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  5. JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.

JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.

Company Details

Name: JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.
Jurisdiction: Kentucky
Profit or Non-Profit: Non-profit
Legal type: Kentucky Corporation
Status: Active
Standing: Good
File Date: 12 Jan 2005 (20 years ago)
Organization Date: 12 Jan 2005 (20 years ago)
Last Annual Report: 26 Jun 2024 (7 months ago)
Organization Number: 0603369
ZIP code: 42743
Primary County: Green
Principal Office: 290 INDUSTRIAL PARK ROAD, GREENSBURG, KY 42743
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JANE TODD CRAWFORD HOSP LIFE INS PLAN 2011 204474637 2013-04-15 JANE TODD CRAWFORD MEMORIAL HOSPITAL INC 163
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2005-06-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL INC
Plan administrator’s address 202 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 170

Signature of
Role Plan administrator
Date 2013-04-15
Name of individual signing RICHARD HENDERSHOT
Valid signature Filed with authorized/valid electronic signature
JANE TODD CRAWFORD ANTHEM BLUE CROSS 2011 204474637 2013-04-15 JANE TODD CRAWFORD MEMORIAL HOSPITAL INC. 140
File View Page
Three-digit plan number (PN) 505
Effective date of plan 2011-10-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL INC.
Plan administrator’s address 202 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 150

Signature of
Role Plan administrator
Date 2013-04-15
Name of individual signing RICHARD HENDERSHOT
Valid signature Filed with authorized/valid electronic signature
JANE TODD CRAWFORD HOSP DISABILITY PLAN 2011 204474637 2013-04-15 JANE TODD CRAWFORD MEMORIAL HOSPITAL INC 163
File View Page
Three-digit plan number (PN) 504
Effective date of plan 2005-06-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL INC
Plan administrator’s address 202 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 170

Signature of
Role Plan administrator
Date 2013-04-15
Name of individual signing RICHARD HENDERSHOT
Valid signature Filed with authorized/valid electronic signature
JANE TODD CRAWFORD HOSPITAL DISABILITY INSURANCE PLAN 2009 204474637 2011-01-28 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. 142
File View Page
Three-digit plan number (PN) 504
Effective date of plan 2005-06-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.
Plan administrator’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 148

Signature of
Role Plan administrator
Date 2011-01-28
Name of individual signing REX TUNGATE
Valid signature Filed with authorized/valid electronic signature
JANE TODD CRAWFORD HOSPITAL DENTAL PLAN 2009 204474637 2011-01-28 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC 98
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2010-01-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC
Plan administrator’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 95

Signature of
Role Plan administrator
Date 2011-01-28
Name of individual signing REX TUNGATE
Valid signature Filed with authorized/valid electronic signature
JANE TODD CRAWFORD HUMANA HEALTH PLAN 2009 204474637 2011-01-28 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC 129
File View Page
Three-digit plan number (PN) 505
Effective date of plan 2009-07-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC
Plan administrator’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 128

Signature of
Role Plan administrator
Date 2011-01-28
Name of individual signing REX TUNGATE
Valid signature Filed with authorized/valid electronic signature
JANE TODD MEMORIAL HOSPITAL BLUEGRASS FAMILY HEALTH, INC 2009 204474637 2011-01-28 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC 128
File View Page
Three-digit plan number (PN) 506
Effective date of plan 2009-10-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC
Plan administrator’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 126

Signature of
Role Plan administrator
Date 2011-01-28
Name of individual signing REX TUNGATE
Valid signature Filed with authorized/valid electronic signature
JANE TODD CRAWFORD HOSPITAL DISABILITY INSURANCE PLAN 2009 204474637 2011-01-28 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC. 142
Three-digit plan number (PN) 504
Effective date of plan 2005-06-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC.
Plan administrator’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 148

Signature of
Role Employer/plan sponsor
Date 2011-01-27
Name of individual signing REX TUNGATE
Valid signature Filed with authorized/valid electronic signature
JANE TODD CRAWFORD HOSPITAL DENTAL PLAN 2009 204474637 2011-01-28 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC 98
Three-digit plan number (PN) 502
Effective date of plan 2010-01-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC
Plan administrator’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 95

Signature of
Role Employer/plan sponsor
Date 2011-01-27
Name of individual signing REX TUNGATE
Valid signature Filed with authorized/valid electronic signature
JANE TODD MEMORIAL HOSPITAL BLUEGRASS FAMILY HEALTH, INC 2009 204474637 2011-01-28 JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC 128
Three-digit plan number (PN) 506
Effective date of plan 2009-10-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC
Plan administrator’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 126

Signature of
Role Employer/plan sponsor
Date 2011-01-27
Name of individual signing REX TUNGATE
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 505
Effective date of plan 2009-07-01
Business code 622000
Sponsor’s telephone number 2709324211
Plan sponsor’s mailing address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Plan sponsor’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743

Plan administrator’s name and address
Administrator’s EIN 204474637
Plan administrator’s name JANE TODD CRAWFORD MEMORIAL HOSPITAL, INC
Plan administrator’s address 202-206 MILBY STREET, GREENSBURG, KY, 42743
Administrator’s telephone number 2709324211

Number of participants as of the end of the plan year
Active participants 128

Signature of
Role Employer/plan sponsor
Date 2011-01-27
Name of individual signing REX TUNGATE
Valid signature Filed with authorized/valid electronic signature

Incorporator

Name Role
RUTHIE SHUFFETT Incorporator
VALERIE PERKINS Incorporator
STEVE LEWIS Incorporator
RICHARD SHUFFETT Incorporator
GREG ALTMAN Incorporator

President

Name Role
RUTHIE SHUFFETT President

Secretary

Name Role
VALERIE PERKINS Secretary

Registered Agent

Name Role
RUTHIE SHUFFETT Registered Agent

Director

Name Role
RUTHIE SHUFFETT Director
VALERIE PERKINS Director
STEVE LEWIS Director
GREG ALTMAN Director
RUTHIE SHUFFETT Director
VALERIE PERKINS Director
STEVE LEWIS Director
JOE SHUFFETT Director
RICHARD SHUFFETT Director

Treasurer

Name Role
VALERIE PERKINS Treasurer

Signature

Name Role
RUTHIE SHUFFETT Signature

Assumed Names

Name Status Expiration Date
GREEN COUNTY PRIMARY CARE Active 2028-07-17
JANE TODD PRIMARY CARE Active 2028-07-17
JANE TODD CRAWFORD HOSPITAL Active 2026-07-15

Filings

Name File Date
Annual Report 2024-06-26
Name Renewal 2023-07-17
Name Renewal 2023-07-14
Registered Agent name/address change 2023-07-06
Annual Report 2023-06-01
Principal Office Address Change 2023-06-01
Annual Report 2022-06-01
Name Renewal 2021-07-14
Annual Report 2021-06-15
Annual Report 2020-04-23

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Related by address

No related companies by address

Date of last update: 12 Jan 2025

Sources: Kentucky Secretary of State

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