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GREEN RIVER ORAL SURGERY LLC

Company Details

Name: GREEN RIVER ORAL SURGERY LLC
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 27 Jun 2012 (13 years ago)
Organization Date: 27 Jun 2012 (13 years ago)
Last Annual Report: 19 Aug 2024 (8 months ago)
Managed By: Members
Organization Number: 0832370
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 42420
City: Henderson
Primary County: Henderson County
Principal Office: 801 NORTH ELM STREET, HENDERSON, KY 42420
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GREEN RIVER ORAL SURGERY CBS BENEFIT PLAN 2023 455573261 2024-12-30 GREEN RIVER ORAL SURGERY 2
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-09-01
Business code 621210
Sponsor’s telephone number 2702120330
Plan sponsor’s address 801 N ELM ST, HENDERSON, KY, 42420

Plan administrator’s name and address

Administrator’s EIN 846429706
Plan administrator’s name JOSEPH HSU
Plan administrator’s address 464 CHENAULT RD, FRANKFORT, KY, 40601
Administrator’s telephone number 5026954700

Signature of

Role Plan administrator
Date 2024-12-30
Name of individual signing JOSEPH HSU
Valid signature Filed with authorized/valid electronic signature
GREEN RIVER ORAL SURGERY CBS BENEFIT PLAN 2022 455573261 2023-12-27 GREEN RIVER ORAL SURGERY 3
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-09-01
Business code 621210
Sponsor’s telephone number 2702120330
Plan sponsor’s address 801 N ELM ST, HENDERSON, KY, 42420

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 2023-12-27
Name of individual signing SHAWNA BURTON
Valid signature Filed with authorized/valid electronic signature
GREEN RIVER ORAL SURGERY CBS BENEFIT PLAN 2021 455573261 2022-12-29 GREEN RIVER ORAL SURGERY 3
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-09-01
Business code 621210
Sponsor’s telephone number 2702120330
Plan sponsor’s address 801 N ELM ST, HENDERSON, KY, 42420

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 2022-12-29
Name of individual signing SHAWNA BURTON
Valid signature Filed with authorized/valid electronic signature
GREEN RIVER ORAL SURGERY CBS BENEFIT PLAN 2020 455573261 2021-12-14 GREEN RIVER ORAL SURGERY 3
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-09-01
Business code 621210
Sponsor’s telephone number 2702120330
Plan sponsor’s address 801 N ELM ST, HENDERSON, KY, 42420

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

Member

Name Role
ROBERT G WAGONER Member

Organizer

Name Role
ROBERT G WAGONER Organizer

Registered Agent

Name Role
ROBERT G WAGONER Registered Agent

Filings

Name File Date
Annual Report 2024-08-19
Annual Report 2023-06-05
Annual Report 2022-06-01
Annual Report 2021-04-16
Annual Report 2020-06-16
Annual Report 2019-06-06
Annual Report 2018-06-07
Annual Report 2017-06-06
Annual Report 2016-07-06
Annual Report 2015-06-05

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6735437003 2020-04-07 0457 PPP 801 N ELM ST, HENDERSON, KY, 42420-2705
Loan Status Date 2021-04-09
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 93600
Loan Approval Amount (current) 93600
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27217
Servicing Lender Name Independence Bank of Kentucky
Servicing Lender Address 2425 Frederica St, OWENSBORO, KY, 42301-5437
Rural or Urban Indicator R
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address HENDERSON, HENDERSON, KY, 42420-2705
Project Congressional District KY-01
Number of Employees 8
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 27217
Originating Lender Name Independence Bank of Kentucky
Originating Lender Address OWENSBORO, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 94446.25
Forgiveness Paid Date 2021-03-11

Sources: Kentucky Secretary of State