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  5. SOUTH FORK MEDICAL CLINIC PLLC

SOUTH FORK MEDICAL CLINIC PLLC

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

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
SKGTQFFM7ZB3 2025-02-04 71 MEDICAL LN, WHITLEY CITY, KY, 42653, 4216, USA PO BOX 250, WHITLEY CITY, KY, 42653, 0250, USA

Business Information
Congressional District 05
State/Country of Incorporation KY, USA
Activation Date 2024-02-07
Initial Registration Date 2010-01-13
Entity Start Date 2002-12-16
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 621111

Points of Contacts
Electronic Business
Title PRIMARY POC
Name JENNY ANN CORRELL
Role BILLIN SUPERVISOR
Address PO BOX 250, WHITLEY CITY, KY, 42653, USA
Title ALTERNATE POC
Name MONICA S LAWSON
Role MANAGING MEMBER
Address PO BOX 250, WHITLEY CITY, KY, 42653, USA
Government Business
Title PRIMARY POC
Name WILLIAM SINGLETON
Role CFO
Address PO BOX 250, WHITLEY CITY, KY, 42653, USA
Title ALTERNATE POC
Name MONICA S LAWSON
Role MANAGING MEMBER
Address PO BOX 250, WHITLEY CITY, KY, 42653, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH FORK MEDICAL CLINIC,PLLC CBS BENEFIT PLAN 2023 050529907 2024-12-30 SOUTH FORK MEDICAL CLINIC,PLLC 13
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2022-01-01
Business code 621491
Sponsor’s telephone number 6063109726
Plan sponsor’s address 71 MEDICAL LANE, WHITLEY CITY, KY, 42653

Plan administrator’s name and address
Administrator’s EIN 846429706
Plan administrator’s name JOSEPH HSU
Plan administrator’s address 464 CHENAULT RD, FRANKFORT, KY, 40601
Administrator’s telephone number 5026954700

Signature of
Role Plan administrator
Date 2024-12-30
Name of individual signing JOSEPH HSU
Valid signature Filed with authorized/valid electronic signature
SOUTH FORK MEDICAL CLINIC,PLLC CBS BENEFIT PLAN 2022 050529907 2023-12-27 SOUTH FORK MEDICAL CLINIC,PLLC 14
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2022-01-01
Business code 621491
Sponsor’s telephone number 6063109726
Plan sponsor’s address 71 MEDICAL LANE, WHITLEY CITY, KY, 42653

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
SOUTH FORK MEDICAL CLINIC,PLLC CBS BENEFIT PLAN 2021 050529907 2022-12-29 SOUTH FORK MEDICAL CLINIC,PLLC 15
Three-digit plan number (PN) 501
Effective date of plan 2022-01-01
Business code 621491
Sponsor’s telephone number 6063109726
Plan sponsor’s address 71 MEDICAL LANE, WHITLEY CITY, KY, 42653

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 2022-12-29
Name of individual signing SHAWNA BURTON
Valid signature Filed with authorized/valid electronic signature

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

Assumed Names

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

Filings

Name File Date
Certificate of Assumed Name 2024-04-19
Annual Report 2024-04-19
Annual Report 2023-07-03
Annual Report 2022-06-28
Annual Report 2021-02-11
Annual Report 2020-04-22
Annual Report 2019-06-06
Annual Report 2018-06-13
Annual Report 2018-06-13
Annual Report 2017-04-25

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
4532278501 2021-02-26 0457 PPS 71 Medical Ln, Whitley City, KY, 42653-4216
Loan Status Date 2022-05-26
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 146477.5
Loan Approval Amount (current) 146477.5
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27983
Servicing Lender Name United Cumberland Bank
Servicing Lender Address 47 S Main St, WHITLEY CITY, KY, 42653-6043
Rural or Urban Indicator R
Hubzone N
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Whitley City, MCCREARY, KY, 42653-4216
Project Congressional District KY-05
Number of Employees 17
NAICS code 621111
Borrower Race White
Borrower Ethnicity Not Hispanic or Latino
Business Type Limited Liability Company(LLC)
Originating Lender ID 27983
Originating Lender Name United Cumberland Bank
Originating Lender Address WHITLEY CITY, KY
Gender Male Owned
Veteran Unanswered
Forgiveness Amount 148122.86
Forgiveness Paid Date 2022-04-18
5684497004 2020-04-06 0457 PPP 71 Medical Lane, WHITLEY CITY, KY, 42653-4216
Loan Status Date 2021-01-13
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 138400
Loan Approval Amount (current) 138400
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27983
Servicing Lender Name United Cumberland Bank
Servicing Lender Address 47 S Main St, WHITLEY CITY, KY, 42653-6043
Rural or Urban Indicator R
Hubzone N
LMI Y
Business Age Description Existing or more than 2 years old
Project Address WHITLEY CITY, MCCREARY, KY, 42653-4216
Project Congressional District KY-05
Number of Employees 19
NAICS code 621111
Borrower Race White
Borrower Ethnicity Not Hispanic or Latino
Business Type Limited Liability Company(LLC)
Originating Lender ID 27983
Originating Lender Name United Cumberland Bank
Originating Lender Address WHITLEY CITY, KY
Gender Male Owned
Veteran Unanswered
Forgiveness Amount 139359.32
Forgiveness Paid Date 2020-12-28

U.S. Small Business Administration Profile

Status User ID Name of Firm Trade Name UEI Address
Active P1174867 SOUTH FORK MEDICAL CLINIC PLLC - SKGTQFFM7ZB3 71 MEDICAL LN, WHITLEY CITY, KY, 42653-4216
Capabilities Statement Link -
Phone Number 606-376-7212
Fax Number 606-376-7216
E-mail Address bill.singleton@kyrhc.com
WWW Page -
E-Commerce Website -
Contact Person WILLIAM SINGLETON
County Code (3 digit) 147
Congressional District 05
Metropolitan Statistical Area -
CAGE Code 5UUK7
Year Established 2002
Accepts Government Credit Card Yes
Legal Structure LLC
Ownership and Self-Certifications Women-Owned Small Business, Woman Owned
Business Development Servicing Office KENTUCKY DISTRICT OFFICE (SBA office code 0457)
Capabilities Narrative Provide Medical services to individuals and families
Special Equipment/Materials (none given)
Business Type Percentages Service (100 %)
Keywords Medical services to the public
Quality Assurance Standards (none given)
Electronic Data Interchange capable -

Current Principals
Name Monica S Lawson
Role Managing Member

SBA Federal Certifications
HUBZone Certified No
Women Owned Certified No
Women Owned Pending No
Economically Disadvantaged Women Owned Certified No
Economically Disadvantaged Women Owned Pending No
Veteran-Owned Small Business Certified No
Veteran-Owned Small Business Joint Venture No
Service-Disabled Veteran-Owned Small Business Certified No
Service-Disabled Veteran-Owned Small Business Joint Venture No

Bonding Levels
Description Construction Bonding Level (per contract)
Level $0
Description Construction Bonding Level (aggregate)
Level $0
Description Service Bonding Level (per contract)
Level $0
Description Service Bonding Level (aggregate)
Level $0

NAICS Codes with Size Determinations by NAICS
Primary Yes
Code 621111
NAICS Code's Description Offices of Physicians (except Mental Health Specialists)
Buy Green Yes

Export Profile (Trade Mission Online)
Exporter No
Export Business Activities (none given)
Exporting to (none given)
Desired Export Business Relationships (none given)
Description of Export Objective(s) (none given)

Related by officers

TERRY A LAWSON

SNL VENTURES, LLC

MONICA S LAWSON

Cumberland Family Clinic, PLLC

Monica S Lawson

SOUTH FORK BILLING, LLC Cumberland Family Clinic, PLLC KENTUCKY RURAL HEALTH CLINIC LLC

Related by address

No related companies by address

Sources: Kentucky Secretary of State

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