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  5. CALVERT CITY CONVALESCENT CENTER, INC.

CALVERT CITY CONVALESCENT CENTER, INC.

Company Details

Name: CALVERT CITY CONVALESCENT CENTER, INC.
Legal type: Kentucky Corporation
Status: Active
Standing: Good
Profit or Non-Profit: Non-profit
File Date: 31 Aug 1971 (54 years ago)
Organization Date: 31 Aug 1971 (54 years ago)
Last Annual Report: 08 Jan 2025 (3 months ago)
Organization Number: 0007285
Industry: Health Services
Number of Employees: Large (100+)
ZIP code: 42029
City: Calvert City
Primary County: Marshall County
Principal Office: 1201 EAST 5TH AVENUE, CALVERT CITY, KY 42029
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2023 610727805 2024-10-15 CALVERT CITY CONVALESCENT CENTER, INC. 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 2703954124
Plan sponsor’s address 1201 E 5TH AVE, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing ERICA D PHELPS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-15
Name of individual signing ERICA D PHELPS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2022 610727805 2023-02-17 CALVERT CITY CONVALESCENT CENTER, INC. 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 2703954124
Plan sponsor’s address 1201 E 5TH AVE, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2023-02-17
Name of individual signing AMY LEVERING
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-02-17
Name of individual signing AMY LEVERING
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2021 610727805 2022-10-03 CALVERT CITY CONVALESCENT CENTER, INC. 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 2703954124
Plan sponsor’s address 1201 E 5TH AVE, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2022-10-03
Name of individual signing AMY LEVERING
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2020 610727805 2021-07-23 CALVERT CITY CONVALESCENT CENTER, INC. 84
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2021-07-23
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-23
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2019 610727805 2020-04-15 CALVERT CITY CONVALESCENT CENTER, INC. 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2020-04-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-04-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2018 610727805 2019-06-13 CALVERT CITY CONVALESCENT CENTER, INC. 74
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2019-06-13
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-13
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2017 610727805 2018-06-15 CALVERT CITY CONVALESCENT CENTER, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2018-06-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2016 610727805 2017-07-07 CALVERT CITY CONVALESCENT CENTER, INC. 82
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2017-07-07
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-07
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2015 610727805 2016-04-20 CALVERT CITY CONVALESCENT CENTER, INC. 80
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2016-04-20
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-04-20
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2014 610727805 2015-06-02 CALVERT CITY CONVALESCENT CENTER, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2015-06-02
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-02
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/19/20140619145140P040452034417001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2014-06-19
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-19
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/11/20130711132843P040299133347001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2013-07-11
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-11
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/05/15/20120515130345P030000894326001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2012-05-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-05-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/19/20110719132845P030002837075001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2011-07-19
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-19
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/17/20100917092827P040123424008001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2010-09-17
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-17
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2010-09-10
Name of individual signing LAURIE TRAVIS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-09-10
Name of individual signing LAURIE TRAVIS
Valid signature Filed with incorrect/unrecognized electronic signature
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2010-09-14
Name of individual signing LAURIE TRAVIS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-09-14
Name of individual signing LAURIE TRAVIS
Valid signature Filed with incorrect/unrecognized electronic signature
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2010-09-15
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-09-15
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with incorrect/unrecognized electronic signature

Registered Agent

Name Role
MRS. KEM COTHRAN Registered Agent

Incorporator

Name Role
LELAND DIETSCH Incorporator
REV. JEROME BROWNE Incorporator
CHARLES R. HINES Incorporator
DANDRIDGE F. WALTON Incorporator
DR. CARROLL TRAYLOR Incorporator

Secretary

Name Role
Tina Muir Secretary

Treasurer

Name Role
Tina Muir Treasurer

Vice President

Name Role
Sandy David Vice President

Director

Name Role
Kay Travis Director
Tina Johnson Director
Kem Cothran Director
Sandy David Director
Terri Bailey Director
Karen Owen Director
Chris Freeland Director
J. B. CONN Director
JIM FERN Director
DR. RICHARD COLBURN Director

President

Name Role
Kem Cothran President

Assumed Names

Name Status Expiration Date
CALVERT CITY NURSING AND REHAB Active 2027-12-05

Filings

Name File Date
Annual Report 2025-01-08
Annual Report 2024-02-28
Registered Agent name/address change 2024-02-28
Annual Report 2023-03-17
Certificate of Assumed Name 2022-12-05
Annual Report 2022-04-22
Registered Agent name/address change 2021-04-27
Principal Office Address Change 2021-04-27
Annual Report 2021-04-27
Annual Report 2020-05-19

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
309116754 0452110 2005-12-01 1201 5TH AVE, CALVERT CITY, KY, 42029
Inspection Type Planned
Scope Complete
Safety/Health Health
Close Conference 2006-01-20
Case Closed 2006-03-23

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 2031004
Issuance Date 2006-01-31
Abatement Due Date 2006-03-06
Current Penalty 600.0
Initial Penalty 1375.0
Nr Instances 3
Nr Exposed 22
Citation ID 01002
Citaton Type Serious
Standard Cited 19100133 A01
Issuance Date 2006-01-30
Abatement Due Date 2006-02-03
Current Penalty 600.0
Initial Penalty 1375.0
Nr Instances 1
Nr Exposed 10
Citation ID 01003
Citaton Type Serious
Standard Cited 19100138 A
Issuance Date 2006-01-31
Abatement Due Date 2006-02-06
Current Penalty 600.0
Initial Penalty 825.0
Nr Instances 1
Nr Exposed 10
Citation ID 02001
Citaton Type Other
Standard Cited 19101030 H02 II
Issuance Date 2006-01-31
Abatement Due Date 2006-02-27
Nr Instances 1
Nr Exposed 110
Citation ID 02002
Citaton Type Other
Standard Cited 19101030 H05 I
Issuance Date 2006-01-31
Abatement Due Date 2006-02-10
Nr Instances 1
Nr Exposed 110

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
61-0727805 Corporation Unconditional Exemption 1201 E 5TH AVE, CALVERT CITY, KY, 42029-8202 1979-08
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Organization that normally receives no more than one-third of its support from gross investment income and unrelated business income and at the same time more than one-third of its support from contributions, fees, and gross receipts related to exempt purposes 509(a)(2)
Tax Period 2023-06
Asset 1,000,000 to 4,999,999
Income 5,000,000 to 9,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Jun
Asset Amount 3511691
Income Amount 8582434
Form 990 Revenue Amount 8582434
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name CALVERT CITY CONVALESCENT CENTER INC
EIN 61-0727805
Tax Period 202206
Filing Type E
Return Type 990
File View File
Organization Name CALVERT CITY CONVALESCENT CENTER INC
EIN 61-0727805
Tax Period 202006
Filing Type E
Return Type 990
File View File
Organization Name CALVERT CITY CONVALESCENT CENTER INC
EIN 61-0727805
Tax Period 201906
Filing Type E
Return Type 990
File View File
Organization Name CALVERT CITY CONVALESCENT CENTER INC
EIN 61-0727805
Tax Period 201806
Filing Type E
Return Type 990
File View File
Organization Name CALVERT CITY CONVALESCENT CENTER INC
EIN 61-0727805
Tax Period 201706
Filing Type E
Return Type 990
File View File
Organization Name CALVERT CITY CONVALESCENT CENTER INC
EIN 61-0727805
Tax Period 201606
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3502177210 2020-04-27 0457 PPP 1201 5th Ave, CALVERT CITY, KY, 42029
Loan Status Date 2020-11-10
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 660200
Loan Approval Amount (current) 660200
Undisbursed Amount 0
Franchise Name -
Lender Location ID 24342
Servicing Lender Name First Financial Bank, National Association
Servicing Lender Address One First Financial Plaza, TERRE HAUTE, IN, 47807-3226
Rural or Urban Indicator R
Hubzone Y
LMI N
Business Age Description Unanswered
Project Address CALVERT CITY, MARSHALL, KY, 42029-0001
Project Congressional District KY-01
Number of Employees 112
NAICS code 623110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 24342
Originating Lender Name First Financial Bank, National Association
Originating Lender Address TERRE HAUTE, IN
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 663537.68
Forgiveness Paid Date 2020-11-03

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Sources: Kentucky Secretary of State

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