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  5. ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC

ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC

Company Details

Name: ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC
Jurisdiction: Kentucky
Profit or Non-Profit: Profit
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
File Date: 12 Dec 2001 (23 years ago)
Organization Date: 12 Dec 2001 (23 years ago)
Last Annual Report: 28 Feb 2024 (a year ago)
Managed By: Members
Organization Number: 0526984
Industry: Health Services
Number of Employees: Medium (20-99)
ZIP code: 42701
Primary County: Hardin
Principal Office: 913 N DIXIE AVE, ELIZABETHTOWN, KY 42701
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EEP RETIREMENT PLAN 2023 611401114 2024-06-24 ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address P.O. BOX 910530, LEXINGTON, KY, 405910530
ELIZABETHTOWN EMERGENCY PHYSICIANS CBS BENEFIT PLAN 2022 611401114 2023-12-27 ELIZABETHTOWN EMERGENCY PHYSICIANS 21
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2023-01-01
Business code 621491
Sponsor’s telephone number 8777836257
Plan sponsor’s address PO BOX 910530, LEXINGTON, KY, 40591

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
EEP RETIREMENT PLAN 2022 611401114 2023-07-20 ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address P.O. BOX 910530, LEXINGTON, KY, 405910530
EEP RETIREMENT PLAN 2021 611401114 2022-07-28 ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address P.O. BOX 910530, LEXINGTON, KY, 405910530
EEP RETIREMENT PLAN 2020 611401114 2021-07-30 ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address P.O. BOX 910530, LEXINGTON, KY, 405910530
EEP RETIREMENT PLAN 2019 611401114 2020-07-17 ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address P.O. BOX 910530, LEXINGTON, KY, 405910530
EEP RETIREMENT PLAN 2018 611401114 2019-06-10 ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address P.O. BOX 910530, LEXINGTON, KY, 405910530
EEP RETIREMENT PLAN 2017 611401114 2018-07-13 ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address P.O. BOX 910530, LEXINGTON, KY, 405910530
EEP RETIREMENT PLAN 2016 611401114 2017-08-29 ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address P.O. BOX 910530, LEXINGTON, KY, 405910530
EEP RETIREMENT PLAN AND TRUST 2015 611401114 2016-07-19 ELIZABETHTOWN EMERGENCY PHYSICIANS 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 8777836257
Plan sponsor’s address P.O. BOX 910530, LEXINGTON, KY, 40591

Signature of
Role Plan administrator
Date 2016-07-19
Name of individual signing PETER POPOVICH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/13/20151013084126P030045066817001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address PO BOX 910530, LEXINGTON, KY, 405910530
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/08/20140608122135P030376595235001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Plan sponsor’s address PO BOX 910530, LEXINGTON, KY, 405910530
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/14/20131014113939P040037111491004.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5022438830
Plan sponsor’s address PO BOX 910530, LEXINGTON, KY, 405910530

Signature of
Role Plan administrator
Date 2013-10-14
Name of individual signing ROSS T WALTON MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/17/20120917143538P040002674437005.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5022438830
Plan sponsor’s address PO BOX 910530, LEXINGTON, KY, 405910530

Plan administrator’s name and address
Administrator’s EIN 611401114
Plan administrator’s name ELIZABETHTOWN EMERGENCY PHYSICIANS
Plan administrator’s address PO BOX 910530, LEXINGTON, KY, 405910530
Administrator’s telephone number 5022438830

Signature of
Role Plan administrator
Date 2012-09-17
Name of individual signing ROSS T WALTON MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/03/20111003145457P030141648913007.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5022438830
Plan sponsor’s address PO BOX 910530, LEXINGTON, KY, 405910530

Plan administrator’s name and address
Administrator’s EIN 611401114
Plan administrator’s name ELIZABETHTOWN EMERGENCY PHYSICIANS
Plan administrator’s address PO BOX 910530, LEXINGTON, KY, 405910530
Administrator’s telephone number 5022438830

Signature of
Role Plan administrator
Date 2011-10-03
Name of individual signing ROSS T WALTON MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/02/20101002132201P030004465809007.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5022438830
Plan sponsor’s address PO BOX 910530, LEXINGTON, KY, 405910530

Plan administrator’s name and address
Administrator’s EIN 611401114
Plan administrator’s name ELIZABETHTOWN EMERGENCY PHYSICIANS
Plan administrator’s address PO BOX 910530, LEXINGTON, KY, 405910530
Administrator’s telephone number 5022438830

Signature of
Role Plan administrator
Date 2010-10-02
Name of individual signing ROBERT GILBERT
Valid signature Filed with authorized/valid electronic signature

Registered Agent

Name Role
FBT LLC LEXINGTON Registered Agent

Member

Name Role
Scott Dishaw, D.O. Member
Peter Popovich,D.O. Member
Todd Bell, D.O. Member
Nick Lepora, D.O. Member
Lize-Mari Dorfling,M.D. Member
Vincent Syers, M.D Member
Joseph Stone, M.D. Member
Berchaun Nicholls, M.D. Member
Ronnie Pridemore, M.D. Member
Tyler Corey, M.D. Member

Organizer

Name Role
MARTIN D BONNEY JR Organizer
ROBERT D GILBERT Organizer
GARY HARRIS Organizer

Filings

Name File Date
Annual Report 2024-02-28
Annual Report 2023-06-02
Annual Report 2022-03-12
Annual Report 2021-04-13
Annual Report 2020-05-20
Annual Report 2019-02-05
Annual Report 2018-04-18
Annual Report 2017-05-19
Annual Report 2016-08-03
Annual Report 2015-04-21

Related by officers

GARY HARRIS

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Related by address

No related companies by address

Date of last update: 29 Dec 2024

Sources: Kentucky Secretary of State

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