CUMBERLAND ANESTHESIA ASSOCIATES, INC.

Company Details

Name:	CUMBERLAND ANESTHESIA ASSOCIATES, INC.
Jurisdiction:	Kentucky
Profit or Non-Profit:	Profit
Legal type:	Kentucky Corporation
Status:	Inactive
Standing:	Bad
File Date:	14 Feb 1991 (34 years ago)
Organization Date:	14 Feb 1991 (34 years ago)
Organization Number:	0282826
Primary County:	Pulaski
Place of Formation:	KENTUCKY
Last Annual Report:	23 Apr 2021 (4 years ago)
Principal Office:	C/O HARRIS & ASSOCIATES PSC, 3844 SOUTH HWY 27, STE C, SOMERSET, KY 42501
Principal Office ZIP code:	42501
Authorized Shares:	1000

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2021

611194550

2022-06-14

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2020

611194550

2021-10-11

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Signature of

Role	Plan administrator
Date	2021-10-11
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2019

611194550

2020-10-12

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Signature of

Role	Plan administrator
Date	2020-10-12
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2018

611194550

2019-07-11

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Signature of

Role	Plan administrator
Date	2019-07-11
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2017

611194550

2018-09-12

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Signature of

Role	Plan administrator
Date	2018-09-12
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2016

611194550

2017-08-15

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Signature of

Role	Plan administrator
Date	2017-08-15
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2015

611194550

2016-07-21

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Signature of

Role	Plan administrator
Date	2016-07-21
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2014

611194550

2015-06-29

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Signature of

Role	Plan administrator
Date	2015-06-29
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2013

611194550

2014-07-08

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Signature of

Role	Plan administrator
Date	2014-07-08
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

CUMBERLAND ANESTHESIA ASSOCIATES, INC. 401(K) PROFIT SHARING PLAN

2012

611194550

2013-07-03

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Signature of

Role	Plan administrator
Date	2013-07-03
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/21/20120621121659P030003946278001.pdf
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564

Plan administrator’s name and address

Administrator’s EIN	611194550
Plan administrator’s name	CUMBERLAND ANESTHESIA ASSOCIATES, INC.
Plan administrator’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564
Administrator’s telephone number	6066783288

Signature of

Role	Plan administrator
Date	2012-06-21
Name of individual signing	EPISON TAN
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/05/20110705121742P040090501409001.pdf
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s mailing address	P.O. BOX 3167, WEST SOMERSET, KY, 42564
Plan sponsor’s address	110 HARDIN LANE, SUITE 2B, SOMERSET, KY, 42501

Plan administrator’s name and address

Administrator’s EIN	611194550
Plan administrator’s name	CUMBERLAND ANESTHESIA ASSOCIATES, INC.
Plan administrator’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564
Administrator’s telephone number	6066783288

Number of participants as of the end of the plan year

Active participants	13
Retired or separated participants receiving benefits	1
Other retired or separated participants entitled to future benefits	12
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits	0
Number of participants with account balances as of the end of the plan year	26
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	1

Signature of

Role	Plan administrator
Date	2011-07-05
Name of individual signing	KIM A. BLANTON
Valid signature	Filed with authorized/valid electronic signature

File	https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/21/20100721185656P040038609971001.pdf
Three-digit plan number (PN)	001
Effective date of plan	1992-01-01
Business code	621111
Sponsor’s telephone number	6066783288
Plan sponsor’s mailing address	P.O. BOX 3167, WEST SOMERSET, KY, 42564
Plan sponsor’s address	110 HARDIN LANE, SUITE 2B, SOMERSET, KY, 42501

Plan administrator’s name and address

Administrator’s EIN	611194550
Plan administrator’s name	CUMBERLAND ANESTHESIA ASSOCIATES, INC.
Plan administrator’s address	P.O. BOX 3167, WEST SOMERSET, KY, 42564
Administrator’s telephone number	6066783288

Number of participants as of the end of the plan year

Active participants	12
Retired or separated participants receiving benefits	1
Other retired or separated participants entitled to future benefits	8
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits	0
Number of participants with account balances as of the end of the plan year	21
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2

Signature of

Role	Plan administrator
Date	2010-07-20
Name of individual signing	KIM A. BLANTON
Valid signature	Filed with authorized/valid electronic signature

Registered Agent

Name	Role
EPISON S. TAN	Registered Agent

Incorporator

Name	Role
MADHUKANTA PATEL	Incorporator

President

Name	Role
Lalitkuma V. Patel	President

Secretary

Name	Role
Epison Tan	Secretary

Treasurer

Name	Role
EPISON TAN	Treasurer

Vice President

Name	Role
WILLIE WANG	Vice President
MOHAMMED FAROOQUI	Vice President
GREGORY KOTTKAMP	Vice President

Director

Name	Role
MADHUKANTA PATEL	Director

Filings

Name	File Date
Administrative Dissolution	2022-10-04
Annual Report	2021-04-23
Annual Report	2020-03-24
Annual Report	2019-06-04
Annual Report	2018-05-10
Annual Report	2017-03-07
Annual Report	2016-03-28
Annual Report	2015-04-22
Annual Report	2014-03-21
Annual Report	2013-04-18
Annual Report	2012-02-23
Annual Report	2011-03-18
Annual Report	2010-04-16
Annual Report	2009-02-26
Annual Report	2008-03-19
Annual Report	2007-03-06
Annual Report	2006-03-20
Annual Report	2005-04-06
Annual Report	2003-08-13
Annual Report	2002-04-23

Date of last update: 07 Nov 2024

Sources: Kentucky Secretary of State

CUMBERLAND ANESTHESIA ASSOCIATES, INC.

Company Details

form 5500

Registered Agent

Incorporator

President

Secretary

Treasurer

Vice President

Director

Filings

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