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CALVERT CITY CONVALESCENT CENTER, INC.

Company Details

Name: CALVERT CITY CONVALESCENT CENTER, INC.
Jurisdiction: Kentucky
Profit or Non-Profit: Non-profit
Legal type: Kentucky Corporation
Status: Active
Standing: Good
File Date: 31 Aug 1971 (53 years ago)
Organization Date: 31 Aug 1971 (53 years ago)
Organization Number: 0007285
Industry: Health Services
Number of Employees: Large (100+)
Primary County: Marshall
Place of Formation: KENTUCKY
Last Annual Report: 28 Feb 2024 (9 months ago)
Principal Office: 1201 EAST 5TH AVENUE, CALVERT CITY, KY 42029
Principal Office ZIP code: 42029

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2023 610727805 2024-10-15 CALVERT CITY CONVALESCENT CENTER, INC. 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 2703954124
Plan sponsor’s address 1201 E 5TH AVE, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing ERICA D PHELPS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-15
Name of individual signing ERICA D PHELPS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2022 610727805 2023-02-17 CALVERT CITY CONVALESCENT CENTER, INC. 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 2703954124
Plan sponsor’s address 1201 E 5TH AVE, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2023-02-17
Name of individual signing AMY LEVERING
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-02-17
Name of individual signing AMY LEVERING
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2021 610727805 2022-10-03 CALVERT CITY CONVALESCENT CENTER, INC. 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 2703954124
Plan sponsor’s address 1201 E 5TH AVE, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2022-10-03
Name of individual signing AMY LEVERING
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2020 610727805 2021-07-23 CALVERT CITY CONVALESCENT CENTER, INC. 84
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2021-07-23
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-23
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2019 610727805 2020-04-15 CALVERT CITY CONVALESCENT CENTER, INC. 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2020-04-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-04-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2018 610727805 2019-06-13 CALVERT CITY CONVALESCENT CENTER, INC. 74
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2019-06-13
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-13
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2017 610727805 2018-06-15 CALVERT CITY CONVALESCENT CENTER, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2018-06-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2016 610727805 2017-07-07 CALVERT CITY CONVALESCENT CENTER, INC. 82
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2017-07-07
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-07
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2015 610727805 2016-04-20 CALVERT CITY CONVALESCENT CENTER, INC. 80
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2016-04-20
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-04-20
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
CALVERT CITY CONVALESCENT CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2014 610727805 2015-06-02 CALVERT CITY CONVALESCENT CENTER, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2015-06-02
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-02
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/19/20140619145140P040452034417001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2014-06-19
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-19
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/11/20130711132843P040299133347001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Signature of
Role Plan administrator
Date 2013-07-11
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-11
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/05/15/20120515130345P030000894326001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2012-05-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-05-15
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/19/20110719132845P030002837075001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2011-07-19
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-19
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/17/20100917092827P040123424008001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2010-09-17
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-17
Name of individual signing LAURIE TRAVIS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2010-09-10
Name of individual signing LAURIE TRAVIS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-09-10
Name of individual signing LAURIE TRAVIS
Valid signature Filed with incorrect/unrecognized electronic signature
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2010-09-14
Name of individual signing LAURIE TRAVIS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-09-14
Name of individual signing LAURIE TRAVIS
Valid signature Filed with incorrect/unrecognized electronic signature
Three-digit plan number (PN) 001
Effective date of plan 1997-06-01
Business code 623000
Sponsor’s telephone number 5023954124
Plan sponsor’s address PO BOX 7, CALVERT CITY, KY, 420290007

Plan administrator’s name and address
Administrator’s EIN 610727805
Plan administrator’s name CALVERT CITY CONVALESCENT CENTER, INC.
Plan administrator’s address PO BOX 7, CALVERT CITY, KY, 420290007
Administrator’s telephone number 5023954124

Signature of
Role Plan administrator
Date 2010-09-15
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-09-15
Name of individual signing BEVERLY MCKINNEY
Valid signature Filed with incorrect/unrecognized electronic signature

Registered Agent

Name Role
MRS. KEM COTHRAN Registered Agent

Secretary

Name Role
Tina Muir Secretary

Treasurer

Name Role
Tina Muir Treasurer

Vice President

Name Role
Sandy David Vice President

Director

Name Role
Kay Travis Director
Tina Johnson Director
Kem Cothran Director
Sandy David Director
Terri Bailey Director
Karen Owen Director
Chris Freeland Director
JIM FERN Director
LYNTON H. THOMAS Director
J. B. CONN Director

Incorporator

Name Role
DR. CARROLL TRAYLOR Incorporator
LELAND DIETSCH Incorporator
REV. JEROME BROWNE Incorporator
CHARLES R. HINES Incorporator
DANDRIDGE F. WALTON Incorporator

President

Name Role
Kem Cothran President

Assumed Names

Name Status Expiration Date
CALVERT CITY NURSING AND REHAB Active 2027-12-05

Filings

Name File Date
Registered Agent name/address change 2024-02-28
Annual Report 2024-02-28
Annual Report 2023-03-17
Certificate of Assumed Name 2022-12-05
Annual Report 2022-04-22
Registered Agent name/address change 2021-04-27
Principal Office Address Change 2021-04-27
Annual Report 2021-04-27
Annual Report 2020-05-19
Annual Report 2019-05-19

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Date of last update: 02 Nov 2024

Sources: Kentucky Secretary of State

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