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HOSPICE OF LAKE CUMBERLAND, INC.

Company Details

Name: HOSPICE OF LAKE CUMBERLAND, INC.
Jurisdiction: Kentucky
Profit or Non-Profit: Non-profit
Legal type: Kentucky Corporation
Status: Active
Standing: Good
File Date: 23 Jul 1984 (40 years ago)
Organization Date: 23 Jul 1984 (40 years ago)
Organization Number: 0191905
Industry: Health Services
Number of Employees: Medium (20-99)
Primary County: Pulaski
Place of Formation: KENTUCKY
Last Annual Report: 29 Feb 2024 (9 months ago)
Principal Office: 100 PARKWAY DRIVE, SOMERSET, KY 42503
Principal Office ZIP code: 42503

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2023 311118731 2024-10-04 HOSPICE OF LAKE CUMBERLAND 80
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2024-10-04
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2022 311118731 2023-07-26 HOSPICE OF LAKE CUMBERLAND 79
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2021 311118731 2022-10-14 HOSPICE OF LAKE CUMBERLAND 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2022-10-14
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2020 311118731 2021-10-14 HOSPICE OF LAKE CUMBERLAND 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2019 311118731 2020-10-14 HOSPICE OF LAKE CUMBERLAND 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2018 311118731 2019-10-14 HOSPICE OF LAKE CUMBERLAND 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2017 311118731 2018-08-23 HOSPICE OF LAKE CUMBERLAND 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2018-08-23
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2016 311118731 2017-08-18 HOSPICE OF LAKE CUMBERLAND 61
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2017-08-18
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2015 311118731 2016-08-02 HOSPICE OF LAKE CUMBERLAND 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2016-08-02
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF LAKE CUMBERLAND 401(K) PLAN 2014 311118731 2015-07-27 HOSPICE OF LAKE CUMBERLAND 68
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2015-07-27
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/14/20140714082122P040012557535001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2014-07-14
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/23/20130723125702P030309714323001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Signature of
Role Plan administrator
Date 2013-07-23
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/08/20121008125319P040000373991001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621610
Sponsor’s telephone number 6066794389
Plan sponsor’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503

Plan administrator’s name and address
Administrator’s EIN 311118731
Plan administrator’s name HOSPICE OF LAKE CUMBERLAND
Plan administrator’s address 100 PARKWAY DRIVE, SOMERSET, KY, 42503
Administrator’s telephone number 6066794389

Signature of
Role Plan administrator
Date 2012-10-08
Name of individual signing BRIAN DAVIS
Valid signature Filed with authorized/valid electronic signature

Treasurer

Name Role
JENNIFER ROBERTSON Treasurer

Vice President

Name Role
DERRICK TERRY Vice President

Director

Name Role
RENNY SMITH Director
MILLIE WEAVER Director
RACHEL SHELTON Director
JAY MCSHURLEY Director
KARA HAWK Director
MARK ROSS Director
RON GLEAVES Director
ROBIN TARTER Director
NORMA ADAMS, ATTY. Director
GENE CHESHIRE Director

Incorporator

Name Role
GERARD WEIGEL, M.D. Incorporator
SALLY MULLINS Incorporator
JERRY ROGERS Incorporator

President

Name Role
GREG REDMON President

Registered Agent

Name Role
EURETHA GODBY Registered Agent

Secretary

Name Role
PAT TAYLER Secretary

Former Company Names

Name Action
SOMERSET PULASKI COUNTY COMMUNITY HOSPICE Old Name

Filings

Name File Date
Annual Report 2024-02-29
Annual Report 2023-04-21
Annual Report 2022-03-24
Annual Report 2021-06-30
Annual Report 2020-04-23
Annual Report 2019-05-15
Annual Report 2018-04-13
Registered Agent name/address change 2017-05-17
Annual Report 2017-05-17
Annual Report 2016-03-08

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Related by address

No related companies by address

Date of last update: 12 Nov 2024

Sources: Kentucky Secretary of State

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