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  5. TRI-STATE BENEFITS ADMINISTRATORS, LLC

TRI-STATE BENEFITS ADMINISTRATORS, LLC

Company Details

Name: TRI-STATE BENEFITS ADMINISTRATORS, LLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Good
Profit or Non-Profit: Profit
File Date: 18 Aug 2000 (25 years ago)
Organization Date: 18 Aug 2000 (25 years ago)
Last Annual Report: 15 Jun 2020 (5 years ago)
Managed By: Members
Organization Number: 0499668
ZIP code: 42420
City: Henderson
Primary County: Henderson County
Principal Office: 702 A BARRET BLVD, HENDERSON, KY 42420
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2018 611374343 2019-06-14 TRI-STATE BENEFITS ADMINISTRATORS, LLC 2
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2018 611374343 2019-06-14 TRI-STATE BENEFITS ADMINISTRATORS, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2017 611374343 2018-06-19 TRI-STATE BENEFITS ADMINISTRATORS, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2018-06-19
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-19
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2016 611374343 2017-07-12 TRI-STATE BENEFITS ADMINISTRATORS, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-12
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2015 611374343 2016-06-07 TRI-STATE BENEFITS ADMINISTRATORS, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2016-06-07
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-07
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLA 2014 611374343 2015-07-02 TRI-STATE BENEFITS ADMINISTRATORS, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2015-07-02
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-02
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLA 2013 611374343 2014-06-18 TRI-STATE BENEFITS ADMINISTRATORS, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 223 N MAIN STREET, HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2014-06-18
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-18
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLA 2012 611374343 2013-06-18 TRI-STATE BENEFITS ADMINISTRATORS, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 223 N MAIN STREET, HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2013-06-18
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-18
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLA 2011 611374343 2012-06-13 TRI-STATE BENEFITS ADMINISTRATORS, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 223 N MAIN STREET, HENDERSON, KY, 42420

Plan administrator’s name and address
Administrator’s EIN 611374343
Plan administrator’s name TRI-STATE BENEFITS ADMINISTRATORS, LLC
Plan administrator’s address 223 N MAIN STREET, HENDERSON, KY, 42420
Administrator’s telephone number 2708271132

Signature of
Role Plan administrator
Date 2012-06-13
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-13
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature

Director

Name Role
STEPHEN PHILLIPS Director

Registered Agent

Name Role
KIMBERLY A CHAVIRA Registered Agent

Member

Name Role
Kimberly A Chavira Member

Organizer

Name Role
MALCOLM E. NEEL II Organizer
MALCOLM E. NEEL III Organizer
CHRISTI DIXON Organizer
KATHLEEN GLASER Organizer

Filings

Name File Date
Dissolution 2021-06-01
Annual Report 2020-06-15
Registered Agent name/address change 2019-04-23
Annual Report 2019-04-23
Annual Report 2018-05-07
Annual Report 2017-04-24
Principal Office Address Change 2016-03-16
Annual Report 2016-03-16
Annual Report 2015-04-15
Annual Report 2014-01-24

Related by officers

MALCOLM E. NEEL II

OHIO VALLEY BENEFITS ADMINISTRATION, LLC NEEL & COMPANY, LLP

MALCOLM E. NEEL III

OHIO VALLEY BENEFITS ADMINISTRATION, LLC NEEL & COMPANY, LLP NEEL CRAFTON & PHILLIPS, LLP ASRB, LLP

CHRISTI DIXON

VOLUNTEER AND INFORMATION CENTER, INC. NEEL & COMPANY, LLP

Related by address

No related companies by address

Sources: Kentucky Secretary of State

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