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BLUEGRASS DERMATOLOGY, PLLC

Company Details

Name: BLUEGRASS DERMATOLOGY, PLLC
Jurisdiction: Kentucky
Legal type: Kentucky Limited Liability Company
Status: Inactive
Standing: Bad
File Date: 26 Jan 2005 (20 years ago)
Organization Date: 26 Jan 2005 (20 years ago)
Organization Number: 0604516
Primary County: McCracken
Place of Formation: KENTUCKY
Last Annual Report: 27 Aug 2015 (9 years ago)
Managed By: Members
Principal Office: 4616 VILLAGE SQUARE DRIVE, PADUCAH, KY 42001
Principal Office ZIP code: 42001

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLUEGRASS DERMATOLOGY, PLLC 401(K) PLAN 2014 320138797 2015-06-17 BLUEGRASS DERMATOLOGY, PLLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-02-01
Business code 621111
Sponsor’s telephone number 2704437546
Plan sponsor’s address 2605 KENTUCKY AVE, SUITE 401, PADUCAH, KY, 42003

Signature of
Role Plan administrator
Date 2015-06-17
Name of individual signing RUSSELL CARRICO
Valid signature Filed with authorized/valid electronic signature
BLUEGRASS DERMATOLOGY, PLLC 401(K) PLAN 2013 320138797 2014-07-08 BLUEGRASS DERMATOLOGY, PLLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-02-01
Business code 621111
Sponsor’s telephone number 2704437546
Plan sponsor’s address 2605 KENTUCKY AVE, SUITE 401, PADUCAH, KY, 42003

Signature of
Role Plan administrator
Date 2014-07-08
Name of individual signing RUSSELL CARRICO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-08
Name of individual signing RUSSELL CARRICO
Valid signature Filed with authorized/valid electronic signature
BLUEGRASS DERMATOLOGY, PLLC 401(K) PLAN 2012 320138797 2013-06-24 BLUEGRASS DERMATOLOGY, PLLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-02-01
Business code 621111
Sponsor’s telephone number 2704437546
Plan sponsor’s address 4616 VILLAGE SQUARE DRIVE, PADUCAH, KY, 42001

Signature of
Role Plan administrator
Date 2013-06-24
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-24
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature
BLUEGRASS DERMATOLOGY, PLLC 401(K) PLAN 2012 320138797 2013-06-24 BLUEGRASS DERMATOLOGY, PLLC 10
Three-digit plan number (PN) 001
Effective date of plan 2005-02-01
Business code 621111
Sponsor’s telephone number 2704437546
Plan sponsor’s address 2605 KENTUCKY AVE, SUITE 401, PADUCAH, KY, 42003

Signature of
Role Plan administrator
Date 2013-06-24
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-24
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature
BLUEGRASS DERMATOLOGY, PLLC 401(K) PLAN 2011 320138797 2012-06-06 BLUEGRASS DERMATOLOGY, PLLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-02-01
Business code 621111
Sponsor’s telephone number 2704437546
Plan sponsor’s address 2605 KENTUCKY AVE, SUITE 401, PADUCAH, KY, 42003

Plan administrator’s name and address
Administrator’s EIN 320138797
Plan administrator’s name BLUEGRASS DERMATOLOGY, PLLC
Plan administrator’s address 2605 KENTUCKY AVE, SUITE 401, PADUCAH, KY, 42003
Administrator’s telephone number 2704437546

Signature of
Role Plan administrator
Date 2012-06-06
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-06
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature
BLUEGRASS DERMATOLOGY, PLLC 401(K) PLAN 2010 320138797 2011-06-16 BLUEGRASS DERMATOLOGY, PLLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-02-01
Business code 621111
Sponsor’s telephone number 2704437546
Plan sponsor’s address 2605 KENTUCKY AVE, SUITE 401, PADUCAH, KY, 42003

Plan administrator’s name and address
Administrator’s EIN 320138797
Plan administrator’s name BLUEGRASS DERMATOLOGY, PLLC
Plan administrator’s address 2605 KENTUCKY AVE, SUITE 401, PADUCAH, KY, 42003
Administrator’s telephone number 2704437546

Signature of
Role Plan administrator
Date 2011-06-16
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-16
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature
BLUEGRASS DERMATOLOGY, PLLC 401(K) PLAN 2009 320138797 2010-06-24 BLUEGRASS DERMATOLOGY, PLLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-02-01
Business code 621111
Sponsor’s telephone number 2704437546
Plan sponsor’s address 2605 KENTUCKY AVE, SUITE 401, PADUCAH, KY, 42003

Plan administrator’s name and address
Administrator’s EIN 320138797
Plan administrator’s name BLUEGRASS DERMATOLOGY, PLLC
Plan administrator’s address 2605 KENTUCKY AVE, SUITE 401, PADUCAH, KY, 42003
Administrator’s telephone number 2704437546

Signature of
Role Plan administrator
Date 2010-06-24
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-06-24
Name of individual signing DOUGLAS M. WILSON, M.D.
Valid signature Filed with authorized/valid electronic signature

Organizer

Name Role
DOUGLAS WILSON, M.D. Organizer

Registered Agent

Name Role
DOUGLAS M. WILSON Registered Agent

Manager

Name Role
Melissa Wilson Manager

Filings

Name File Date
Administrative Dissolution 2016-10-01
Annual Report 2015-08-27
Annual Report 2014-07-17
Annual Report 2013-02-05
Annual Report 2012-02-13
Registered Agent name/address change 2011-02-14
Annual Report 2011-02-14
Principal Office Address Change 2011-02-10
Annual Report 2010-09-10
Annual Report 2009-01-22

Related by officers

DOUGLAS M. WILSON

THOMAS AND KING, INC. WILSON INTERESTS, LTD. DERBY CITY THUNDERBIRD CLUB, INC. THE WILSON REAL ESTATE DEVELOPMENT AND MARKETING COMPANY, INC. CREATIVE RESTAURANT CONCEPTS, INC. WILSON PROPERTIES, LLC

Melissa Wilson

MANGINO ENTERPRISES, INC. BLACK DIAMOND C. B. CLUB, INC. GOD'S PANTRY FOOD BANK, INC. ASHLAND PARK NEIGHBORHOOD ASSOCIATION, INC. WINBURN MIDDLE SCHOOL PTSA INC. WILSON PSYCHOLOGICAL SERVICES, PLLC Society for Obstetric Anesthesia and Perinatology Inc

Related by address

4616 VILLAGE SQUARE DRIVE, PADUCAH, KY 42001

FREEMAN HOLDINGS PADUCAH, LLC FREEMAN HOLDINGS MAYFIELD, LLC FREEMAN HOLDINGS FLORIDA, LLC

Date of last update: 04 Nov 2024

Sources: Kentucky Secretary of State

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