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  5. SOUTH FORK MEDICAL CLINIC PLLC

SOUTH FORK MEDICAL CLINIC PLLC

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Company Details

Name: SOUTH FORK MEDICAL CLINIC PLLC
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 06 Sep 2002 (23 years ago)
Organization Date: 06 Sep 2002 (23 years ago)
Last Annual Report: 19 Apr 2024 (a year ago)
Managed By: Members
Organization Number: 0544000
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 42653
City: Whitley City
Primary County: McCreary County
Principal Office: PO BOX 250, WHITLEY CITY, KY 42653
Place of Formation: KENTUCKY

Organizer

Name Role
TERRY A LAWSON Organizer
MONICA S LAWSON Organizer

Registered Agent

Name Role
MONICA S LAWSON Registered Agent

Member

Name Role
Monica S Lawson Member

U.S. Small Business Administration Profile

Phone Number:
606-376-7212
E-mail Address:
bill.singleton@kyrhc.com
Fax Number:
606-376-7216
Contact Person:
WILLIAM SINGLETON
Ownership and Self-Certifications:
Women-Owned Small Business, Woman Owned
User ID:
P1174867

Unique Entity ID

Unique Entity ID:
SKGTQFFM7ZB3
CAGE Code:
5UUK7
UEI Expiration Date:
2026-02-11

Business Information

Activation Date:
2025-02-13
Initial Registration Date:
2010-01-13

Commercial and government entity program

CAGE number:
5UUK7
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2025-02-13
CAGE Expiration:
2030-02-13
SAM Expiration:
2026-02-11

Contact Information

POC:
WILLIAM SINGLETON

National Provider Identifier

NPI Number:
1205616265
Certification Date:
2024-04-15
Link:
View on NPI website

Authorized Person:

Name:
VIRGINIA ANN CORRELL
Role:
CREDENTIALING
Phone:
6063767212

Taxonomy:

Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
Yes

Contacts:

Phone:
+1 606-376-7211
Fax:
6063769219

Form 5500 Series

Employer Identification Number (EIN):
050529907
Plan Year:
2023
Number Of Participants:
13
Sponsors Telephone Number:
6063109726
File:
View File
Plan Year:
2022
Number Of Participants:
14
Sponsors Telephone Number:
6063109726
File:
View File
Plan Year:
2021
Number Of Participants:
15
Sponsors Telephone Number:
6063109726

Assumed Names

Name Status Expiration Date
SOUTH FORK CLINIC Active 2029-04-19

Filings

Name File Date
Annual Report 2024-04-19
Certificate of Assumed Name 2024-04-19
Annual Report 2023-07-03
Annual Report 2022-06-28
Annual Report 2021-02-11

USAspending Awards / Financial Assistance

Date:
2021-02-26
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
146477.50
Total Face Value Of Loan:
146477.50
Date:
2020-04-07
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
138400.00
Total Face Value Of Loan:
138400.00

Paycheck Protection Program

Jobs Reported:
17
Initial Approval Amount:
$146,477.5
Date Approved:
2021-02-26
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$146,477.5
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Unanswered
Forgiveness Amount:
$148,122.86
Servicing Lender:
United Cumberland Bank
Use of Proceeds:
Payroll: $146,472.5
Utilities: $1
Jobs Reported:
19
Initial Approval Amount:
$138,400
Date Approved:
2020-04-06
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$138,400
Race:
White
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Unanswered
Forgiveness Amount:
$139,359.32
Servicing Lender:
United Cumberland Bank
Use of Proceeds:
Payroll: $103,800
Utilities: $17,300
Mortgage Interest: $17,300

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Sources: Kentucky Secretary of State

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