Search icon

GRAYSON COUNTY MEDICAL FOUNDATION, INC.

Company Details

Name: GRAYSON COUNTY MEDICAL FOUNDATION, INC.
Legal type: Kentucky Corporation
Status: Inactive
Standing: Bad
Profit or Non-Profit: Non-profit
File Date: 12 Oct 1994 (31 years ago)
Organization Date: 12 Oct 1994 (31 years ago)
Last Annual Report: 07 Mar 2022 (3 years ago)
Organization Number: 0337047
ZIP code: 42754
City: Leitchfield
Primary County: Grayson County
Principal Office: 130 EAST MARKET STREET, LEITCHFIELD, KY 42754
Place of Formation: KENTUCKY

Director

Name Role
David Downs Director
Marla Cantway Director
Kenneth Green Director
PAUL BRYANT Director
CAROLYNTHOMASON Director
ANNA RAYE MONTGOMERY Director
Trevor Ray Director
Edwin McKinney Director

Incorporator

Name Role
STEPHEN L. MEREDITH Incorporator

Registered Agent

Name Role
WAYNE MERIWETHER Registered Agent

President

Name Role
Trevor Ray President

Secretary

Name Role
Edwin McKinney Secretary

Treasurer

Name Role
Edwin McKinney Treasurer

Vice President

Name Role
David Downs Vice President

National Provider Identifier

NPI Number:
1205870862
Certification Date:
2019-12-09

Authorized Person:

Name:
DENEACE CLEMONS
Role:
COO
Phone:

Taxonomy:

Selected Taxonomy:
207V00000X - Obstetrics & Gynecology Physician
Is Primary:
No
Selected Taxonomy:
207X00000X - Orthopaedic Surgery Physician
Is Primary:
No
Selected Taxonomy:
207Y00000X - Otolaryngology Physician
Is Primary:
No
Selected Taxonomy:
207QS0010X - Sports Medicine (Family Medicine) Physician
Is Primary:
No
Selected Taxonomy:
207R00000X - Internal Medicine Physician
Is Primary:
No
Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
No
Selected Taxonomy:
2084N0400X - Neurology Physician
Is Primary:
No
Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
No
Selected Taxonomy:
208D00000X - General Practice Physician
Is Primary:
No
Selected Taxonomy:
231H00000X - Audiologist
Is Primary:
No
Selected Taxonomy:
363LA2200X - Adult Health Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LP2300X - Primary Care Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2702599582

Form 5500 Series

Employer Identification Number (EIN):
611269278
Plan Year:
2018
Number Of Participants:
1
Sponsors Telephone Number:
Plan Year:
2017
Number Of Participants:
2
Sponsors Telephone Number:
Plan Year:
2017
Number Of Participants:
2
Sponsors Telephone Number:
Plan Year:
2016
Number Of Participants:
3
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
4
Sponsors Telephone Number:

Former Company Names

Name Action
TWIN LAKES MEDICAL FOUNDATION, INC. Old Name

Filings

Name File Date
Administrative Dissolution 2023-10-04
Annual Report 2022-03-07
Principal Office Address Change 2021-06-14
Annual Report 2021-06-14
Amendment 2020-12-07

Sources: Kentucky Secretary of State