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  5. FAMILY MEDICINE SPECIALISTS, PLLC

FAMILY MEDICINE SPECIALISTS, PLLC

Company Details

Name: FAMILY MEDICINE SPECIALISTS, PLLC
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
File Date: 03 Feb 2004 (21 years ago)
Organization Date: 03 Feb 2004 (21 years ago)
Last Annual Report: 08 Feb 2012 (13 years ago)
Managed By: Members
Organization Number: 0577960
ZIP code: 42301
City: Owensboro, Saint Joseph, St Joseph, Stanley
Primary County: Daviess County
Principal Office: 2315 MAYFIAR DRIVE, SUITE 8, OWENSBORO, KY 42301
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FAMILY MEDICINE SPECIALISTS, PLLC 401(K) P/S PLAN 2012 200695866 2013-05-14 FAMILY MEDICINE SPECIALISTS PLLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-09-01
Business code 621111
Sponsor’s telephone number 2706848424
Plan sponsor’s address 2315 MAYFAIR DRIVE, SUITE 8, OWENSBORO, KY, 42301

Plan administrator’s name and address
Administrator’s EIN 200695866
Plan administrator’s name FAMILY MEDICINE SPECIALISTS PLLC
Plan administrator’s address 2315 MAYFAIR DRIVE, SUITE 8, OWENSBORO, KY, 42301
Administrator’s telephone number 2706848424

Signature of
Role Plan administrator
Date 2013-05-14
Name of individual signing FELICITY W. POLIO
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICINE SPECIALISTS, PLLC 401(K) P/S PLAN 2012 200695866 2013-11-14 FAMILY MEDICINE SPECIALISTS, PLLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-09-01
Business code 621111
Sponsor’s telephone number 2706846255
Plan sponsor’s address 2315 MAYFAIR DRIVE SUITE 8, OWENSBORO, KY, 42301

Signature of
Role Plan administrator
Date 2013-11-14
Name of individual signing FELICITY POLIO
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICINE SPECIALISTS, PLLC 401(K) P/S PLAN 2011 200695866 2012-10-16 FAMILY MEDICINE SPECIALISTS PLLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-09-01
Business code 621111
Sponsor’s telephone number 2706848424
Plan sponsor’s address 2315 MAYFAIR DRIVE, SUITE 8, OWENSBORO, KY, 42301

Plan administrator’s name and address
Administrator’s EIN 200695866
Plan administrator’s name FAMILY MEDICINE SPECIALISTS PLLC
Plan administrator’s address 2315 MAYFAIR DRIVE, SUITE 8, OWENSBORO, KY, 42301
Administrator’s telephone number 2706848424

Signature of
Role Plan administrator
Date 2012-10-16
Name of individual signing FELICITY W. POLIO
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICINE SPECIALISTS, PLLC 401(K) P/S PLAN 2010 200695866 2011-06-29 FAMILY MEDICINE SPECIALISTS PLLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-09-01
Business code 621111
Sponsor’s telephone number 2706848424
Plan sponsor’s address 2315 MAYFAIR DRIVE, SUITE 8, OWENSBORO, KY, 42301

Plan administrator’s name and address
Administrator’s EIN 200695866
Plan administrator’s name FAMILY MEDICINE SPECIALISTS PLLC
Plan administrator’s address 2315 MAYFAIR DRIVE, SUITE 8, OWENSBORO, KY, 42301
Administrator’s telephone number 2706848424

Signature of
Role Plan administrator
Date 2011-06-29
Name of individual signing FELICITY W. POLIO
Valid signature Filed with authorized/valid electronic signature
FAMILY MEDICINE SPECIALISTS, PLLC 401(K) P/S PLAN 2009 200695866 2010-07-21 FAMILY MEDICINE SPECIALISTS PLLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-09-01
Business code 621111
Sponsor’s telephone number 2706848424
Plan sponsor’s address 2315 MAYFAIR DRIVE, SUITE 8, OWENSBORO, KY, 42301

Plan administrator’s name and address
Administrator’s EIN 200695866
Plan administrator’s name FAMILY MEDICINE SPECIALISTS PLLC
Plan administrator’s address 2315 MAYFAIR DRIVE, SUITE 8, OWENSBORO, KY, 42301
Administrator’s telephone number 2706848424

Signature of
Role Plan administrator
Date 2010-07-21
Name of individual signing FELICITY W. POLIO
Valid signature Filed with authorized/valid electronic signature

Registered Agent

Name Role
WILLIAM H. ENGLE SR. Registered Agent

Member

Name Role
FELICITY W POLIO Member

Signature

Name Role
FELICITY W POLIO Signature

Organizer

Name Role
F. POLIO, MD Organizer

Filings

Name File Date
Administrative Dissolution Return 2013-10-23
Administrative Dissolution 2013-09-28
Sixty Day Notice Return 2013-08-15
Annual Report 2012-02-08
Annual Report 2011-03-28
Annual Report 2010-03-25
Annual Report 2009-02-19
Annual Report 2008-03-04
Annual Report 2007-02-16
Annual Report 2006-03-27

Related by officers

No related officers

Related by address

No related companies by address

Sources: Kentucky Secretary of State

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