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  5. PENNYROYAL HOSPICE, INC.

PENNYROYAL HOSPICE, INC.

Company Details

Name: PENNYROYAL HOSPICE, INC.
Jurisdiction: Kentucky
Profit or Non-Profit: Non-profit
Legal type: Kentucky Corporation
Status: Active
Standing: Good
File Date: 14 Apr 1982 (43 years ago)
Organization Date: 14 Apr 1982 (43 years ago)
Last Annual Report: 15 May 2024 (8 months ago)
Organization Number: 0165993
Industry: Health Services
Number of Employees: Medium (20-99)
ZIP code: 42240
Primary County: Christian
Principal Office: 220 BURLEY AVENUE, HOPKINSVILLE, KY 42240
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PENNYROYAL HOSPICE, INC 401(K) PLAN 2023 311076528 2024-05-15 PENNYROYAL HOSPICE, INC. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2024-05-15
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-05-15
Name of individual signing KELLY MARTIN
Valid signature Filed with authorized/valid electronic signature
PENNYROYAL HOSPICE, INC 401(K) PLAN 2022 311076528 2023-05-25 PENNYROYAL HOSPICE, INC. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2023-05-25
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-05-25
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
PENNYROYAL HOSPICE, INC 401(K) PLAN 2021 311076528 2022-04-28 PENNYROYAL HOSPICE, INC. 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2022-04-28
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
PENNYROYAL HOSPICE, INC 401(K) PLAN 2020 311076528 2021-05-18 PENNYROYAL HOSPICE, INC. 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2021-05-18
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-05-18
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
PENNYROYAL HOSPICE, INC 401(K) PLAN 2019 311076528 2020-05-01 PENNYROYAL HOSPICE, INC. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2020-05-01
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-01
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
PENNYROYAL HOSPICE, INC 401(K) PLAN 2018 311076528 2019-05-31 PENNYROYAL HOSPICE, INC. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2019-05-31
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-31
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
PENNYROYAL HOSPICE, INC 401(K) PLAN 2017 311076528 2018-05-10 PENNYROYAL HOSPICE, INC. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2018-05-10
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-10
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
PENNYROYAL HOSPICE, INC 401(K) PLAN 2016 311076528 2017-05-22 PENNYROYAL HOSPICE, INC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2017-05-22
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-22
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
PENNYROYAL HOSPICE, INC 401(K) PLAN 2015 311076528 2016-06-09 PENNYROYAL HOSPICE, INC 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2016-06-09
Name of individual signing SELINA PYLE
Valid signature Filed with authorized/valid electronic signature
PENNYROYAL HOSPICE, INC 401(K) PLAN 2014 311076528 2015-06-10 PENNYROYAL HOSPICE, INC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2015-06-10
Name of individual signing BARBARA C PTASZEK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/08/14/20140814142144P040085477143001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2014-08-14
Name of individual signing BARBARA PTASZEK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-08-14
Name of individual signing BARBARA PTASZEK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/12/20130712132054P030108291237001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Signature of
Role Plan administrator
Date 2013-07-12
Name of individual signing BARBARA PTASZEK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-12
Name of individual signing BARBARA PTASZEK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/08/20120608150436P040032257970001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240

Plan administrator’s name and address
Administrator’s EIN 311076528
Plan administrator’s name PENNYROYAL HOSPICE
Plan administrator’s address 220 BURLEY AVENUE, HOPKINSVILLE, KY, 42240
Administrator’s telephone number 2708856428

Signature of
Role Plan administrator
Date 2012-06-08
Name of individual signing BARBARA PTASZEK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/09/20100709101019P030037749555001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621610
Sponsor’s telephone number 2708856428
Plan sponsor’s address 220 BURLEY AVE., HOPKINSVILLE, KY, 42240

Plan administrator’s name and address
Administrator’s EIN 311076528
Plan administrator’s name PENNYROYAL HOSPICE
Plan administrator’s address 220 BURLEY AVE., HOPKINSVILLE, KY, 42240
Administrator’s telephone number 2708856428

Signature of
Role Plan administrator
Date 2010-07-09
Name of individual signing BARBARA PTASZEK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-09
Name of individual signing BARBARA PTASZEK
Valid signature Filed with authorized/valid electronic signature

Registered Agent

Name Role
KELLY MARTIN Registered Agent

Incorporator

Name Role
GARY GRAGG Incorporator
LYNN COHN Incorporator
DAVID COTTHOFF Incorporator
ROBERT M. FRANZ Incorporator
CONNIE NILES Incorporator

Officer

Name Role
Rebecca Boggess Officer
Selina Pyle Officer
Kelly Martin Officer

Director

Name Role
Hollis White Director
Carolyn Self Director
Stephen Underwood Director
LYNN COHN Director
DAVID COTTHOFF Director
ROBERT M. FRANZ Director
GARY GRAGG Director
CONNIE NILES Director

Filings

Name File Date
Annual Report 2024-05-15
Annual Report 2023-03-17
Annual Report 2022-03-07
Annual Report 2021-02-10
Annual Report 2020-03-12
Annual Report 2019-04-24
Annual Report 2018-04-25
Annual Report 2017-04-20
Annual Report 2016-04-15
Annual Report 2015-03-11

Related by officers

KELLY MARTIN

NATIONAL RETAIL CONSTRUCTION LLC IT DENT, LLC KELMAR TRUCKING, INC. ADMAR CONSTRUCTION CORP. INNOVATED CONSTRUCTION, LLC

Selina Pyle

GREAT OAKS RESIDENTS' ASSOCIATION, INC.

Kelly Martin

WORTHVILLE BAPTIST CHURCH, INC. KENTUCKY HOSPICE NETWORK, INC. NATIONAL RETAIL CONSTRUCTION LLC JERSEY PRODUCTIONS, INC. SUREFIRE MEDICAL, INC. Kelly Renee Corporation

Hollis White

JENNIE STUART MEDICAL CENTER, INC. THE FIRST UNITED METHODIST CHURCH OF HOPKINSVILLE, KENTUCKY, INC. JENNIE STUART HEALTH FOUNDATION, INC.

Carolyn Self

BENCAR ASSOCIATES, LLC

Related by address

220 BURLEY AVENUE, HOPKINSVILLE, KY 42240

WESTERN KENTUCKY HOSPICE ALLIANCE, LLC

Date of last update: 06 Dec 2024

Sources: Kentucky Secretary of State

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