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TRI-STATE BENEFITS ADMINISTRATORS, LLC

Company Details

Name: TRI-STATE BENEFITS ADMINISTRATORS, LLC
Jurisdiction: Kentucky
Profit or Non-Profit: Profit
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Good
File Date: 18 Aug 2000 (24 years ago)
Organization Date: 18 Aug 2000 (24 years ago)
Organization Number: 0499668
Primary County: Henderson
Place of Formation: KENTUCKY
Last Annual Report: 15 Jun 2020 (4 years ago)
Managed By: Members
Principal Office: 702 A BARRET BLVD, HENDERSON, KY 42420
Principal Office ZIP code: 42420

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2018 611374343 2019-06-14 TRI-STATE BENEFITS ADMINISTRATORS, LLC 2
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2018 611374343 2019-06-14 TRI-STATE BENEFITS ADMINISTRATORS, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2017 611374343 2018-06-19 TRI-STATE BENEFITS ADMINISTRATORS, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2018-06-19
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-19
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2016 611374343 2017-07-12 TRI-STATE BENEFITS ADMINISTRATORS, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-12
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLAN 2015 611374343 2016-06-07 TRI-STATE BENEFITS ADMINISTRATORS, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2016-06-07
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-07
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLA 2014 611374343 2015-07-02 TRI-STATE BENEFITS ADMINISTRATORS, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 702 A BARRET BLVD., HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2015-07-02
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-02
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLA 2013 611374343 2014-06-18 TRI-STATE BENEFITS ADMINISTRATORS, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 223 N MAIN STREET, HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2014-06-18
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-18
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLA 2012 611374343 2013-06-18 TRI-STATE BENEFITS ADMINISTRATORS, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 223 N MAIN STREET, HENDERSON, KY, 42420

Signature of
Role Plan administrator
Date 2013-06-18
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-18
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
TRI-STATE BENEFITS ADMINISTRATORS, LLC 401(K) PLA 2011 611374343 2012-06-13 TRI-STATE BENEFITS ADMINISTRATORS, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 561110
Sponsor’s telephone number 2708271132
Plan sponsor’s address 223 N MAIN STREET, HENDERSON, KY, 42420

Plan administrator’s name and address
Administrator’s EIN 611374343
Plan administrator’s name TRI-STATE BENEFITS ADMINISTRATORS, LLC
Plan administrator’s address 223 N MAIN STREET, HENDERSON, KY, 42420
Administrator’s telephone number 2708271132

Signature of
Role Plan administrator
Date 2012-06-13
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-13
Name of individual signing KIMBERLY A. CHAVIRA
Valid signature Filed with authorized/valid electronic signature

Registered Agent

Name Role
KIMBERLY A CHAVIRA Registered Agent

Member

Name Role
Kimberly A Chavira Member

Director

Name Role
STEPHEN PHILLIPS Director

Organizer

Name Role
MALCOLM E. NEEL II Organizer
MALCOLM E. NEEL III Organizer
CHRISTI DIXON Organizer
KATHLEEN GLASER Organizer

Filings

Name File Date
Dissolution 2021-06-01
Annual Report 2020-06-15
Registered Agent name/address change 2019-04-23
Annual Report 2019-04-23
Annual Report 2018-05-07
Annual Report 2017-04-24
Principal Office Address Change 2016-03-16
Annual Report 2016-03-16
Annual Report 2015-04-15
Annual Report 2014-01-24

Related by officers

MALCOLM E. NEEL II

OHIO VALLEY BENEFITS ADMINISTRATION, LLC NEEL & COMPANY, LLP

MALCOLM E. NEEL III

OHIO VALLEY BENEFITS ADMINISTRATION, LLC NEEL & COMPANY, LLP NEEL CRAFTON & PHILLIPS, LLP ASRB, LLP

CHRISTI DIXON

NEEL & COMPANY, LLP

Related by address

No related companies by address

Date of last update: 09 Nov 2024

Sources: Kentucky Secretary of State

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