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  5. HOSPICE OF LAKE CUMBERLAND, INC.

HOSPICE OF LAKE CUMBERLAND, INC.

Company Details

Name: HOSPICE OF LAKE CUMBERLAND, INC.
Legal type: Kentucky Corporation
Status: Active
Standing: Good
Profit or Non-Profit: Non-profit
File Date: 23 Jul 1984 (41 years ago)
Organization Date: 23 Jul 1984 (41 years ago)
Last Annual Report: 29 Feb 2024 (a year ago)
Organization Number: 0191905
Industry: Health Services
Number of Employees: Medium (20-99)
ZIP code: 42503
City: Somerset
Primary County: Pulaski County
Principal Office: 100 PARKWAY DRIVE, SOMERSET, KY 42503
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2023 311118731 2024-10-04 HOSPICE OF LAKE CUMBERLAND 80
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2024-10-04
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2022 311118731 2023-07-26 HOSPICE OF LAKE CUMBERLAND 79
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2021 311118731 2022-10-14 HOSPICE OF LAKE CUMBERLAND 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2022-10-14
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2020 311118731 2021-10-14 HOSPICE OF LAKE CUMBERLAND 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2019 311118731 2020-10-14 HOSPICE OF LAKE CUMBERLAND 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2018 311118731 2019-10-14 HOSPICE OF LAKE CUMBERLAND 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2017 311118731 2018-08-23 HOSPICE OF LAKE CUMBERLAND 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2018-08-23
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2016 311118731 2017-08-18 HOSPICE OF LAKE CUMBERLAND 61
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2017-08-18
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2015 311118731 2016-08-02 HOSPICE OF LAKE CUMBERLAND 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2016-08-02
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2014 311118731 2015-07-27 HOSPICE OF LAKE CUMBERLAND 68
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2015-07-27
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/14/20140714082122P040012557535001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2014-07-14
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/23/20130723125702P030309714323001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2013-07-23
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/08/20121008125319P040000373991001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Plan administrator’s name and address
Administrator’s EIN 311118731
Plan administrator’s name HOSPICE OF LAKE CUMBERLAND
Plan administrator’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503
Administrator’s telephone number 6066794389

Signature of
Role Plan administrator
Date 2012-10-08
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature

President

Name Role
GREG REDMON President

Director

Name Role
KARA HAWK Director
MARK ROSS Director
RON GLEAVES Director
ROBIN TARTER Director
LINDA FRYE Director
JAY MCSHURLEY Director
GENE CHESHIRE Director
ROSCOE KELLEY Director
RENNY SMITH Director
MILLIE WEAVER Director

Incorporator

Name Role
JERRY ROGERS Incorporator
GERARD WEIGEL, M.D. Incorporator
SALLY MULLINS Incorporator

Registered Agent

Name Role
EURETHA GODBY Registered Agent

Secretary

Name Role
PAT TAYLER Secretary

Treasurer

Name Role
JENNIFER ROBERTSON Treasurer

Vice President

Name Role
DERRICK TERRY Vice President

Licenses

Department License Number License Type / Line of Authority Status Issue Date Effective Date Inactive Date Expiry Date Address
Department of Charitable Gaming EXE0002482 Exempt Organization Inactive - - - - Somerset, PULASKI, KY

Former Company Names

Name Action
SOMERSET PULASKI COUNTY COMMUNITY HOSPICE Old Name

Filings

Name File Date
Annual Report 2024-02-29
Annual Report 2023-04-21
Annual Report 2022-03-24
Annual Report 2021-06-30
Annual Report 2020-04-23
Annual Report 2019-05-15
Annual Report 2018-04-13
Registered Agent name/address change 2017-05-17
Annual Report 2017-05-17
Annual Report 2016-03-08

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
31-1118731 Corporation Unconditional Exemption 100 PARKWAY DR, SOMERSET, KY, 42503-3450 1985-02
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 normally receives no more than one-third of its support from gross investment income and unrelated business income and at the same time more than one-third of its support from contributions, fees, and gross receipts related to exempt purposes 509(a)(2)
Tax Period 2023-12
Asset 10,000,000 to 49,999,999
Income 10,000,000 to 49,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 10483270
Income Amount 11782936
Form 990 Revenue Amount 10765994
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 HOSPICE OF LAKE CUMBERLAND INC
EIN 31-1118731
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF LAKE CUMBERLAND INC
EIN 31-1118731
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF LAKE CUMBERLAND INC
EIN 31-1118731
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF LAKE CUMBERLAND INC
EIN 31-1118731
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF LAKE CUMBERLAND INC
EIN 31-1118731
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF LAKE CUMBERLAND INC
EIN 31-1118731
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF LAKE CUMBERLAND INC
EIN 31-1118731
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF LAKE CUMBERLAND INC
EIN 31-1118731
Tax Period 201612
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
8400127001 2020-04-08 0457 PPP 100 PARKWAY DR, SOMERSET, KY, 42503-3450
Loan Status Date 2021-02-06
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 974000
Loan Approval Amount (current) 974000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27925
Servicing Lender Name The Citizens National Bank of Somerset
Servicing Lender Address 44 Public Sq, SOMERSET, KY, 42501-1414
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address SOMERSET, PULASKI, KY, 42503-3450
Project Congressional District KY-05
Number of Employees 76
NAICS code 423450
Borrower Race White
Borrower Ethnicity Not Hispanic or Latino
Business Type Non-Profit Organization
Originating Lender ID 27925
Originating Lender Name The Citizens National Bank of Somerset
Originating Lender Address SOMERSET, KY
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 981764.94
Forgiveness Paid Date 2021-01-28

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No related companies by address

Sources: Kentucky Secretary of State

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