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  5. AMERICAN FAMILY DENTAL GROUP, LLC

AMERICAN FAMILY DENTAL GROUP, LLC

Company Details

Name: AMERICAN FAMILY DENTAL GROUP, LLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
Profit or Non-Profit: Profit
File Date: 10 Dec 2001 (23 years ago)
Organization Date: 10 Dec 2001 (23 years ago)
Last Annual Report: 22 May 2018 (7 years ago)
Managed By: Managers
Organization Number: 0526765
ZIP code: 40243
City: Louisville, Douglass Hills, Douglass Hls, Middletown...
Primary County: Jefferson County
Principal Office: 12802 TOWNEPARKE WAY, STE 100, LOUISVILLE, KY 40243
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AFO SHUSTER, LLC 401(K) RETIREMENT PLAN 2018 611351365 2019-03-21 AMERICAN FAMILY DENTAL GROUP, LLC 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s address 12802 TOWNEPARK WAY, SUITE 100, LOUISVILLE, KY, 40243
AFO SHUSTER, LLC 401(K) RETIREMENT PLAN 2017 611351365 2018-10-13 AMERICAN FAMILY DENTAL GROUP, LLC 39
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s address 12802 TOWNEPARK WAY, SUITE 100, LOUISVILLE, KY, 40243
AFO SHUSTER, LLC 401(K) RETIREMENT PLAN 2017 611351365 2019-03-21 AMERICAN FAMILY DENTAL GROUP, LLC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s address 12802 TOWNEPARK WAY, SUITE 100, LOUISVILLE, KY, 40243
AFO SHUSTER, LLC 401(K) RETIREMENT PLAN 2016 611351365 2017-10-16 AMERICAN FAMILY DENTAL GROUP, LLC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s address 12802 TOWNEPARK WAY, SUITE 100, LOUISVILLE, KY, 40243

Signature of
Role Plan administrator
Date 2017-10-16
Name of individual signing TIM HOAGLAND
Valid signature Filed with authorized/valid electronic signature
AMERICAN FAMILY DENTAL GROUP 2011 611351365 2012-11-06 AMERICAN FAMILY DENTAL GROUP 56
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2011-06-01
Business code 621210
Sponsor’s telephone number 5022870286
Plan sponsor’s DBA name AMERICAN FAMILY DENTAL GROUP
Plan sponsor’s mailing address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Plan sponsor’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611351365
Plan administrator’s name AMERICAN FAMILY DENTAL GROUP
Plan administrator’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Administrator’s telephone number 5022870286

Number of participants as of the end of the plan year
Active participants 56

Signature of
Role Plan administrator
Date 2012-11-06
Name of individual signing PATRICIA MORGAN
Valid signature Filed with authorized/valid electronic signature
AMERICAN FAMILY DENTAL GROUP 2010 611351365 2011-10-21 AMERICAN FAMILY DENTAL GROUP 51
Three-digit plan number (PN) 503
Effective date of plan 2010-06-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s DBA name AMERICAN FAMILY DENTAL GROUP
Plan sponsor’s mailing address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Plan sponsor’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611237516
Plan administrator’s name ANTHEM HEALTH PLANS OF KENTUCKY, INC
Plan administrator’s address 3350 PEACHTREE ROAD, P O BOX 30302-445, ATLANTA, GA, 30326

Number of participants as of the end of the plan year
Active participants 51

Signature of
Role Employer/plan sponsor
Date 2011-10-21
Name of individual signing PATRICIA MORGAN
Valid signature Filed with authorized/valid electronic signature
AMERICAN FAMILY DENTAL GROUP 2010 611351365 2011-10-21 AMERICAN FAMILY DENTAL GROUP 51
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2010-06-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s DBA name AMERICAN FAMILY DENTAL GROUP
Plan sponsor’s mailing address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Plan sponsor’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611351365
Plan administrator’s name AMERICAN FAMILY DENTAL GROUP
Plan administrator’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Administrator’s telephone number 5024239111

Number of participants as of the end of the plan year
Active participants 51

Signature of
Role Plan administrator
Date 2011-10-21
Name of individual signing PATRICIA MORGAN
Valid signature Filed with authorized/valid electronic signature
AMERICAN FAMILY DENTAL GROUP 2010 611351365 2011-10-21 AMERICAN FAMILY DENTAL GROUP 51
Three-digit plan number (PN) 503
Effective date of plan 2010-06-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s DBA name AMERICAN FAMILY DENTAL GROUP
Plan sponsor’s mailing address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Plan sponsor’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611351365
Plan administrator’s name AMERICAN FAMILY DENTAL GROUP
Plan administrator’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Administrator’s telephone number 5024239111

Number of participants as of the end of the plan year
Active participants 51

Signature of
Role Plan administrator
Date 2011-10-21
Name of individual signing PATRICIA MORGAN
Valid signature Filed with authorized/valid electronic signature
AMERICAN FAMILY DENTAL GROUP 2010 611351365 2011-10-21 AMERICAN FAMILY DENTAL GROUP 51
Three-digit plan number (PN) 503
Effective date of plan 2010-06-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s DBA name AMERICAN FAMILY DENTAL GROUP
Plan sponsor’s mailing address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Plan sponsor’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611351365
Plan administrator’s name AMERICAN FAMILY DENTAL GROUP
Plan administrator’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Administrator’s telephone number 5024239111

Number of participants as of the end of the plan year
Active participants 51

Signature of
Role Employer/plan sponsor
Date 2011-10-21
Name of individual signing PATRICIA MORGAN
Valid signature Filed with authorized/valid electronic signature
AMERICAN FAMILY DENTAL GROUP 2010 611351365 2011-10-21 AMERICAN FAMILY DENTAL GROUP 51
Three-digit plan number (PN) 503
Effective date of plan 2010-06-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s DBA name AMERICAN FAMILY DENTAL GROUP
Plan sponsor’s mailing address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Plan sponsor’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611237516
Plan administrator’s name ANTHEM HEALTH PLANS OF KENTUCKY, INC
Plan administrator’s address 3350 PEACHTREE ROAD, P O BOX 30302-445, ATLANTA, GA, 30326

Number of participants as of the end of the plan year
Active participants 51

Signature of
Role Employer/plan sponsor
Date 2011-10-21
Name of individual signing PATRICIA MORGAN
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 503
Effective date of plan 2010-06-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s DBA name AMERICAN FAMILY DENTAL GROUP
Plan sponsor’s mailing address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Plan sponsor’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611237516
Plan administrator’s name ANTHEM HEALTH PLANS OF KENTUCKY, INC
Plan administrator’s address 3350 PEACHTREE ROAD, P O BOX 30302-445, ATLANTA, GA, 30326

Number of participants as of the end of the plan year
Active participants 51

Signature of
Role Employer/plan sponsor
Date 2011-10-21
Name of individual signing PATRICIA MORGAN
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 503
Effective date of plan 2010-06-01
Business code 621210
Sponsor’s telephone number 5024239111
Plan sponsor’s DBA name AMERICAN FAMILY DENTAL GROUP
Plan sponsor’s mailing address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243
Plan sponsor’s address 12802 TOWNEPARK WAY SUITE 100, LOUISVILLE, KY, 40243

Plan administrator’s name and address
Administrator’s EIN 611237516
Plan administrator’s name ANTHEM HEALTH PLANS OF KENTUCKY, INC
Plan administrator’s address 3350 PEACHTREE ROAD, P O BOX 30302-445, ATLANTA, GA, 30326

Number of participants as of the end of the plan year
Active participants 51

Signature of
Role Employer/plan sponsor
Date 2011-10-21
Name of individual signing PATRICIA MORGAN
Valid signature Filed with authorized/valid electronic signature

Registered Agent

Name Role
TIMOTHY HOAGLAND Registered Agent

Manager

Name Role
Timothy W. Hoagland Manager

Organizer

Name Role
PATRICK J. WELSH Organizer

Filings

Name File Date
Administrative Dissolution Return 2019-12-04
Sixty Day Notice Return 2019-10-22
Administrative Dissolution 2019-10-16
Annual Report 2018-05-22
Registered Agent name/address change 2017-06-28
Annual Report 2017-06-28
Annual Report 2016-06-30
Annual Report 2015-06-30
Annual Report 2014-07-14
Annual Report 2013-05-29

Related by officers

TIMOTHY HOAGLAND

AMERICAN FAMILY ORTHODONTICS - JACKSON, LLC AMERICAN FAMILY ORTHODONTICS OF LOUISVILLE, INC. AFO, INC. AMERICAN FAMILY ORTHODONTICS, LLC AMERICAN FAMILY ORTHODONTICS - BROOKS, LLC AMERICAN FAMILY ORTHODONTICS - ANGELL, LLC AMERICAN FAMILY ORTHODONTICS - SPRINGHURST, LLC AMERICAN FAMILY ORTHODONTICS - FISHER, LLC AMERICAN FAMILY ORTHODONTICS - SHUSTER, LLC AMERICAN FAMILY ORTHODONTICS - GAITHER, LLC

Timothy W. Hoagland

AMERICAN FAMILY ORTHODONTICS, LLC AMERICAN FAMILY DENTAL GROUP-WASHINGTON SQUARE, LLC

PATRICK J. WELSH

SBC, INC. FUTURE FITNESS, INC. YEAGER'S FOOD MARKET, INC. DERBY CITY BREWING, INC. SHEA ENTERPRISES, INC. PSC TITLE COMPANY SILO ACQUISITIONS, LLC SPATH ENTERPRISES, LLC AMERICAN FAMILY ORTHODONTICS - JACKSON, LLC AUTOTOTE SYSTEMS, INC.

Related by address

No related companies by address

Sources: Kentucky Secretary of State

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