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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.
Legal type: Kentucky Corporation
Status: Active
Standing: Good
Profit or Non-Profit: Non-profit
File Date: 12 Jan 2005 (20 years ago)
Organization Date: 12 Jan 2005 (20 years ago)
Last Annual Report: 26 Jun 2024 (10 months ago)
Organization Number: 0603369
ZIP code: 42743
City: Greensburg
Primary County: Green County
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

Director

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

Signature

Name Role
RUTHIE SHUFFETT Signature

Incorporator

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

President

Name Role
RUTHIE SHUFFETT President

Secretary

Name Role
VALERIE PERKINS Secretary

Treasurer

Name Role
VALERIE PERKINS Treasurer

Registered Agent

Name Role
RUTHIE SHUFFETT Registered Agent

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

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
61-0595335 Association Unconditional Exemption 202 MILBY ST # 206, GREENSBURG, KY, 42743-1136 1987-02
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 Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period -
Asset 0
Income 0
Filing Requirement 990 - Not required to file (all other)
PF Filing Requirement No 990-PF return
Accounting Period Jun
Asset Amount -
Income Amount -
Form 990 Revenue Amount -
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)

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6814427401 2020-05-15 0457 PPP 202 206 MILBY ST, GREENSBURG, KY, 42743-1136
Loan Status Date 2021-07-07
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 2285900
Loan Approval Amount (current) 2285900
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27196
Servicing Lender Name Central Bank & Trust Co.
Servicing Lender Address 300 W Vine St, LEXINGTON, KY, 40507-1621
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address GREENSBURG, GREEN, KY, 42743-1136
Project Congressional District KY-02
Number of Employees 242
NAICS code 622110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 27196
Originating Lender Name Central Bank & Trust Co.
Originating Lender Address LEXINGTON, KY
Gender Male Owned
Veteran Unanswered
Forgiveness Amount 2309965.45
Forgiveness Paid Date 2021-06-10

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Sources: Kentucky Secretary of State

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