Search icon

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 (2 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

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
P3H6A914MJQ3 2024-10-09 101 CHAD STREET, EVARTS, KY, 40828, 8200, USA P.O. BOX 39, EVARTS, KY, 40828, 0039, USA

Business Information

URL cloverforkclinic.org
Division Name CLOVER FORK OUTPATIENT MEDICAL PROJECT
Congressional District 05
State/Country of Incorporation KY, USA
Activation Date 2023-10-11
Initial Registration Date 2012-08-28
Entity Start Date 1970-08-20
Fiscal Year End Close Date Jun 30

Points of Contacts

Electronic Business
Title PRIMARY POC
Name JACK MINIARD
Role CEO
Address PO BOX 39, P O BOX 39, EVARTS, KY, 40828, 0039, USA
Government Business
Title PRIMARY POC
Name JACK A MINIARD
Role CEO
Address PO BOX 39, P O BOX 39, EVARTS, KY, 40828, 0039, USA
Title ALTERNATE POC
Name LINDA BLEVINS
Role CFO
Address 101 CHAD STREET, P O BOX 39, EVARTS, KY, 40828, 0039, USA
Past Performance Information not Available

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

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
Annual Report 2020-02-11
Annual Report 2019-05-03
Registered Agent name/address change 2019-05-03
Annual Report 2018-04-10
Annual Report 2017-05-30

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
61-0704701 Corporation Unconditional Exemption PO BOX 39, EVARTS, KY, 40828-0039 1970-11
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, 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)
Deductibility Contributions are deductible.
Foundation Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2023-06
Asset 10,000,000 to 49,999,999
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 21602131
Income Amount 8445064
Form 990 Revenue Amount 6666863
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 CLOVER FORK OUTPATIENT MEDICAL PROJECT INC
EIN 61-0704701
Tax Period 202306
Filing Type E
Return Type 990
File View File
Organization Name CLOVER FORK OUTPATIENT MEDICAL PROJECT INC
EIN 61-0704701
Tax Period 202206
Filing Type E
Return Type 990
File View File
Organization Name CLOVER FORK OUTPATIENT MEDICAL PROJECT INC
EIN 61-0704701
Tax Period 202106
Filing Type E
Return Type 990
File View File
Organization Name CLOVER FORK OUTPATIENT MEDICAL PROJECT INC
EIN 61-0704701
Tax Period 201906
Filing Type E
Return Type 990
File View File
Organization Name CLOVER FORK OUTPATIENT MEDICAL PROJECT INC
EIN 61-0704701
Tax Period 201806
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
1247288708 2021-03-26 0457 PPS 101 Chad St, Evarts, KY, 40828-8200
Loan Status Date 2021-10-06
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 395762.5
Loan Approval Amount (current) 395762.5
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27616
Servicing Lender Name Monticello Banking Company
Servicing Lender Address 50 N Main St, MONTICELLO, KY, 42633-2851
Rural or Urban Indicator R
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Evarts, HARLAN, KY, 40828-8200
Project Congressional District KY-05
Number of Employees 43
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 27616
Originating Lender Name Monticello Banking Company
Originating Lender Address MONTICELLO, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 397583.59
Forgiveness Paid Date 2021-09-15
4417247109 2020-04-13 0457 PPP 101 CHAD ST, EVARTS, KY, 40828-8200
Loan Status Date 2021-02-09
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 395762
Loan Approval Amount (current) 395762
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27616
Servicing Lender Name Monticello Banking Company
Servicing Lender Address 50 N Main St, MONTICELLO, KY, 42633-2851
Rural or Urban Indicator R
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address EVARTS, HARLAN, KY, 40828-8200
Project Congressional District KY-05
Number of Employees 43
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 27616
Originating Lender Name Monticello Banking Company
Originating Lender Address MONTICELLO, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 398686.24
Forgiveness Paid Date 2021-01-07

Sources: Kentucky Secretary of State