Administrator’s telephone number 8592601273

Signature of
Role Plan administrator
Date 2011-07-07
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with incorrect/unrecognized electronic signature
DAVID M. BLAKE, M.D., P.S.C. PROFIT SHARING PLAN 2010 611352070 2011-07-05 DAVID M. BLAKE, M.D., P.S.C. 11
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Plan administrator’s name and address
Administrator’s EIN 611352070
Plan administrator’s name DAVID M. BLAKE, M.D., P.S.C.
Plan administrator’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504
Administrator’s telephone number 8592601273

Signature of
Role Plan administrator
Date 2011-07-05
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with incorrect/unrecognized electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/13/20100713133450P030039176787001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1999-10-10
Business code 621111
Sponsor’s telephone number 8592601273
Plan sponsor’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504

Plan administrator’s name and address
Administrator’s EIN 611352070
Plan administrator’s name DAVID M. BLAKE, M.D., P.S.C.
Plan administrator’s address 1451 HARRODSBURG ROAD, STE D-302, LEXINGTON, KY, 40504
Administrator’s telephone number 8592601273

Signature of
Role Plan administrator
Date 2010-07-13
Name of individual signing DAVID M. BLAKE, M.D.
Valid signature Filed with authorized/valid electronic signature

Registered Agent

Name Role
DAVID M. BLAKE, M.D. Registered Agent

Incorporator

Name Role
DAVID M. BLAKE, M.D. Incorporator

Filings

Name File Date
Dissolution 2017-05-23
Annual Report 2016-07-05
Annual Report 2015-06-02
Annual Report 2014-04-02
Annual Report 2013-01-14
Annual Report 2012-06-14
Annual Report 2011-04-01
Annual Report 2010-03-16
Annual Report 2009-04-02
Annual Report 2008-03-19

Related by officers

No related officers

Related by address

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Date of last update: 26 Dec 2024

Sources: Kentucky Secretary of State

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