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  5. MT. WASHINGTON FAMILY PRACTICE, PLLC

MT. WASHINGTON FAMILY PRACTICE, PLLC

Company Details

Name: MT. WASHINGTON FAMILY PRACTICE, PLLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Good
Profit or Non-Profit: Profit
File Date: 29 Oct 2003 (21 years ago)
Organization Date: 29 Oct 2003 (21 years ago)
Last Annual Report: 05 Jun 2023 (2 years ago)
Managed By: Members
Organization Number: 0571085
ZIP code: 40047
City: Mount Washington, Mt Washington
Primary County: Bullitt County
Principal Office: PO BOX 67, 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY 40047
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2022 743106243 2023-09-07 MT. WASHINGTON FAMILY PRACTICE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5029555800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2023-09-07
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2022 743106243 2023-09-11 MT. WASHINGTON FAMILY PRACTICE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5029555800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2023-09-11
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2021 743106243 2022-10-07 MT. WASHINGTON FAMILY PRACTICE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5029555800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2022-10-07
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2020 743106243 2021-10-06 MT. WASHINGTON FAMILY PRACTICE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5029555800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2021-10-06
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2019 743106243 2020-09-09 MT. WASHINGTON FAMILY PRACTICE 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5029555800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2020-09-09
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2018 743106243 2019-06-20 MT. WASHINGTON FAMILY PRACTICE 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5029555800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2019-06-20
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2017 743106243 2018-06-27 MT. WASHINGTON FAMILY PRACTICE 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5029555800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2018-06-27
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2016 743106243 2017-09-26 MT. WASHINGTON FAMILY PRACTICE 10
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5025384800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2017-09-26
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2016 743106243 2018-06-27 MT. WASHINGTON FAMILY PRACTICE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5025384800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2018-06-27
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
MT. WASHINGTON FAMILY PRACTICE 401(K) PROFIT SHARING PLAN 2015 743106243 2016-10-03 MT. WASHINGTON FAMILY PRACTICE 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5025384800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2016-10-03
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/15/20151015092231P040003013045001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5025384800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/18/20140918121920P030008247665001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5025384800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2014-09-18
Name of individual signing DENISE GORE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/22/20130722075631P040114635925001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5025384800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Signature of
Role Plan administrator
Date 2013-07-22
Name of individual signing MICHAEL PAYNE, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/24/20120724082409P030000977220001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5025384800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Plan administrator’s name and address
Administrator’s EIN 743106243
Plan administrator’s name MT. WASHINGTON FAMILY PRACTICE
Plan administrator’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047
Administrator’s telephone number 5025384800

Signature of
Role Plan administrator
Date 2012-07-24
Name of individual signing MICHAEL PAYNE, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/20/20110720160653P030456352992001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5025384800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Plan administrator’s name and address
Administrator’s EIN 743106243
Plan administrator’s name MT. WASHINGTON FAMILY PRACTICE
Plan administrator’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047
Administrator’s telephone number 5025384800

Signature of
Role Plan administrator
Date 2011-07-20
Name of individual signing MICHAEL PAYNE, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/13/20100913093036P030496017329001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 5025384800
Plan sponsor’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047

Plan administrator’s name and address
Administrator’s EIN 743106243
Plan administrator’s name MT. WASHINGTON FAMILY PRACTICE
Plan administrator’s address 532 NORTH BARDSTOWN ROAD, MT. WASHINGTON, KY, 40047
Administrator’s telephone number 5025384800

Signature of
Role Plan administrator
Date 2010-09-13
Name of individual signing MICHAEL PAYNE, MD
Valid signature Filed with authorized/valid electronic signature

Member

Name Role
STEVEN PAYNE Member

Registered Agent

Name Role
BRYAN D GATEWOOD Registered Agent

Organizer

Name Role
DR. MICHAEL STEVEN PAYNE Organizer

Filings

Name File Date
Dissolution 2024-04-25
Annual Report 2023-06-05
Annual Report 2022-05-24
Annual Report 2021-06-09
Annual Report 2020-05-06
Annual Report 2019-05-21
Annual Report 2018-05-21
Annual Report 2017-04-27
Annual Report 2016-04-25
Annual Report 2015-04-23

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5621247209 2020-04-27 0457 PPP 532 North Bardstown Rd, Mount Washington, KY, 40047-7642
Loan Status Date 2021-02-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 74800
Loan Approval Amount (current) 74800
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27542
Servicing Lender Name Republic Bank & Trust Company
Servicing Lender Address 601 W Market St Republic Corporate Center, LOUISVILLE, KY, 40202
Rural or Urban Indicator R
Hubzone N
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Mount Washington, BULLITT, KY, 40047-7642
Project Congressional District KY-02
Number of Employees 9
NAICS code 524114
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 27542
Originating Lender Name Republic Bank & Trust Company
Originating Lender Address LOUISVILLE, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 75336.07
Forgiveness Paid Date 2021-01-14

Related by officers

STEVEN PAYNE

532 N. BARDSTOWN ROAD, LLC

BRYAN D GATEWOOD

ORCHARD MANOR CIRCLE APARTMENTS LIMITED LIABILITY COMPANY CAWEIN WAY ENTERPRISES LIMITED LIABILITY COMPANY 231 SOUTH FIFTH STREET, LLC

Related by address

No related companies by address

Sources: Kentucky Secretary of State

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