| Name: | DR. MENDOZA'S PEDIATRIC & ADOLESCENT CLINIC, PLLC |
| Legal type: | Kentucky Limited Liability Company |
| Status: | Inactive |
| Standing: | Good |
| Profit or Non-Profit: | Profit |
| File Date: | 02 Aug 2005 (20 years ago) |
| Organization Date: | 02 Aug 2005 (20 years ago) |
| Last Annual Report: | 24 Jun 2015 (10 years ago) |
| Managed By: | Members |
| Organization Number: | 0618760 |
| ZIP code: | 41339 |
| City: | Jackson, Altro, Athol, Canoe, Decoy, Elkatawa, Fr... |
| Primary County: | Breathitt County |
| Principal Office: | 540 JETT DRIVE, JACKSON, KY 41339 |
| Place of Formation: | KENTUCKY |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR. MENDOZA'S CLINIC 401(K) PLAN | 2013 | 020757560 | 2014-09-02 | DR. MENDOZA'S PEDIATRIC & ADOLESCENT CLINIC, PLLC | 8 | |||||||||||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2014-09-01 |
| Name of individual signing | EDGAR A. MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2014-09-01 |
| Name of individual signing | EDGAR A. MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 6066934800 |
| Plan sponsor’s address | 540 JETT DRIVE, JACKSON, KY, 41339 |
Signature of
| Role | Plan administrator |
| Date | 2014-07-10 |
| Name of individual signing | EDGAR A. MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2014-07-10 |
| Name of individual signing | EDGAR A. MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 6066934800 |
| Plan sponsor’s address | 540 JETT DRIVE, JACKSON, KY, 41339 |
Signature of
| Role | Plan administrator |
| Date | 2013-07-16 |
| Name of individual signing | EDGAR A. MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-07-16 |
| Name of individual signing | EDGAR A. MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 6066934800 |
| Plan sponsor’s address | 540 JETT DRIVE, JACKSON, KY, 41339 |
Plan administrator’s name and address
| Administrator’s EIN | 020757560 |
| Plan administrator’s name | DR. MENDOZA'S PEDIATRIC & ADOLESCENT CLINIC, PLLC |
| Plan administrator’s address | 540 JETT DRIVE, JACKSON, KY, 41339 |
| Administrator’s telephone number | 6066934800 |
Signature of
| Role | Plan administrator |
| Date | 2012-07-17 |
| Name of individual signing | EDGAR A. MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2012-07-17 |
| Name of individual signing | EDGAR A. MENDOZA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| Edgar Allan Mendoza MD | Member |
| Name | Role |
|---|---|
| EDGAR ALLAN MENDOZA, M.D. | Organizer |
| Name | Role |
|---|---|
| EDGAR ALLAN MENDOZA, M.D. | Registered Agent |
| Name | File Date |
|---|---|
| Dissolution | 2016-04-26 |
| Annual Report | 2015-06-24 |
| Annual Report | 2014-04-16 |
| Annual Report Amendment | 2013-01-15 |
| Registered Agent name/address change | 2013-01-10 |
| Annual Report | 2013-01-10 |
| Annual Report Amendment | 2012-05-15 |
| Annual Report | 2012-01-13 |
| Annual Report | 2011-02-11 |
| Annual Report | 2010-03-09 |
Sources: Kentucky Secretary of State
