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VERSAILLES FAMILY MEDICINE, PLLC

Company Details

Name: VERSAILLES FAMILY MEDICINE, PLLC
Jurisdiction: Kentucky
Profit or Non-Profit: Profit
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
File Date: 08 Sep 2006 (18 years ago)
Organization Date: 08 Sep 2006 (18 years ago)
Organization Number: 0646640
Industry: Health Services
Number of Employees: Medium (20-99)
Primary County: Woodford
Place of Formation: KENTUCKY
Last Annual Report: 14 Feb 2024 (9 months ago)
Managed By: Members
Principal Office: 460 WILSON AVENUE, FIRST FLOOR, VERSAILLES, KY 40383
Principal Office ZIP code: 40383

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
PZVCN9JHJMF9 2024-10-23 460 WILSON AVE, VERSAILLES, KY, 40383, 1947, USA 460 WILSON AVE FL 1, VERSAILLES, KY, 40383, 1947, USA

Business Information
Doing Business As VERSAILLES FAMILY MEDICINE
URL www.versaillesfamilymedicine.com
Congressional District 06
State/Country of Incorporation KY, USA
Activation Date 2023-10-26
Initial Registration Date 2020-04-13
Entity Start Date 2006-04-01
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name BRIAN SMITH
Role DR.
Address 460 WILSON AVENUE, VERSAILLES, KY, 40383, 1947, USA
Government Business
Title PRIMARY POC
Name BRIAN SMITH
Role DR.
Address 460 WILSON AVE, VERSAILLES, KY, 40383, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
VERSAILLES FAMILY MEDICINE RETIREMENT PLAN 2023 113800760 2024-06-20 VERSAILLES FAMILY MEDICINE, PLLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2024-06-20
Name of individual signing DEANNA RAMSEY CPA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-06-20
Name of individual signing BRIAN SMITH
Valid signature Filed with authorized/valid electronic signature
VERSAILLES FAMILY MEDICINE RETIREMENT PLAN 2022 113800760 2023-06-15 VERSAILLES FAMILY MEDICINE, PLLC 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2023-06-15
Name of individual signing DEANNA RAMSEY CPA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-06-15
Name of individual signing BRIAN A SMITH
Valid signature Filed with authorized/valid electronic signature
VERSAILLES FAMILY MEDICINE RETIREMENT PLAN 2021 113800760 2022-03-31 VERSAILLES FAMILY MEDICINE, PLLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2022-03-31
Name of individual signing BRIAN A SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-03-31
Name of individual signing BRIAN A SMITH
Valid signature Filed with authorized/valid electronic signature
VERSAILLES FAMILY MEDICINE RETIREMENT PLAN 2020 113800760 2022-04-14 VERSAILLES FAMILY MEDICINE, PLLC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2022-04-14
Name of individual signing BRIAN AARON SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-04-14
Name of individual signing BRIAN AARON SMITH
Valid signature Filed with authorized/valid electronic signature
VERSAILLES FAMILY MEDICINE CBS BENEFIT PLAN 2020 113800760 2021-12-14 VERSAILLES FAMILY MEDICINE 19
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-01-01
Business code 621491
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

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
VERSAILLES FAMILY MEDICINE RETIREMENT PLAN 2019 113800760 2020-05-01 VERSAILLES FAMILY MEDICINE, PLLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2020-05-01
Name of individual signing BRIAN SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-01
Name of individual signing BRIAN SMITH
Valid signature Filed with authorized/valid electronic signature
VERSAILLES FAMILY MEDICINE CBS BENEFIT PLAN 2019 113800760 2020-12-23 VERSAILLES FAMILY MEDICINE 18
Three-digit plan number (PN) 501
Effective date of plan 2020-01-01
Business code 621491
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Plan administrator’s name and address
Administrator’s EIN 846429706
Plan administrator’s name KELLY WOLF
Plan administrator’s address 464 CHENAULT RD, FRANKFORT, KY, 40601
Administrator’s telephone number 5026954700

Signature of
Role Plan administrator
Date 2020-12-23
Name of individual signing KELLY WOLF
Valid signature Filed with authorized/valid electronic signature
VERSAILLES FAMILY MEDICINE RETIREMENT PLAN 2018 113800760 2019-05-03 VERSAILLES FAMILY MEDICINE, PLLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2019-05-03
Name of individual signing BRIAN SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-03
Name of individual signing BRIAN SMITH
Valid signature Filed with authorized/valid electronic signature
VERSAILLES FAMILY MEDICINE RETIREMENT PLAN 2017 113800760 2018-05-10 VERSAILLES FAMILY MEDICINE, PLLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2018-05-10
Name of individual signing BRIAN A SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-10
Name of individual signing BRIAN A SMITH
Valid signature Filed with authorized/valid electronic signature
VERSAILLES FAMILY MEDICINE RETIREMENT PLAN 2016 113800760 2017-05-04 VERSAILLES FAMILY MEDICINE, PLLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2017-05-04
Name of individual signing BRIAN A. SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-04
Name of individual signing BRIAN A. SMITH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/07/22/20160722131719P030036038013001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2016-05-16
Name of individual signing BRIAN SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-16
Name of individual signing BRIAN SMITH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/14/20151014162440P030049015921001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/14/20141014105401P030017118879001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 460 WILSON AVENUE, VERSAILLES, KY, 40383
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/09/20131009071034P030026715907001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 360 AMSDEN AVENUE, STE 504, VERSAILLES, KY, 40383

Signature of
Role Plan administrator
Date 2013-10-09
Name of individual signing KATHY KEATON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/12/20121012173705P030006147297001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 360 AMSDEN AVENUE, STE 504, VERSAILLES, KY, 40383

Plan administrator’s name and address
Administrator’s EIN 113800760
Plan administrator’s name VERSAILLES FAMILY MEDICINE, PLLC
Plan administrator’s address 360 AMSDEN AVENUE, STE 504, VERSAILLES, KY, 40383
Administrator’s telephone number 8598790111

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing BRIAN A. SMITH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/14/20111014112241P030004337412001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 8598790111
Plan sponsor’s address 360 AMSDEN AVENUE, STE 504, VERSAILLES, KY, 40383

Plan administrator’s name and address
Administrator’s EIN 113800760
Plan administrator’s name VERSAILLES FAMILY MEDICINE, PLLC
Plan administrator’s address 360 AMSDEN AVENUE, STE 504, VERSAILLES, KY, 40383
Administrator’s telephone number 8598790111

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing BRIAN A. SMITH
Valid signature Filed with authorized/valid electronic signature

Registered Agent

Name Role
BRIAN A. SMITH Registered Agent

Member

Name Role
Brian Aaron Smith Member

Organizer

Name Role
BRIAN A. SMITH Organizer

Assumed Names

Name Status Expiration Date
LAWRENCEBURG FAMILY MEDICINE Inactive 2024-04-26
MIDWAY FAMILY MEDICINE Inactive 2021-10-19

Filings

Name File Date
Annual Report 2024-02-14
Annual Report 2023-02-07
Annual Report 2022-05-18
Annual Report 2021-02-03
Registered Agent name/address change 2020-03-06
Annual Report 2020-03-06
Certificate of Assumed Name 2019-04-26
Annual Report 2019-03-25
Annual Report 2018-06-01
Annual Report 2017-03-12

Related by officers

BRIAN A. SMITH

B & D PRESSURE WASHING, LLC Northside Growth Investments L.L.C.

Brian Aaron Smith

VERSAILLES HOLDINGS, LLC SMITH CAPITAL, LLC

Related by address

460 WILSON AVENUE, FIRST FLOOR, VERSAILLES, KY 40383

VERSAILLES HOLDINGS, LLC SMITH CAPITAL, LLC

Date of last update: 14 Nov 2024

Sources: Kentucky Secretary of State

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