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  5. HOSPICE OF SOUTHERN KENTUCKY, INC.

HOSPICE OF SOUTHERN KENTUCKY, INC.

Company Details

Name: HOSPICE OF SOUTHERN KENTUCKY, INC.
Jurisdiction: Kentucky
Profit or Non-Profit: Non-profit
Legal type: Kentucky Corporation
Status: Active
Standing: Good
Organization Date: 27 Jan 1981 (44 years ago)
Last Annual Report: 27 Jun 2024 (7 months ago)
Organization Number: 0153316
Industry: Health Services
Number of Employees: Medium (20-99)
ZIP code: 42104
Primary County: Warren
Principal Office: 5872 SCOTTSVILLE RD, BOWLING GREEN, KY 42104
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HOSPICE OF SOUTHERN KENTUCKY, INC. 401(K) PROFIT SHARING PLAN 2023 311035478 2024-07-02 HOSPICE OF SOUTHERN KENTUCKY, INC. 64
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707469300
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 42104

Signature of
Role Plan administrator
Date 2024-07-02
Name of individual signing MEGAN DICK
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF SOUTHERN KENTUCKY, INC. 401(K) PROFIT SHARING PLAN 2022 311035478 2023-05-31 HOSPICE OF SOUTHERN KENTUCKY, INC. 52
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707469300
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 42104

Signature of
Role Plan administrator
Date 2023-05-31
Name of individual signing MEGAN DICK
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF SOUTHERN KENTUCKY, INC. 401(K) PROFIT SHARING PLAN 2021 311035478 2022-06-02 HOSPICE OF SOUTHERN KENTUCKY, INC. 28
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 42104

Signature of
Role Plan administrator
Date 2022-06-02
Name of individual signing MEGAN DICK
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF SOUTHERN KENTUCKY, INC. 401(K) PROFIT SHARING PLAN 2020 311035478 2021-03-16 HOSPICE OF SOUTHERN KENTUCKY, INC. 31
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 42104

Signature of
Role Plan administrator
Date 2021-03-16
Name of individual signing MEGAN DICK
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF SOUTHERN KENTUCKY, INC. 401(K) PROFIT SHARING PLAN 2019 311035478 2020-04-27 HOSPICE OF SOUTHERN KENTUCKY, INC. 50
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 42104

Signature of
Role Plan administrator
Date 2020-04-27
Name of individual signing MEGAN DICK
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF SOUTHERN KENTUCKY, INC. 401(K) PROFIT SHARING PLAN 2018 311035478 2019-05-22 HOSPICE OF SOUTHERN KENTUCKY, INC. 46
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2019-05-22
Name of individual signing MEGAN DICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-22
Name of individual signing MEGAN DICK
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF SOUTHERN KENTUCKY, INC. 401(K) PROFIT SHARING PLAN 2017 311035478 2018-05-23 HOSPICE OF SOUTHERN KENTUCKY, INC. 49
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2018-05-23
Name of individual signing MEGAN DICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-23
Name of individual signing MEGAN DICK
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF SOUTHERN KENTUCKY 403(B) PLAN 2016 311035478 2017-06-07 HOSPICE OF SOUTHERN KENTUCKY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-06-12
Business code 621900
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF SOUTHERN KENTUCKY 403(B) PLAN 2016 311035478 2017-06-12 HOSPICE OF SOUTHERN KENTUCKY, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-06-12
Business code 621900
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF SOUTHERN KENTUCKY 403(B) PLAN 2016 311035478 2017-06-15 HOSPICE OF SOUTHERN KENTUCKY, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-06-12
Business code 621900
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/06/13/20170613122707P040004595799001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-06-12
Business code 621900
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/06/13/20170613122707P040004595799002.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-06-12
Business code 621900
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/03/01/20170301135531P040038781239002.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2017-03-01
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-03-01
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/06/20/20170620091006P030014354919001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-06-12
Business code 621900
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/03/07/20160307163435P030023448663002.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2016-03-04
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-03-04
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/06/22/20170622111549P040014431335001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-06-12
Business code 621900
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/05/11/20150511075730P030202335687001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 42104

Signature of
Role Plan administrator
Date 2015-05-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-05-07
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/06/22/20170622073429P040018513137001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2000-06-12
Business code 621900
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 421047853

Signature of
Role Plan administrator
Date 2017-06-21
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-21
Name of individual signing STACEY MARR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/08/01/20140801104105P030023010943005.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2707823402
Plan sponsor’s address 5872 SCOTTSVILLE ROAD, BOWLING GREEN, KY, 42104

Signature of
Role Plan administrator
Date 2014-08-01
Name of individual signing GARY MAXEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-08-01
Name of individual signing GARY MAXEY
Valid signature Filed with authorized/valid electronic signature

Director

Name Role
Steve Sinclair Director
Catherine Heltsley Director
Romanza Johnson Director
Dixie Mahurin Director
Pearl Taylor Director
Brenda Gildersleeve Director
Jamie Jarboe Director
Kelly Bell Director
Dot Darby-Paschall Director
Kim Vickous Director

Officer

Name Role
Steve Jantz Officer

Treasurer

Name Role
David Smith Treasurer

Secretary

Name Role
Gail Broady Secretary

Incorporator

Name Role
C. WAYNE HIGGINS Incorporator
HEIDI WILSON Incorporator

President

Name Role
Ken Whitley President

Registered Agent

Name Role
STEVE JANTZ Registered Agent

Vice President

Name Role
Portia Pennington Vice President

Former Company Names

Name Action
HOSPICE OF BOWLING GREEN, INC. Old Name

Assumed Names

Name Status Expiration Date
PALLIATIVE CARE OF SOUTHERN KENTUCKY Active 2028-12-15
PHYSICIANS' PALLIATIVE CARE OF SOUTHERN KENTUCKY Inactive 2016-01-11

Filings

Name File Date
Annual Report 2024-06-27
Certificate of Assumed Name 2023-12-15
Annual Report 2023-06-28
Registered Agent name/address change 2022-09-29
Annual Report Amendment 2022-09-29
Annual Report 2022-06-02
Registered Agent name/address change 2022-06-02
Annual Report 2021-03-01
Annual Report 2020-04-27
Registered Agent name/address change 2019-10-29

Related by officers

Steve Sinclair

UNITED WAY OF SOUTHERN KENTUCKY, INC.

Steve Jantz

KENTUCKY HOSPICE NETWORK, INC.

David Smith

THE BELIEVERS CHURCH, INCORPORATED GREATER LOUISVILLE COMMUNICATIONS, INC. KENTUCKY SANTA GERTRUDIS ASSOCIATION, INC. COMMON CAUSE, INC. CENTRAL KENTUCKY APARTMENT ASSOCIATION, INC. LIFE WAY CHRISTIAN RESOURCES OF THE SOUTHERN BAPTIST CONVENTION, INC. MT. AYR SQUARE HOMEOWNER'S ASSOCIATION, INC. GIAC LEASING CORPORATION EMINENCE BEVERAGE SHOPPE, INC. THE AMBURGEY FAMILY ASSOCIATION, INC.

Romanza Johnson

FRIENDS OF KENTUCKY EDUCATIONAL TELEVISION, INC.

Kelly Bell

CROSSROADS COUNSELING CENTER PLLC

Julie Wedge

BOWLING GREEN CHAMBER ORCHESTRA, INC. ARTS OF SOUTHERN KENTUCKY FOUNDATION, INC. SOUTHERN KENTUCKY PERFORMING ARTS FOUNDATION, INC.

Mark Alcott

HERITAGE BANK USA, INC. Sherman Lane Development, LLC

Related by address

5872 SCOTTSVILLE RD, BOWLING GREEN, KY 42104

H AND M ARCHITECTS/ENGINEERS (KY), INC. STICK & RUDDER AVIATION, LLC

Date of last update: 09 Jan 2025

Sources: Kentucky Secretary of State

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