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  5. TRI-STATE VASCULAR GROUP, PSC

TRI-STATE VASCULAR GROUP, PSC

Company Details

Name: TRI-STATE VASCULAR GROUP, PSC
Jurisdiction: Kentucky
Profit or Non-Profit: Profit
Legal type: Kentucky Professional Services Corp
Status: Inactive
Standing: Good
File Date: 15 Dec 2005 (19 years ago)
Organization Date: 15 Dec 2005 (19 years ago)
Last Annual Report: 01 Feb 2012 (13 years ago)
Organization Number: 0627706
ZIP code: 41101
Primary County: Boyd
Principal Office: 2301 LEXINGTON AVENUE , SUITE 230, ASHLAND, KY 41101
Place of Formation: KENTUCKY
Authorized Shares: 100

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TRI-STATE VASCULAR GROUP, PSC 401K PROFIT SHARING PLAN 2012 203981871 2013-07-15 TRI-STATE VASCULAR GROUP, PSC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-02-15
Business code 621111
Sponsor’s telephone number 6063261675
Plan sponsor’s address PO BOX 149, ASHLAND, KY, 41105

Plan administrator’s name and address
Administrator’s EIN 203981871
Plan administrator’s name TRI-STATE VASCULAR GROUP, PSC
Plan administrator’s address PO BOX 149, ASHLAND, KY, 41105
Administrator’s telephone number 6063261675

Signature of
Role Plan administrator
Date 2013-07-15
Name of individual signing OMRAN ABUL-KHOUDOUD, M.D.
Valid signature Filed with authorized/valid electronic signature
TRI-STATE VASCULAR GROUP, PSC 401(K) PROFIT SHARING PLAN (B) 2012 203981871 2013-07-15 TRI-STATE VASCULAR GROUP, PSC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-02-15
Business code 621111
Sponsor’s telephone number 6063261675
Plan sponsor’s address PO BOX 149, ASHLAND, KY, 41105

Signature of
Role Plan administrator
Date 2013-07-15
Name of individual signing OMRAN ABUL-KHOUDOUD, M.D.
Valid signature Filed with authorized/valid electronic signature
TRI-STATE VASCULAR GROUP, PSC 401K PROFIT SHARING PLAN 2011 203981871 2012-10-12 TRI-STATE VASCULAR GROUP, PSC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-02-15
Business code 621111
Sponsor’s telephone number 6063261675
Plan sponsor’s address 2301 LEXINGTON AVENUE, SUITE 230, ASHLAND, KY, 41101

Plan administrator’s name and address
Administrator’s EIN 203981871
Plan administrator’s name TRI-STATE VASCULAR GROUP, PSC
Plan administrator’s address 2301 LEXINGTON AVENUE, SUITE 230, ASHLAND, KY, 41101
Administrator’s telephone number 6063261675

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing OMRAN ABUL-KHOUDOUD, M.D.
Valid signature Filed with authorized/valid electronic signature
TRI-STATE VASCULAR GROUP, PSC 401K PROFIT SHARING PLAN 2010 203981871 2011-08-18 TRI-STATE VASCULAR GROUP, PSC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-02-15
Business code 621111
Sponsor’s telephone number 6063261675
Plan sponsor’s address 2301 LEXINGTON AVENUE, SUITE 230, ASHLAND, KY, 41101

Plan administrator’s name and address
Administrator’s EIN 203981871
Plan administrator’s name TRI-STATE VASCULAR GROUP, PSC
Plan administrator’s address 2301 LEXINGTON AVENUE, SUITE 230, ASHLAND, KY, 41101
Administrator’s telephone number 6063261675

Signature of
Role Plan administrator
Date 2011-08-18
Name of individual signing OMRAN ABUL-KHOUDOUD, M.D.
Valid signature Filed with authorized/valid electronic signature
TRI-STATE VASCULAR GROUP, PSC 401K PROFIT SHARING PLAN 2009 203981871 2010-07-29 TRI-STATE VASCULAR GROUP, PSC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-02-15
Business code 621111
Sponsor’s telephone number 6063261675
Plan sponsor’s address 2301 LEXINGTON AVENUE, SUITE 230, ASHLAND, KY, 41101

Plan administrator’s name and address
Administrator’s EIN 203981871
Plan administrator’s name TRI-STATE VASCULAR GROUP, PSC
Plan administrator’s address 2301 LEXINGTON AVENUE, SUITE 230, ASHLAND, KY, 41101
Administrator’s telephone number 6063261675

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing OMRAN ABUL-KHOUDOUD, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-29
Name of individual signing OMRAN ABUL-KHOUDOUD, M.D.
Valid signature Filed with authorized/valid electronic signature

Registered Agent

Name Role
OMRAN ABUL KHOUDOUD Registered Agent

Director

Name Role
OMRAN ABUL KHOUDOUD Director

President

Name Role
OMRAN ABUL KHOUDOUD President

Signature

Name Role
OMRAN ABUL KHOUDOUD Signature

Shareholder

Name Role
OMRAN ABUL KHOUDOUD Shareholder

Incorporator

Name Role
OMRAN ABUL-KHOUDOUD, MD Incorporator

Filings

Name File Date
Dissolution 2012-12-28
Annual Report 2012-02-01
Annual Report 2011-04-14
Annual Report 2010-04-26
Reinstatement 2009-04-14
Registered Agent name/address change 2009-04-14
Administrative Dissolution 2009-02-11
Sixty Day Notice 2008-12-11
Agent Resignation 2008-09-08
Annual Report 2008-05-23

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 11 Nov 2024

Sources: Kentucky Secretary of State

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