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  5. CCMH CORPORATION

CCMH CORPORATION

Company Details

Name: CCMH CORPORATION
Legal type: Kentucky Corporation
Status: Active
Standing: Good
Profit or Non-Profit: Non-profit
File Date: 16 Oct 1995 (29 years ago)
Organization Date: 16 Oct 1995 (29 years ago)
Last Annual Report: 28 Feb 2024 (a year ago)
Organization Number: 0406686
Industry: Health Services
Number of Employees: Large (100+)
ZIP code: 41008
City: Carrollton
Primary County: Carroll County
Principal Office: 309 11TH ST, CARROLLTON, KY 41008-1435
Place of Formation: KENTUCKY

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
HY44RJBJ9723 2024-07-31 309 11TH ST, CARROLLTON, KY, 41008, 1435, USA 309 ELEVENTH STREET, CARROLLTON, KY, 41008, 1435, USA

Business Information
Doing Business As CARROLL COUNTY MEMORIAL HOSPITAL
URL http://www.ccmhosp.com
Congressional District 04
State/Country of Incorporation KY, USA
Activation Date 2023-08-03
Initial Registration Date 2008-04-03
Entity Start Date 2007-04-08
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name KIM HAVERLY
Role CEO
Address 309 11TH STREET, CARROLLTON, KY, 41008, USA
Government Business
Title PRIMARY POC
Name KIM HAVERLY
Role CEO
Address 309 ELEVENTH STREET, CARROLLTON, KY, 41008, 1435, USA
Past Performance
Title PRIMARY POC
Name AMANDA KINMAN
Role CFO
Address 309 ELEVENTH STREET, CARROLLTON, KY, 41008, USA
Title ALTERNATE POC
Name DAVID BOWLING
Role CFO
Address 309 11TH ST, CARROLLTON, KY, 41008, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CCMH CORPORATION 401(K) PLAN 2012 611297707 2013-09-20 CCMH CORPORATION 126
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 5027324321
Plan sponsor’s mailing address 309 11TH STREET, CARROLLTON, KY, 41008
Plan sponsor’s address 309 11TH STREET, CARROLLTON, KY, 41008

Plan administrator’s name and address
Administrator’s EIN 611297707
Plan administrator’s name CCMH CORPORATION
Plan administrator’s address 309 11TH STREET, CARROLLTON, KY, 41008
Administrator’s telephone number 5027324321

Number of participants as of the end of the plan year
Active participants 122
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 7
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 83
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 1

Signature of
Role Plan administrator
Date 2013-09-20
Name of individual signing MICHAEL KOZAR
Valid signature Filed with authorized/valid electronic signature
CCMH CORPORATION 401(K) PLAN 2011 611297707 2012-10-11 CCMH CORPORATION 110
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 5027324321
Plan sponsor’s mailing address 309 11TH STREET, CARROLLTON, KY, 41008
Plan sponsor’s address 309 11TH STREET, CARROLLTON, KY, 41008

Plan administrator’s name and address
Administrator’s EIN 611297707
Plan administrator’s name CCMH CORPORATION
Plan administrator’s address 309 11TH STREET, CARROLLTON, KY, 41008
Administrator’s telephone number 5027324321

Number of participants as of the end of the plan year
Active participants 118
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 8
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 74
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 4

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing STEVE EIGEL
Valid signature Filed with authorized/valid electronic signature
CCMH CORPORATION 401(K) PLAN 2010 611297707 2011-10-14 CCMH CORPORATION 108
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 5027324321
Plan sponsor’s mailing address 309 11TH STREET, CARROLLTON, KY, 41008
Plan sponsor’s address 309 11TH STREET, CARROLLTON, KY, 41008

Plan administrator’s name and address
Administrator’s EIN 611297707
Plan administrator’s name CCMH CORPORATION
Plan administrator’s address 309 11TH STREET, CARROLLTON, KY, 41008
Administrator’s telephone number 5027324321

Number of participants as of the end of the plan year
Active participants 98
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 12
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 74
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 10

Signature of
Role Employer/plan sponsor
Date 2011-10-14
Name of individual signing DAVID PARRISH
Valid signature Filed with authorized/valid electronic signature
CCMH CORPORATION 401(K) PLAN 2009 611297707 2010-10-15 CCMH CORPORATION 122
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 5027324321
Plan sponsor’s mailing address 309 11TH STREET, CARROLLTON, KY, 41008
Plan sponsor’s address 309 11TH STREET, CARROLLTON, KY, 41008

Plan administrator’s name and address
Administrator’s EIN 611297707
Plan administrator’s name CCMH CORPORATION
Plan administrator’s address 309 11TH STREET, CARROLLTON, KY, 41008
Administrator’s telephone number 5027324321

Number of participants as of the end of the plan year
Active participants 103
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 5
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 85
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 10

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing DAVID PARRISH
Valid signature Filed with authorized/valid electronic signature

Director

Name Role
Scott Nab Director
Nick Marsh Director
THOEDA FRANKLIN Director
JAMES MONK Director
Jim Conti Director
David Wilhoite Director
MR. WALTER ARCHINAL Director
DONALD GARNER Director
HERBERT KINMAN Director
JEAN PYLES Director

Incorporator

Name Role
GENE MCMURRY Incorporator

Registered Agent

Name Role
JAKE THOMPSON Registered Agent

President

Name Role
Dennis Raisor President

Secretary

Name Role
Jim Stephenson Secretary

Assumed Names

Name Status Expiration Date
CCMH OUTPATIENT PHARMACY Active 2027-03-07
Carroll County Memorial Hospital Outpatient Pharmacy Inactive 2026-12-22
EMPOWERED LIVING Inactive 2024-05-13
CARROLL COUNTY FAMILY PRACTICE Inactive 2024-02-20
CARROLL COUNTY MEMORIAL HEALTH CARE FOUNDATION Inactive 2021-05-10
WARSAW FAMILY PRACTICE Inactive 2016-01-10
CCMH HEALTH CARE FOUNDATION Inactive 2014-02-20
CCMH HOSPITAL AND HEALTH SERVICES Inactive 2014-02-20
CCMH PHYSICIAN SPECIALTY CENTER Inactive 2014-02-20
CCMH MEDICAL OFFICE PARK Inactive 2014-02-20

Filings

Name File Date
Annual Report 2024-02-28
Annual Report 2023-05-01
Registered Agent name/address change 2023-05-01
Certificate of Withdrawal of Assumed Name 2022-03-07
Certificate of Assumed Name 2022-03-07
Annual Report 2022-03-02
Certificate of Assumed Name 2021-12-22
Registered Agent name/address change 2021-02-11
Annual Report 2021-02-11
Annual Report 2020-02-13

USAspending Awards. Contracts

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
No data IDV VA249P0736 2012-06-30 No data No data
Unique Award Key CONT_IDV_VA249P0736_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 94559.14
Potential Award Amount 1290000.00

Description
Title RADIOLOGY SERVICES
NAICS Code 621512: DIAGNOSTIC IMAGING CENTERS
Product and Service Codes Q522: RADIOLOGY SERVICES

Recipient Details
Recipient CCMH CORP
UEI HY44RJBJ9723
Recipient Address 309 11TH ST, CARROLLTON, CARROLL, KENTUCKY, 410081435, UNITED STATES
DO AWARD V603C10011 2010-10-04 2011-05-31 2012-05-31
Unique Award Key CONT_AWD_V603C10011_3600_VA249P0736_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title RADIOLOGY SERVICES
NAICS Code 621512: DIAGNOSTIC IMAGING CENTERS
Product and Service Codes Q522: RADIOLOGY SERVICES

Recipient Details
Recipient CCMH CORP
UEI HY44RJBJ9723
Legacy DUNS 074099557
Recipient Address 309 11TH ST, CARROLLTON, 410081435, UNITED STATES
DO AWARD V603DC1029 2010-10-01 2011-05-31 2012-05-31
Unique Award Key CONT_AWD_V603DC1029_3600_VA249P0736_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title RADIOLOGY SERVICES
NAICS Code 621512: DIAGNOSTIC IMAGING CENTERS
Product and Service Codes Q522: RADIOLOGY SERVICES

Recipient Details
Recipient CCMH CORP
UEI HY44RJBJ9723
Legacy DUNS 074099557
Recipient Address 309 11TH ST, CARROLLTON, 410081435, UNITED STATES
DO AWARD V603C90523 2009-08-01 2010-08-01 2012-05-31
Unique Award Key CONT_AWD_V603C90523_3600_VA249P0736_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title RADIOLOGY SERVICES
NAICS Code 621512: DIAGNOSTIC IMAGING CENTERS
Product and Service Codes Q522: RADIOLOGY SERVICES

Recipient Details
Recipient CCMH CORP
UEI HY44RJBJ9723
Legacy DUNS 074099557
Recipient Address 309 11TH ST, CARROLLTON, 410081435, UNITED STATES
DO AWARD V603C00022 2009-05-31 2011-05-31 2012-05-31
Unique Award Key CONT_AWD_V603C00022_3600_VA249P0736_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title RADIOLOGY SERVICES
NAICS Code 621512: DIAGNOSTIC IMAGING CENTERS
Product and Service Codes Q522: RADIOLOGY SERVICES

Recipient Details
Recipient CCMH CORP
UEI HY44RJBJ9723
Legacy DUNS 074099557
Recipient Address 309 11TH ST, CARROLLTON, 410081435, UNITED STATES

USAspending Awards. Financial Assistance

FAIN Awarding Agency Assistance Listings Start Date End Date Description
C76HF09471 Department of Health and Human Services 93.887 - HEALTH CARE AND OTHER FACILITIES 2008-06-01 2009-05-31 HEALTH CARE AND OTHER FACILITIES
Recipient CCMH CORP
Recipient Name Raw CCMH CORPORATION
Recipient UEI HY44RJBJ9723
Recipient DUNS 074099557
Recipient Address 309 ELEVENTH STREET, CARROLLTON, CARROLL, KENTUCKY, 41008
Obligated Amount 284030.00
Non-Federal Funding 0.00
Original Subsidy Cost 0.00
Face Value of Direct Loan 0.00
Link View Page

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
61-1297707 Corporation Unconditional Exemption 309 11TH ST, CARROLLTON, KY, 41008-1435 1996-07
In Care of Name % ROGER WILLIAMS
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 Organizations operated solely for the benefit of and in conjunction with organizations described in 10 through 16 above 509(a)(3)
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 15791364
Income Amount 26953831
Form 990 Revenue Amount 26953831
National Taxonomy of Exempt Entities Health Care: Community Health Systems
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 supporting organization, unspecified type. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 201612
Filing Type E
Return Type 990
File View File
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 201612
Filing Type E
Return Type 990
File View File
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 201512
Filing Type E
Return Type 990
File View File
Organization Name CCMH CORPORATION
EIN 61-1297707
Tax Period 201512
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
6668897000 2020-04-07 0457 PPP 309 11TH ST, CARROLLTON, KY, 41008-1400
Loan Status Date 2021-01-21
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 1591000
Loan Approval Amount (current) 1591000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27680
Servicing Lender Name The Paducah Bank and Trust Company
Servicing Lender Address 555 Jefferson St, PADUCAH, KY, 42001-1088
Rural or Urban Indicator R
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address CARROLLTON, CARROLL, KY, 41008-1400
Project Congressional District KY-04
Number of Employees 155
NAICS code 622110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 27680
Originating Lender Name The Paducah Bank and Trust Company
Originating Lender Address PADUCAH, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 1601810.08
Forgiveness Paid Date 2020-12-22

Government Spending

Branch Date of Service Fiscal Year Cabinet Department Classification Item Name Amount
Executive 2024-10-16 2025 Transportation Cabinet Public Transportation Grants Mass Transit Dvlopmnt Payments 14900
Executive 2023-09-28 2024 Justice & Public Safety Cabinet Kentucky State Police Non Pro Contract Lab Tests & Anal Fees 1099 Rep 94
Executive 2023-09-18 2024 Transportation Cabinet Public Transportation Grants Mass Transit Dvlopmnt Payments 15354
Executive 2023-07-18 2024 Transportation Cabinet Public Transportation Grants Mass Transit Dvlopmnt Payments 19573

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Sources: Kentucky Secretary of State

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