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CLOVER FORK OUTPATIENT MEDICAL PROJECT, INC.

Company Details

Name: CLOVER FORK OUTPATIENT MEDICAL PROJECT, INC.
Legal type: Kentucky Corporation
Status: Active
Standing: Good
Profit or Non-Profit: Non-profit
Organization Date: 12 Jan 1970 (55 years ago)
Last Annual Report: 04 Feb 2025 (4 months ago)
Organization Number: 0010120
Industry: Health Services
Number of Employees: Medium (20-99)
ZIP code: 40828
City: Evarts, Bailey Creek, Dizney, Louellen, Redbud, ...
Primary County: Harlan County
Principal Office: P. O. BOX 39, EVARTS, KY 40828
Place of Formation: KENTUCKY

Director

Name Role
Jerry Haynes Director
Eugene Enix Director
Tammie Chapman Director
WILLIAM A. BUCKNER Director
DON PARSONS Director
Sonja Lawson Director
Claude Wayne Collett Director
Barry Martin Director
Kim Brown Director
Darlene Lemarr Director

Incorporator

Name Role
WILLIAM A. BUCKNER Incorporator
HAROLD PARSONS Incorporator
DON PARSONS Incorporator

Registered Agent

Name Role
JACK A. MINIARD Registered Agent

President

Name Role
Jack A Miniard President

Officer

Name Role
Linda Blevins Officer

Vice President

Name Role
Britt Lewis Jr Vice President

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Unique Entity ID:
P3H6A914MJQ3
CAGE Code:
6T4C2
UEI Expiration Date:
2025-07-16

Business Information

Division Name:
CLOVER FORK OUTPATIENT MEDICAL PROJECT
Activation Date:
2024-07-18
Initial Registration Date:
2012-08-28

National Provider Identifier

NPI Number:
1497195036

Authorized Person:

Name:
MR. BRITT LEWIS JR.
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
261QR1300X - Rural Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QF0400X - Federally Qualified Health Center (FQHC)
Is Primary:
Yes

Contacts:

Fax:
6068379389

Filings

Name File Date
Annual Report 2025-02-04
Annual Report 2024-03-04
Annual Report 2023-03-20
Annual Report 2022-02-07
Annual Report 2021-04-13

USAspending Awards / Financial Assistance

Date:
2023-08-29
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2023 BRIDGE ACCESS PROGRAM
Obligated Amount:
10951.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2023-05-18
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2023 EXPANDING COVID-19 VACCINATION
Obligated Amount:
113418.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2021-07-09
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
AMERICAN RESCUE PLAN ACT FUNDING FOR LOOK-ALIKES
Obligated Amount:
1171625.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2021-03-26
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
395762.50
Total Face Value Of Loan:
395762.50
Date:
2021-01-05
Awarding Agency Name:
Department of Agriculture
Transaction Description:
DLT GRANTS- CARES ACT - MEDICAL
Obligated Amount:
59524.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Tax Exempt

Employer Identification Number (EIN) :
61-0704701
Classification:
Government Instrumentality, Title-Holding Corporation, Charitable Organization, Educational Organization, Scientific Organization, Local Association of Employees, Agricultural Organization, Horticultural Organization, Board of Trade, Business League, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Voluntary Employees' Beneficiary Association (Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Mutual Ditch or Irrigation Co., Burial Association, Cemetery Company, Credit Union, Other Mutual Corp. or Assoc., 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)
Ruling Date:
1970-11
Deductibility:
Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Paycheck Protection Program

Date Approved:
2021-03-26
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
395762.5
Current Approval Amount:
395762.5
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
397583.59
Date Approved:
2020-04-13
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
395762
Current Approval Amount:
395762
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
398686.24

Sources: Kentucky Secretary of State