| Name: | FAMILY COMMUNITY CLINIC, INC. |
| Jurisdiction: | Kentucky |
| Profit or Non-Profit: | Non-profit |
| Legal type: | Kentucky Corporation |
| Status: | Active |
| Standing: | Good |
| File Date: | 02 Jun 2010 (15 years ago) |
| Organization Date: | 02 Jun 2010 (15 years ago) |
| Last Annual Report: | 01 Feb 2024 (a year ago) |
| Organization Number: | 0759000 |
| Industry: | Health Services |
| Number of Employees: | Small (0-19) |
| ZIP code: | 40206 |
| Primary County: | Jefferson |
| Principal Office: | 1420 E. WASHINGTON ST, LOUISVILLE, KY 40206 |
| Place of Formation: | KENTUCKY |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FAMILY COMMUNITY CLINIC CBS BENEFIT PLAN | 2021 | 272994215 | 2022-12-29 | FAMILY COMMUNITY CLINIC | 1 | |||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||
| Administrator’s EIN | 846429706 |
| Plan administrator’s name | SHAWNA BURTON |
| Plan administrator’s address | 464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number | 5026954700 |
Signature of
| Role | Plan administrator |
| Date | 2022-12-29 |
| Name of individual signing | SHAWNA BURTON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 501 |
| Effective date of plan | 2020-07-01 |
| Business code | 621491 |
| Sponsor’s telephone number | 5023848444 |
| Plan sponsor’s address | 1420 E WASHINGTON STREET, LOUISVILLE, KY, 40206 |
Plan administrator’s name and address
| Administrator’s EIN | 846429706 |
| Plan administrator’s name | SHAWNA BURTON |
| Plan administrator’s address | 464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number | 5026954700 |
Signature of
| Role | Plan administrator |
| Date | 2021-12-14 |
| Name of individual signing | SHAWNA BURTON |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| TIMOTHY D. LANGE | Registered Agent |
| Name | Role |
|---|---|
| BEVERLY BECKMAN | Secretary |
| Name | Role |
|---|---|
| BILL FREY | Treasurer |
| Name | Role |
|---|---|
| BOB MUELLER | President |
| Name | Role |
|---|---|
| DAVID CASEY | Vice President |
| Name | Role |
|---|---|
| MANUEL GRIMALDI | Director |
| MUHAMMAD BABAR | Director |
| LISA TWOHEY | Director |
| JAMES RANSDELL | Director |
| PHILLP BOND | Director |
| KEVIN SHURN | Director |
| DEEPAK AZAD | Director |
| LAURA CHANDLER | Director |
| NANCY MARTIN | Director |
| SCOTT COLOSI | Director |
| Name | Role |
|---|---|
| TIMOTHY D. LANGE | Incorporator |
| Name | Action |
|---|---|
| FAMILY COMMUNITY CLINIC, INC. | Type Conversion |
| Name | File Date |
|---|---|
| Annual Report | 2024-02-01 |
| Annual Report | 2023-06-05 |
| Annual Report | 2022-05-17 |
| Principal Office Address Change | 2022-03-07 |
| Annual Report | 2021-04-14 |
| Annual Report | 2020-06-01 |
| Annual Report | 2019-06-21 |
| Annual Report | 2018-04-16 |
| Amendment | 2017-12-27 |
| Annual Report | 2017-06-19 |
Date of last update: 11 Jan 2025
Sources: Kentucky Secretary of State
