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  5. MERCY CLINIC OF JACKSON, PLLC

MERCY CLINIC OF JACKSON, PLLC

Company Details

Name: MERCY CLINIC OF JACKSON, PLLC
Jurisdiction: Kentucky
Profit or Non-Profit: Profit
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
File Date: 23 Feb 2005 (20 years ago)
Organization Date: 23 Feb 2005 (20 years ago)
Last Annual Report: 06 Mar 2024 (a year ago)
Managed By: Managers
Organization Number: 0606791
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 41339
Primary County: Breathitt
Principal Office: 1550 KY. HWY. 15 SOUTH, STE 80, JACKSON, KY 41339
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MERCY CLINIC OF JACKSON 401K PLAN 2014 202416550 2015-06-09 MERCY CLINIC OF JACKSON, PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6066930343
Plan sponsor’s address 1550 HWY.15 S STE 80, JACKSON, KY, 41339

Signature of
Role Plan administrator
Date 2015-06-09
Name of individual signing SUSAN PRATT
Valid signature Filed with authorized/valid electronic signature
MERCY CLINIC OF JACKSON 401K PLAN 2013 202416550 2014-09-23 MERCY CLINIC OF JACKSON, PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6066930343
Plan sponsor’s address 1550 HWY.15 S STE 80, JACKSON, KY, 41339

Signature of
Role Plan administrator
Date 2014-09-23
Name of individual signing SUSAN PRATT
Valid signature Filed with authorized/valid electronic signature
MERCY CLINIC OF JACKSON 401K PLAN 2012 202416550 2013-03-04 MERCY CLINIC OF JACKSON, PLLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6066930343
Plan sponsor’s address 1550 HWY.15 S STE 80, JACKSON, KY, 41339

Signature of
Role Plan administrator
Date 2013-03-04
Name of individual signing SUSAN PRATT
Valid signature Filed with authorized/valid electronic signature
MERCY CLINIC OF JACKSON 401K PLAN 2011 202416550 2012-09-17 MERCY CLINIC OF JACKSON, PLLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6066930343
Plan sponsor’s address 1550 HWY.15 S STE 80, JACKSON, KY, 41339

Plan administrator’s name and address
Administrator’s EIN 202416550
Plan administrator’s name MERCY CLINIC OF JACKSON, PLLC
Plan administrator’s address 1550 HWY.15 S STE 80, JACKSON, KY, 41339
Administrator’s telephone number 6066930343

Signature of
Role Plan administrator
Date 2012-09-17
Name of individual signing SUSAN PRATT
Valid signature Filed with authorized/valid electronic signature
MERCY CLINIC OF JACKSON 401K PLAN 2010 202416550 2011-05-24 MERCY CLINIC OF JACKSON, PLLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6066930343
Plan sponsor’s address 1550 HWY.15 S STE 80, JACKSON, KY, 413390000000

Plan administrator’s name and address
Administrator’s EIN 202416550
Plan administrator’s name MERCY CLINIC OF JACKSON, PLLC
Plan administrator’s address 1550 HWY.15 S STE 80, JACKSON, KY, 413390000000
Administrator’s telephone number 6066930343

Signature of
Role Plan administrator
Date 2011-05-24
Name of individual signing SUSAN PRATT
Valid signature Filed with authorized/valid electronic signature
MERCY CLINIC OF JACKSON 401K PLAN 2009 202416550 2010-08-03 MERCY CLINIC OF JACKSON, PLLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6066930343
Plan sponsor’s address 1550 HWY.15 S STE 80, JACKSON, KY, 413390000000

Plan administrator’s name and address
Administrator’s EIN 202416550
Plan administrator’s name MERCY CLINIC OF JACKSON, PLLC
Plan administrator’s address 1550 HWY.15 S STE 80, JACKSON, KY, 413390000000
Administrator’s telephone number 6066930343

Signature of
Role Plan administrator
Date 2010-08-03
Name of individual signing SUSAN PRATT
Valid signature Filed with authorized/valid electronic signature

Member

Name Role
CESAR O AGTARAP, MD Member

Manager

Name Role
AIDA A RYNKOWSKI Manager

Registered Agent

Name Role
CESAR O. AGTARAP, M.D. Registered Agent

Organizer

Name Role
CESAR O. AGTARAT, M.D. Organizer

Filings

Name File Date
Annual Report 2024-03-06
Principal Office Address Change 2024-03-06
Annual Report 2023-03-16
Annual Report 2022-03-07
Annual Report 2021-02-10
Annual Report 2020-02-17
Annual Report 2019-06-21
Annual Report 2018-06-21
Annual Report 2017-04-27
Annual Report 2016-08-23

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 04 Jan 2025

Sources: Kentucky Secretary of State

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