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  5. WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC

WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC

Company Details

Name: WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC
Legal type: Kentucky Professional Services Corp
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 28 Nov 2001 (23 years ago)
Organization Date: 28 Nov 2001 (23 years ago)
Last Annual Report: 07 Mar 2024 (a year ago)
Organization Number: 0526141
Industry: Health Services
Number of Employees: Medium (20-99)
ZIP code: 42101
City: Bowling Green, Hadley, Plum Springs, Richardsville
Primary County: Warren County
Principal Office: 421 US 31W BY-PASS, WESTERN KENTUCKY HEART, LUNG AND GASTROENTEROLOGY, BOWLING GREEN, KY 42101
Place of Formation: KENTUCKY
Authorized Shares: 100

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) PROFIT SHARING PLAN 2022 611400757 2023-05-25 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND STREET, SUITE B1, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2023-05-25
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) P 2021 611400757 2022-08-18 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 51
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 421 US 31W BYP, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2022-08-18
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) P 2020 611400757 2021-08-06 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 421 US 31W BYP, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2021-08-06
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) P 2019 611400757 2020-08-31 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 421 U.S. 31 W BYPASS, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2020-08-31
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) P 2018 611400757 2019-10-07 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND AVE., STE. B1, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2019-10-07
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) P 2017 611400757 2018-06-27 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND AVE., STE. B1, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2018-06-27
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) P 2016 611400757 2017-07-25 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND AVE., STE. B1, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2017-07-25
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) P 2015 611400757 2016-07-13 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND AVE., STE. B1, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2016-07-13
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) P 2014 611400757 2015-07-10 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND AVE., STE. B1, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2015-07-10
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
WESTERN KENTUCKY HEART & LUNG ASSOCIATES 401(K) P 2013 611400757 2014-07-10 WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND AVE., STE. B1, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2014-07-10
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/06/20/20130620150007P040093673509001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND AVE., STE. B1, BOWLING GREEN, KY, 42101

Signature of
Role Plan administrator
Date 2013-06-20
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/11/20120711160311P030000093379001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND AVE., STE. B1, BOWLING GREEN, KY, 42101

Plan administrator’s name and address
Administrator’s EIN 611400757
Plan administrator’s name WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC
Plan administrator’s address 825 SECOND AVE., STE. B1, BOWLING GREEN, KY, 42101
Administrator’s telephone number 2707820151

Signature of
Role Plan administrator
Date 2012-07-11
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/11/20111011141111P030021610194002.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101

Plan administrator’s name and address
Administrator’s EIN 611400757
Plan administrator’s name WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC
Plan administrator’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101
Administrator’s telephone number 2707820151

Signature of
Role Plan administrator
Date 2011-10-11
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101

Plan administrator’s name and address
Administrator’s EIN 611400757
Plan administrator’s name WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC
Plan administrator’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101
Administrator’s telephone number 2707820151

Signature of
Role Plan administrator
Date 2010-06-04
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/13/20100713140646P040372808545001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101

Plan administrator’s name and address
Administrator’s EIN 611400757
Plan administrator’s name WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC
Plan administrator’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101
Administrator’s telephone number 2707820151

Signature of
Role Plan administrator
Date 2010-07-13
Name of individual signing VIVIAN GRISE
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101

Plan administrator’s name and address
Administrator’s EIN 611400757
Plan administrator’s name WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC
Plan administrator’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101
Administrator’s telephone number 2707820151

Signature of
Role Plan administrator
Date 2010-06-03
Name of individual signing VIVIAN GRISE
Valid signature Filed with incorrect/unrecognized electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101

Plan administrator’s name and address
Administrator’s EIN 611400757
Plan administrator’s name WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC
Plan administrator’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101
Administrator’s telephone number 2707820151

Signature of
Role Plan administrator
Date 2010-06-04
Name of individual signing VIVIAN GRISE
Valid signature Filed with incorrect/unrecognized electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 2707820151
Plan sponsor’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101

Plan administrator’s name and address
Administrator’s EIN 611400757
Plan administrator’s name WESTERN KENTUCKY HEART & LUNG ASSOCIATES, PSC
Plan administrator’s address 825 SECOND ST., STE. B1, BOWLING GREEN, KY, 42101
Administrator’s telephone number 2707820151

Signature of
Role Plan administrator
Date 2010-06-04
Name of individual signing VIVIAN GRISE
Valid signature Filed with incorrect/unrecognized electronic signature

Registered Agent

Name Role
VIVIAN GRISE Registered Agent

Shareholder

Name Role
MOHAMMED KAZIMUDDIN Shareholder
NISARFATHIMA KAZIMUDDIN Shareholder

Incorporator

Name Role
DR MOHAMMED KAZIMUDDIN Incorporator

President

Name Role
MOHAMMED KAZIMUDDIN President

Secretary

Name Role
NISARFATHIMA KAZIMUDDIN Secretary

Filings

Name File Date
Annual Report 2024-03-07
Annual Report 2023-05-01
Annual Report 2022-03-08
Annual Report 2021-04-15
Annual Report 2020-02-13
Registered Agent name/address change 2019-03-27
Principal Office Address Change 2019-03-27
Annual Report 2019-03-27
Annual Report 2018-04-05
Annual Report 2017-02-28

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
1362077104 2020-04-10 0457 PPP 421 US 31W BYP, BOWLING GREEN, KY, 42101-1775
Loan Status Date 2020-11-11
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 666686.82
Loan Approval Amount (current) 666686.82
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27217
Servicing Lender Name Independence Bank of Kentucky
Servicing Lender Address 2425 Frederica St, OWENSBORO, KY, 42301-5437
Rural or Urban Indicator R
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address BOWLING GREEN, WARREN, KY, 42101-1775
Project Congressional District KY-02
Number of Employees 58
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 27217
Originating Lender Name Independence Bank of Kentucky
Originating Lender Address OWENSBORO, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 670394.69
Forgiveness Paid Date 2020-11-03
3059868402 2021-02-04 0457 PPS 421 US 31W Byp, Bowling Green, KY, 42101-1775
Loan Status Date 2021-12-23
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 542365
Loan Approval Amount (current) 542365
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27217
Servicing Lender Name Independence Bank of Kentucky
Servicing Lender Address 2425 Frederica St, OWENSBORO, KY, 42301-5437
Rural or Urban Indicator R
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Bowling Green, WARREN, KY, 42101-1775
Project Congressional District KY-02
Number of Employees 52
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 27217
Originating Lender Name Independence Bank of Kentucky
Originating Lender Address OWENSBORO, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 546926.81
Forgiveness Paid Date 2021-12-10

Related by officers

VIVIAN GRISE

KAZIMUDDIN MEDICAL PROPERTIES, LLC WESTERN KENTUCKY HEART & LUNG PROPERTIES, LLC WESTERN KENTUCKY HEART & LUNG MEDICAL EQUIPMENT, LLC MONSHA ESTATE, LLC BARREN RIVER AREA MEDICAL GROUP MANAGEMENT ASSOCIATION, INC. WESTERN KENTUCKY HEART & LUNG RESEARCH FOUNDATION & EDUCATIONAL TRUST, INC. GRISE FAMILY FARMS, LLC

MOHAMMED KAZIMUDDIN

KAZIMUDDIN PROPERTIES, LLC KAZIMUDDIN MEDICAL PROPERTIES, LLC WESTERN KENTUCKY HEART & LUNG MEDICAL EQUIPMENT, LLC WESTERN KENTUCKY HEART & LUNG RESEARCH FOUNDATION & EDUCATIONAL TRUST, INC.

Related by address

No related companies by address

Sources: Kentucky Secretary of State

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