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NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS, INC.

Company Details

Name: NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS, INC.
Legal type: Kentucky Corporation
Status: Active
Standing: Good
Profit or Non-Profit: Non-profit
File Date: 18 Nov 1981 (43 years ago)
Organization Date: 18 Nov 1981 (43 years ago)
Last Annual Report: 10 Feb 2025 (2 months ago)
Organization Number: 0161717
Industry: Social Services
Number of Employees: Medium (20-99)
ZIP code: 40517
City: Lexington
Primary County: Fayette County
Principal Office: 3138 CUSTER DRIVE, SUITE 110, LEXINGTON, KY 40517
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TAX DEFERRED ANNUITY PLAN OF NURSING HOME OMBUDSMAN AGENCY, INC. 2011 610996520 2012-07-26 NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-07-01
Business code 624100
Sponsor’s telephone number 8592779215
Plan sponsor’s address 1530 NICHOLASVILLE ROAD, LEXINGTON, KY, 40503

Plan administrator’s name and address

Administrator’s EIN 610996520
Plan administrator’s name NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS, INC.
Plan administrator’s address 1530 NICHOLASVILLE ROAD, LEXINGTON, KY, 40503
Administrator’s telephone number 8592779215

Signature of

Role Plan administrator
Date 2012-07-26
Name of individual signing SHERRY CULP
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS, IN 2009 610996520 2010-10-08 NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS, INC. 34
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Three-digit plan number (PN) 001
Effective date of plan 1995-07-01
Business code 624100
Sponsor’s telephone number 6062786072
Plan sponsor’s address 1530 NICHOLASVILLE RD, LEXINGTON, KY, 40503

Plan administrator’s name and address

Administrator’s EIN 610996520
Plan administrator’s name NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS, INC.
Plan administrator’s address 1530 NICHOLASVILLE RD, LEXINGTON, KY, 40503
Administrator’s telephone number 6062786072

Signature of

Role Plan administrator
Date 2010-10-08
Name of individual signing SHERRY CULP
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-08
Name of individual signing SHERRY CULP
Valid signature Filed with authorized/valid electronic signature

Registered Agent

Name Role
DENISE WELLS Registered Agent

Vice President

Name Role
Brian Dufresne Vice President

President

Name Role
Stephanie Humes President

Treasurer

Name Role
Donna Smith Treasurer

Secretary

Name Role
Kimberly Iden Secretary

Director

Name Role
Don Pasley Director
Karen Williams Director
Ryles Kjellsen Director
Jennifer Mazza Director
ALBERTHA GERSON Director
MAE CLEVELAND Director
CAROL HENDRICKS Director
RON EPLING Director
LOU ANN GREHORE Director

Incorporator

Name Role
JERRY H. SMITH Incorporator
CAROL D. HENDRICKS Incorporator

Former Company Names

Name Action
BLUEGRASS LONG TERM CARE OMBUDSMAN PROGRAM, INC. Old Name

Filings

Name File Date
Annual Report 2025-02-10
Annual Report 2024-02-28
Annual Report 2023-03-14
Annual Report 2022-03-09
Annual Report 2021-04-07
Registered Agent name/address change 2020-02-12
Annual Report 2020-02-12
Annual Report 2019-04-25
Annual Report 2018-04-10
Annual Report 2017-05-04

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
61-0996520 Corporation Unconditional Exemption 3138 CUSTER DR STE 110, LEXINGTON, KY, 40517-4064 1982-10
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 receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2023-06
Asset 500,000 to 999,999
Income 500,000 to 999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Jun
Asset Amount 791957
Income Amount 780655
Form 990 Revenue Amount 780655
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 NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS INC
EIN 61-0996520
Tax Period 202306
Filing Type E
Return Type 990
File View File
Organization Name NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS INC
EIN 61-0996520
Tax Period 202206
Filing Type E
Return Type 990
File View File
Organization Name NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS INC
EIN 61-0996520
Tax Period 202106
Filing Type E
Return Type 990
File View File
Organization Name NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS INC
EIN 61-0996520
Tax Period 202006
Filing Type E
Return Type 990
File View File
Organization Name NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS INC
EIN 61-0996520
Tax Period 201906
Filing Type E
Return Type 990
File View File
Organization Name NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS INC
EIN 61-0996520
Tax Period 201806
Filing Type P
Return Type 990
File View File
Organization Name NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS INC
EIN 61-0996520
Tax Period 201706
Filing Type P
Return Type 990
File View File
Organization Name NURSING HOME OMBUDSMAN AGENCY OF THE BLUEGRASS INC
EIN 61-0996520
Tax Period 201606
Filing Type P
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6676657706 2020-05-01 0457 PPP 3138 CUSTER DR, LEXINGTON, KY, 40517-4064
Loan Status Date 2021-06-10
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 112600
Loan Approval Amount (current) 107100
Undisbursed Amount 0
Franchise Name -
Lender Location ID 44449
Servicing Lender Name PNC Bank, National Association
Servicing Lender Address 222 Delaware Ave, WILMINGTON, DE, 19801-1621
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Unanswered
Project Address LEXINGTON, FAYETTE, KY, 40517-4064
Project Congressional District KY-06
Number of Employees 28
NAICS code 813319
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 44449
Originating Lender Name PNC Bank, National Association
Originating Lender Address WILMINGTON, DE
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 108132.33
Forgiveness Paid Date 2021-05-03

Contracts

Branch Contract Id Procurement Type Begin Date End Date Amount
Executive 2400001862 MOA/PSC Exception 2024-07-01 2026-06-30 1203538.99
Department CHFS - Department for Aging and Independent Living
Category (952) HUMAN SERVICES
Authorization Memorandum of Agreement - Non Profit 501 (c) 3
Document View Document
Executive 2200004259 MOA/PSC Exception 2022-07-01 2024-06-30 704217
Department CHFS - Department for Aging and Independent Living
Category (952) HUMAN SERVICES
Authorization Memorandum of Agreement - Non Profit 501 (c) 3
Document View Document
Executive 2000002606 MOA/PSC Exception 2020-07-01 2022-06-30 642217
Department CHFS - Department for Aging and Independent Living
Category (952) HUMAN SERVICES
Authorization Memorandum of Agreement - Non Profit 501 (c) 3
Document View Document
Executive 1900000385 Memorandum of Agreement 2018-07-01 2020-06-30 588666
Department CHFS - Department for Aging and Independent Living
Category (952) HUMAN SERVICES
Authorization Memorandum of Agreement - Non Profit 501 (c) 3

Sources: Kentucky Secretary of State