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PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.

Company Details

Name: PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Jurisdiction: Kentucky
Profit or Non-Profit: Non-profit
Legal type: Kentucky Corporation
Status: Inactive
Standing: Bad
File Date: 24 Sep 1953 (71 years ago)
Organization Date: 24 Sep 1953 (71 years ago)
Organization Number: 0041539
Primary County: Bell
Place of Formation: KENTUCKY
Last Annual Report: 18 Jul 2018 (6 years ago)
Principal Office: 850 RIVERVEIW AVE., PINEVILLE, KY 40977
Principal Office ZIP code: 40977

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 403 (B) RETIREMENT PLAN 2018 610541901 2019-10-15 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 202
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants with account balances as of the end of the plan year 0

Signature of
Role Plan administrator
Date 2019-10-15
Name of individual signing CHUCK BISHOP
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-15
Name of individual signing CHUCK BISHOP
Valid signature Filed with authorized/valid electronic signature
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. PROFIT SHARING PLAN 2017 610541901 2018-10-15 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 308
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
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 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 41

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing CHARLES BISHOP
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-15
Name of individual signing CHARLES BISHOP
Valid signature Filed with authorized/valid electronic signature
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 403 (B) RETIREMENT PLAN 2017 610541901 2018-10-15 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 372
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 241
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 57
Number of participants with account balances as of the end of the plan year 153

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing CHARLES BISHOP
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-15
Name of individual signing CHARLES BISHOP
Valid signature Filed with authorized/valid electronic signature
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 403 (B) RETIREMENT PLAN 2016 610541901 2018-07-25 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 346
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 323
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 17
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 156
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2018-07-25
Name of individual signing CHARLES BISHOP
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-25
Name of individual signing CHARLES BISHOP
Valid signature Filed with authorized/valid electronic signature
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. PROFIT SHARING PLAN 2016 610541901 2017-10-16 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 313
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 231
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 38
Number of participants with account balances as of the end of the plan year 264
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 7

Signature of
Role Plan administrator
Date 2017-10-16
Name of individual signing KEVIN COUCH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-16
Name of individual signing KEVIN COUCH
Valid signature Filed with authorized/valid electronic signature
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 403 (B) RETIREMENT PLAN 2015 610541901 2018-07-25 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 297
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 281
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants with account balances as of the end of the plan year 281
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2018-07-25
Name of individual signing CHARLES BISHOP
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-25
Name of individual signing CHARLES BISHOP
Valid signature Filed with authorized/valid electronic signature
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 403 (B) RETIREMENT PLAN 2015 610541901 2016-10-17 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 297
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 281
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants with account balances as of the end of the plan year 281
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2016-10-17
Name of individual signing GORDON LARSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-17
Name of individual signing GORDON LARSON
Valid signature Filed with authorized/valid electronic signature
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. PROFIT SHARING PLAN 2015 610541901 2016-10-17 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 308
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 229
Retired or separated participants receiving benefits 229
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 294
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 14

Signature of
Role Plan administrator
Date 2016-10-17
Name of individual signing GORDON LARSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-17
Name of individual signing GORDON LARSON
Valid signature Filed with authorized/valid electronic signature
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 403 (B) RETIREMENT PLAN 2015 610541901 2016-10-17 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 297
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 281
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants with account balances as of the end of the plan year 281
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2016-10-17
Name of individual signing GORDON LARSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-17
Name of individual signing GORDON LARSON
Valid signature Filed with authorized/valid electronic signature
PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 403 (B) RETIREMENT PLAN 2015 610541901 2016-10-17 PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC. 297
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 281
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants with account balances as of the end of the plan year 281
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2016-10-17
Name of individual signing GORDON LARSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-17
Name of individual signing GORDON LARSON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/09/20151009125623P030039117841001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 282
Retired or separated participants receiving benefits 3
Other retired or separated participants entitled to future benefits 1
Number of participants with account balances as of the end of the plan year 163
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2015-10-09
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-09
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/09/20151009125944P040017217583001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 255
Retired or separated participants receiving benefits 35
Other retired or separated participants entitled to future benefits 0
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 290
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 7

Signature of
Role Plan administrator
Date 2015-10-09
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-09
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/15/20141015142217P040020505487001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 270
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 38
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 308
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 9

Signature of
Role Plan administrator
Date 2014-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/15/20141015142047P030052486311001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 280
Retired or separated participants receiving benefits 5
Other retired or separated participants entitled to future benefits 78
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 181
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2014-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/02/05/20140205125720P030012797328001.pdf
Three-digit plan number (PN) 504
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 6063374281
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 58
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2014-02-05
Name of individual signing JOSHUA D COLLETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/15/20131015133826P040002088978001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 303
Retired or separated participants receiving benefits 4
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 195
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/15/20131015134535P030017735477001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 292
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 31
Number of participants with account balances as of the end of the plan year 323
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 9

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/02/27/20140227071254P030078269477001.pdf
Three-digit plan number (PN) 503
Effective date of plan 2011-07-01
Business code 622000
Sponsor’s telephone number 6063374281
Plan sponsor’s mailing address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC
Plan administrator’s address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063374281

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2014-02-27
Name of individual signing JOSHUA D COLLETT
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 503
Effective date of plan 2011-07-01
Business code 622000
Plan sponsor’s mailing address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC
Plan administrator’s address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 274

Signature of
Role Plan administrator
Date 2012-11-15
Name of individual signing GREGORY NUNNELLEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/08/31/20120831101641P030042444626001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 325
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 8
Number of participants with account balances as of the end of the plan year 209
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-08-31
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-31
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 289
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 27
Number of participants with account balances as of the end of the plan year 316
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 7

Signature of
Role Plan administrator
Date 2012-08-31
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-31
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 325
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 8
Number of participants with account balances as of the end of the plan year 209
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-08-16
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-16
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/08/31/20120831123150P040003618771001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 289
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 27
Number of participants with account balances as of the end of the plan year 316
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 7

Signature of
Role Plan administrator
Date 2012-08-31
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-31
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 289
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 27
Number of participants with account balances as of the end of the plan year 316
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 7

Signature of
Role Plan administrator
Date 2012-08-16
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-16
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 325
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 8
Number of participants with account balances as of the end of the plan year 209
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-08-29
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-29
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 289
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 27
Number of participants with account balances as of the end of the plan year 316
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 7

Signature of
Role Plan administrator
Date 2012-08-29
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-29
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 325
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 8
Number of participants with account balances as of the end of the plan year 209
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-08-01
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-01
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 289
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 27
Number of participants with account balances as of the end of the plan year 316
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 7

Signature of
Role Plan administrator
Date 2012-08-01
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-08-01
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/18/20120718145359P030000504004001.pdf
Three-digit plan number (PN) 504
Effective date of plan 2011-06-01
Business code 622000
Plan sponsor’s mailing address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC
Plan administrator’s address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 23

Signature of
Role Plan administrator
Date 2012-07-18
Name of individual signing GREGORY NUNNELLEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/18/20120718142954P040019239936001.pdf
Three-digit plan number (PN) 503
Effective date of plan 2011-06-01
Business code 622000
Plan sponsor’s mailing address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC
Plan administrator’s address 850 RIVERVIEW AVE, PINEVILLE, KY, 40977

Number of participants as of the end of the plan year
Active participants 177

Signature of
Role Plan administrator
Date 2012-07-18
Name of individual signing GREGORY NUNNELLEY
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/09/14/20110914092043P040133242081001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 310
Retired or separated participants receiving benefits 10
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 227
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-09-14
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-14
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 310
Retired or separated participants receiving benefits 10
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 227
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-09-13
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-13
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/09/14/20110914100023P030129989857001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 287
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 32
Number of participants with account balances as of the end of the plan year 320
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 17

Signature of
Role Plan administrator
Date 2011-09-14
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-14
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 287
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 32
Number of participants with account balances as of the end of the plan year 320
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 17

Signature of
Role Plan administrator
Date 2011-09-13
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-13
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 287
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 32
Number of participants with account balances as of the end of the plan year 320
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 17

Signature of
Role Plan administrator
Date 2011-09-14
Name of individual signing JAMES BROOKS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2011-09-14
Name of individual signing JAMES BROOKS
Valid signature Filed with incorrect/unrecognized electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/14/20101014152602P040027296881001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 301
Other retired or separated participants entitled to future benefits 22
Number of participants with account balances as of the end of the plan year 323
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 6

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-14
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/15/20101015091329P030004500979001.pdf
Three-digit plan number (PN) 004
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 322
Other retired or separated participants entitled to future benefits 7
Number of participants with account balances as of the end of the plan year 222
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/15/20101015091118P030028765521001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1990-01-01
Business code 622000
Sponsor’s telephone number 6063373051
Plan sponsor’s mailing address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Plan sponsor’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977

Plan administrator’s name and address
Administrator’s EIN 610541901
Plan administrator’s name PINEVILLE COMMUNITY HOSPITAL ASSOCIATION, INC.
Plan administrator’s address 850 RIVERVIEW AVENUE, PINEVILLE, KY, 40977
Administrator’s telephone number 6063373051

Number of participants as of the end of the plan year
Active participants 301
Other retired or separated participants entitled to future benefits 22
Number of participants with account balances as of the end of the plan year 323
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 6

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-15
Name of individual signing JAMES BROOKS
Valid signature Filed with authorized/valid electronic signature

Director

Name Role
JERRY G WOOLUM Director
JAY STEEL Director
DAVID GAMBREL Director
John Combs Director
Mansfield Dixon Director
JAMES S. GOLDEN, M. D. Director
ADAM STACY, JR., M. D. Director
C. B. STACY, M. D. Director
EDWARD S. WILSON, M. D. Director
John Jones Director

Incorporator

Name Role
GEORGE M. ASHER, M. D. Incorporator
JAMES S. GOLDEN, M. D. Incorporator
ADAM STACY, JR., M. D. Incorporator
EDWARD WILSON Incorporator
EDWARD S. WILSON Incorporator

Chairman

Name Role
Charles Bishop Chairman

Registered Agent

Name Role
CHARLES M BISHOP Registered Agent

Assumed Names

Name Status Expiration Date
TOTAL CARE PHARMACY PCH Inactive 2021-09-20
TOTAL CARE RURAL CLINIC Inactive 2021-06-03

Filings

Name File Date
Administrative Dissolution 2019-10-16
Registered Agent name/address change 2018-07-18
Annual Report 2018-07-18
Reinstatement Approval Letter Revenue 2017-10-13
Reinstatement Certificate of Existence 2017-10-13
Registered Agent name/address change 2017-10-13
Reinstatement 2017-10-13
Administrative Dissolution 2017-10-09
Certificate of Assumed Name 2016-09-20
Registered Agent name/address change 2016-09-01

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No related companies by address

Date of last update: 18 Nov 2024

Sources: Kentucky Secretary of State

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