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Lafayette Nursing Home, LLC

Details

Name: Lafayette Nursing Home, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 24 Nov 2003 (21 years ago)
Entity Number: 000-695-064
Register Number: 000695064
County: Chambers
Place of Formation: Chambers County
Principal Address: LAFAYETTE, AL
Registered Office Street Address: 555 B ST SWLAFAYETTE, AL 36862
Registered Office Street Address ZIP Code: 36862

Activities OPERATE SKILLED NURSING FACILITY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAFAYETTE NURSING HOME LLC 401K PLAN 2023 200420319 2024-03-06 LAFAYETTE NURSING HOME LLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 623000
Sponsor’s telephone number 3348649371
Plan sponsor’s address 555 B STREET S W, LAFAYETTE, AL, 36862

Signature of

Role Plan administrator
Date 2024-03-06
Name of individual signing JOHN HOLMES
LAFAYETTE NURSING HOME LLC 401K PLAN 2022 200420319 2023-08-18 LAFAYETTE NURSING HOME LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 623000
Sponsor’s telephone number 3348649371
Plan sponsor’s address 555 B STREET S W, LAFAYETTE, AL, 36862

Signature of

Role Plan administrator
Date 2023-08-18
Name of individual signing JOHN HOLMES
LAFAYETTE NURSING HOME LLC 401K PLAN 2021 200420319 2022-09-23 LAFAYETTE NURSING HOME LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 623000
Sponsor’s telephone number 3348649371
Plan sponsor’s address 555 B STREET S W, LAFAYETTE, AL, 36862

Signature of

Role Plan administrator
Date 2022-09-23
Name of individual signing JOHN HOLMES
LAFAYETTE NURSING HOME LLC 401K PLAN 2020 200420319 2021-09-30 LAFAYETTE NURSING HOME LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 623000
Sponsor’s telephone number 3348649371
Plan sponsor’s address 555 B STREET S W, LAFAYETTE, AL, 36862

Signature of

Role Plan administrator
Date 2021-09-30
Name of individual signing JOHN HOLMES
LAFAYETTE NURSING HOME LLC 401K PLAN 2019 200420319 2020-07-02 LAFAYETTE NURSING HOME LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 623000
Sponsor’s telephone number 3348649371
Plan sponsor’s address 555 B STREET S W, LAFAYETTE, AL, 36862

Signature of

Role Plan administrator
Date 2020-07-02
Name of individual signing JOHN HOLMES
LAFAYETTE NURSING HOME LLC 401K PLAN 2018 200420319 2019-02-19 LAFAYETTE NURSING HOME LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 623000
Sponsor’s telephone number 3348649371
Plan sponsor’s address 555 B STREET S W, LAFAYETTE, AL, 36862

Signature of

Role Plan administrator
Date 2019-02-19
Name of individual signing JOHN HOLMES
LAFAYETTE NURSING HOME LLC 401K PLAN 2017 200420319 2018-09-26 LAFAYETTE NURSING HOME LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 623000
Sponsor’s telephone number 3348649371
Plan sponsor’s address 555 B STREET S W, LAFAYETTE, AL, 36862

Signature of

Role Plan administrator
Date 2018-09-26
Name of individual signing TOMMY F PIKE

Agent

Name Role
HOLMES, J MELVIN Agent

Member

Name Role
LAFAYETTE NURSING HOME INC Member

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State