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Summerford Nursing Home, Inc.

Details

Name: Summerford Nursing Home, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Exists
Date of registration: 29 Mar 1965 (60 years ago) (Companies founded in March 1965)
Entity Number: 000-017-891
Register Number: 000017891
Place of Formation: Morgan County
Principal Address: FALKVILLE, AL
Authorized Capital: $1,000
Paid Share Capital: $1,000

Activities OPERATE REST HOME

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1427045673 2005-10-03 2018-04-05 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319, US 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319, US

Contacts
Phone +1 256-784-5275
Fax 2567845852

Authorized person
Name MR. ROBERT A. SUMMERFORD II
Role ADMINISTRATOR
Phone 2567845275

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number 7119
State AL
Is Primary No
Taxonomy Code 291U00000X - Clinical Medical Laboratory
License Number 01D0641594
State AL
Is Primary No
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number 10634
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 4750750S
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SUMMERFORD NURSING HOME, INC. PROFIT SHARING PLAN 2020 630505935 2022-03-14 SUMMERFORD NURSING HOME INC 167
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 623000
Sponsor’s telephone number 2567845255
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 167
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 7

Signature of
Role Plan administrator
Date 2022-03-14
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-03-14
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
SUMMERFORD NURSING HOME, INC. 2020 630505935 2021-07-07 SUMMERFORD NURSING HOME INC 190
File View Page
Three-digit plan number (PN) 510
Effective date of plan 1990-02-01
Business code 623000
Sponsor’s telephone number 2567845275
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 0

Signature of
Role Plan administrator
Date 2021-07-07
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
SUMMERFORD NURSING HOME, INC. PROFIT SHARING PLAN 2019 630505935 2021-04-06 SUMMERFORD NURSING HOME INC 188
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1884-07-01
Business code 623000
Sponsor’s telephone number 2567845255
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 167
Retired or separated participants receiving benefits 21
Number of participants with account balances as of the end of the plan year 167
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 15

Signature of
Role Plan administrator
Date 2021-04-06
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
SUMMERFORD NURSING HOME, INC. 2019 630505935 2020-07-17 SUMMERFORD NURSING HOME INC 184
File View Page
Three-digit plan number (PN) 510
Effective date of plan 1990-02-01
Business code 623000
Sponsor’s telephone number 2567845275
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 190

Signature of
Role Plan administrator
Date 2020-07-17
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-17
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
SUMMERFORD NURSING HOME, INC. PROFIT SHARING PLAN 2018 630505935 2020-01-16 SUMMERFORD NURSING HOME INC 190
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 623000
Sponsor’s telephone number 2567845275
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 171
Retired or separated participants receiving benefits 19
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 10

Signature of
Role Plan administrator
Date 2020-01-16
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-01-16
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
SUMMERFORD NURSING HOME, INC. 2018 630505935 2019-07-11 SUMMERFORD NURSING HOME INC 232
File View Page
Three-digit plan number (PN) 510
Effective date of plan 1990-02-01
Business code 623000
Sponsor’s telephone number 2567845275
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 184

Signature of
Role Plan administrator
Date 2019-07-11
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-11
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
SUMMERFORD NURSING HOME, INC. PROFIT SHARING PLAN 2017 630505935 2019-01-16 SUMMERFORD NURSING HOME INC 164
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 623000
Sponsor’s telephone number 2567845275
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 168
Retired or separated participants receiving benefits 15
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 8

Signature of
Role Plan administrator
Date 2019-01-16
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-01-16
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
SUMMERFORD NURSING HOME, INC. 2017 630505935 2018-07-26 SUMMERFORD NURSING HOME INC 190
File View Page
Three-digit plan number (PN) 510
Effective date of plan 1990-02-01
Business code 623000
Sponsor’s telephone number 2567845275
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 232

Signature of
Role Plan administrator
Date 2018-07-26
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-26
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
SUMMERFORD NURSING HOME, INC. PROFIT SHARING PLAN 2016 630505935 2018-01-12 SUMMERFORD NURSING HOME INC 145
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 623000
Sponsor’s telephone number 2567845275
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 164
Retired or separated participants receiving benefits 1
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 8

Signature of
Role Plan administrator
Date 2018-01-12
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-01-12
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
SUMMERFORD NURSING HOME, INC. 2016 630505935 2017-01-23 SUMMERFORD NURSING HOME INC 151
File View Page
Three-digit plan number (PN) 510
Effective date of plan 1990-02-01
Business code 623000
Sponsor’s telephone number 2567845275
Plan sponsor’s mailing address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319
Plan sponsor’s address 4087 HIGHWAY 31 SW, FALKVILLE, AL, 356226319

Number of participants as of the end of the plan year
Active participants 190

Signature of
Role Plan administrator
Date 2017-01-23
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-01-23
Name of individual signing ROBERT SUMMERFORD
Valid signature Filed with authorized/valid electronic signature

Incorporator

Name Role
SUMMERFORD, ROBERT O Incorporator
SUMMERFORD, BEVERLY Incorporator
SUMMERFORD, ROBERT A II Incorporator
SUMMERFORD, JOHN PHILIP Incorporator

Related by officers

SUMMERFORD, ROBERT O

Summerford Drugs, Inc. Cullman Sports-Fit and Wellness Center, Inc. Summerford Self-Storage, Inc. RAS Land & Cattle Company, LLC Tombigbee Properties, LLC

SUMMERFORD, ROBERT A II

Cullman Sports-Fit and Wellness Center, Inc. Summerford Properties LLC Summerford Holdings, LLC Summerford Equipment, LLC RAS Land & Cattle Company, LLC

Related by address

FALKVILLE, AL

North Alabama Toy Distributors, Inc. Summerford Drugs, Inc. Whiteway Dairy Farm, Inc. Southland Quality Feed Service, Inc. Just-Rite Machine, Inc. McCaig's Grocery, Inc. Buck-Busters, Inc. Industrial Rubber Products Company of Alabama, Inc. Falkville Motor Company

Date of last update: 30 Jul 2024

Sources: Alabama Secretary of State

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