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  5. BROWNSBORO DERMATOLOGY, PLLC

BROWNSBORO DERMATOLOGY, PLLC

Company Details

Name: BROWNSBORO DERMATOLOGY, PLLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
File Date: 12 May 2000 (25 years ago)
Organization Date: 12 May 2000 (25 years ago)
Last Annual Report: 13 Apr 2023 (2 years ago)
Managed By: Members
Organization Number: 0494464
ZIP code: 40222
City: Louisville, Bancroft, Bellemeade, Crossgate, Glenvie...
Primary County: Jefferson County
Principal Office: 4938 BROWNSBORO ROAD, STE 206, LOUISVILLE, KY 40222
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BROWNSBORO DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2022 611368998 2023-10-16 BROWNSBORO DERMATOLOGY, PLLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222
BROWNSBORO DERMATOLOGY CBS BENEFIT PLAN 2022 611368998 2023-12-27 BROWNSBORO DERMATOLOGY 7
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-12-01
Business code 621491
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Plan administrator’s name and address
Administrator’s EIN 846429706
Plan administrator’s name SHAWNA BURTON
Plan administrator’s address 464 CHENAULT RD, FRANKFORT, KY, 40601
Administrator’s telephone number 5026954700

Signature of
Role Plan administrator
Date 2023-12-27
Name of individual signing SHAWNA BURTON
Valid signature Filed with authorized/valid electronic signature
BROWNSBORO DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2022 611368998 2023-10-16 BROWNSBORO DERMATOLOGY, PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222
BROWNSBORO DERMATOLOGY CBS BENEFIT PLAN 2021 611368998 2022-12-29 BROWNSBORO DERMATOLOGY 8
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-12-01
Business code 621491
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Plan administrator’s name and address
Administrator’s EIN 846429706
Plan administrator’s name SHAWNA BURTON
Plan administrator’s address 464 CHENAULT RD, FRANKFORT, KY, 40601
Administrator’s telephone number 5026954700

Signature of
Role Plan administrator
Date 2022-12-29
Name of individual signing SHAWNA BURTON
Valid signature Filed with authorized/valid electronic signature
BROWNSBORO DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2021 611368998 2022-10-17 BROWNSBORO DERMATOLOGY, PLLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222
BROWNSBORO DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2020 611368998 2021-10-12 BROWNSBORO DERMATOLOGY, PLLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-12
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
BROWNSBORO DERMATOLOGY CBS BENEFIT PLAN 2020 611368998 2021-12-14 BROWNSBORO DERMATOLOGY 7
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-12-01
Business code 621491
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Plan administrator’s name and address
Administrator’s EIN 846429706
Plan administrator’s name SHAWNA BURTON
Plan administrator’s address 464 CHENAULT RD, FRANKFORT, KY, 40601
Administrator’s telephone number 5026954700

Signature of
Role Plan administrator
Date 2021-12-14
Name of individual signing SHAWNA BURTON
Valid signature Filed with authorized/valid electronic signature
BROWNSBORO DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2019 611368998 2020-07-30 BROWNSBORO DERMATOLOGY, PLLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Signature of
Role Plan administrator
Date 2020-07-30
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
BROWNSBORO DERMATOLOGY CBS BENEFIT PLAN 2019 611368998 2020-12-23 BROWNSBORO DERMATOLOGY 8
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-12-01
Business code 621491
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Plan administrator’s name and address
Administrator’s EIN 846429706
Plan administrator’s name KELLY WOLF
Plan administrator’s address 464 CHENAULT RD, FRANKFORT, KY, 40601
Administrator’s telephone number 5026954700

Signature of
Role Plan administrator
Date 2020-12-23
Name of individual signing KELLY WOLF
Valid signature Filed with authorized/valid electronic signature
BROWNSBORO DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2018 611368998 2019-05-06 BROWNSBORO DERMATOLOGY, PLLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Signature of
Role Plan administrator
Date 2019-05-02
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/03/30/20180330095129P040027110593001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Signature of
Role Plan administrator
Date 2018-03-29
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/03/14/20170314102155P040044426221001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Signature of
Role Plan administrator
Date 2017-03-13
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/10/11/20161011070432P040020679505001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Signature of
Role Plan administrator
Date 2016-10-10
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/07/28/20150728072957P040116480759001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Signature of
Role Plan administrator
Date 2015-07-27
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/08/20141008075722P040013928367001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Signature of
Role Plan administrator
Date 2014-10-08
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/14/20131014074630P030036052995001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Signature of
Role Plan administrator
Date 2013-10-13
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-13
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/02/20121002101808P030007484000001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Plan administrator’s name and address
Administrator’s EIN 611368998
Plan administrator’s name BROWNSBORO DERMATOLOGY, PLLC
Plan administrator’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222
Administrator’s telephone number 5023392922

Signature of
Role Plan administrator
Date 2012-10-01
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/07/20110607134619P030072005169001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Plan administrator’s name and address
Administrator’s EIN 611368998
Plan administrator’s name BROWNSBORO DERMATOLOGY, PLLC
Plan administrator’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222
Administrator’s telephone number 5023392922

Signature of
Role Plan administrator
Date 2011-06-02
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/07/20101007100326P070003582232001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 5023392922
Plan sponsor’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222

Plan administrator’s name and address
Administrator’s EIN 611368998
Plan administrator’s name BROWNSBORO DERMATOLOGY, PLLC
Plan administrator’s address 4938 BROWNSBORO RD, STE 206, LOUISVILLE, KY, 40222
Administrator’s telephone number 5023392922

Signature of
Role Plan administrator
Date 2010-10-06
Name of individual signing LAURA KLEIN
Valid signature Filed with authorized/valid electronic signature

Organizer

Name Role
LAURA R. KLEIN, M.D. Organizer

Registered Agent

Name Role
LAURA R. KLEIN, M.D. Registered Agent

Member

Name Role
Denise L Puthuff MD Member
Laura R Klein MD Member

Former Company Names

Name Action
DERMATOLOGY EAST, PLLC Old Name

Filings

Name File Date
Administrative Dissolution 2024-10-12
Annual Report 2023-04-13
Annual Report 2022-06-29
Annual Report 2021-02-10
Annual Report 2020-03-20
Annual Report 2019-04-22
Annual Report 2018-04-23
Annual Report 2017-04-24
Annual Report 2016-03-16
Annual Report 2015-04-17

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8358607303 2020-05-01 0457 PPP 4938 Brownsboro Road, Louisville, KY, 40222-6385
Loan Status Date 2021-03-12
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 166000
Loan Approval Amount (current) 166000
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, 40222-6385
Project Congressional District KY-03
Number of Employees 13
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 27542
Originating Lender Name Republic Bank & Trust Company
Originating Lender Address LOUISVILLE, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 167355.67
Forgiveness Paid Date 2021-03-01

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Sources: Kentucky Secretary of State

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