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  5. DECATUR MEMORIAL HOSPITAL

DECATUR MEMORIAL HOSPITAL

Company Details

Entity Name: DECATUR MEMORIAL HOSPITAL
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 09 Sep 1902
Company Number: CORP_08712468
File Number: 08712468
Type of Business: Not for Profit
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
XNLXJGLVACC9 2025-04-19 2300 N EDWARD ST, DECATUR, IL, 62526, 4163, USA 2300 N. EDWARD ST., DECATUR, IL, 62526, 4163, USA

Business Information
URL memorial.health
Congressional District 13
State/Country of Incorporation IL, USA
Activation Date 2024-04-23
Initial Registration Date 2003-10-29
Entity Start Date 1902-09-09
Fiscal Year End Close Date Sep 30

Service Classifications
NAICS Codes 622110
Product and Service Codes Q201, Q301, Q401, Q403, Q501, Q502, Q505, Q507, Q509, Q510, Q513, Q514, Q515, Q516, Q518, Q519, Q521, Q522, Q523, Q525, Q999

Points of Contacts
Electronic Business
Title PRIMARY POC
Name DREW EARLY
Role PRESIDENT & CEO - DMH
Address 2300 N. EDWARD ST., DECATUR, IL, 62526, 4163, USA
Title ALTERNATE POC
Name KATHRYN J KEIM
Role MH SENIOR VP & CFO
Address 400 W. LAWRENCE AVE, SPRINGFIELD, IL, 62704, 4163, USA
Government Business
Title PRIMARY POC
Name DREW EARLY
Role PRESIDENT & CEO - DMH
Address 2300 N. EDWARD ST., DECATUR, IL, 62526, 4163, USA
Title ALTERNATE POC
Name KATHRYN J KEIM
Role MH SENIOR VP & CFO
Address 400 W. LAWRENCE AVE., SPRINGFIELD, IL, 62704, USA
Past Performance
Title PRIMARY POC
Name KATHRYN J KEIM
Role MH SENIOR VP & CFO
Address 400 W. LAWRENCE AVE., SPRINGFIELD, IL, 62704, USA
Title ALTERNATE POC
Name PAUL EDDINGTON
Role DIRECTOR STRATEGIC FINANCE
Address 400 W. LAWRENCE AVE., SPRINGFIELD, IL, 62704, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FIXED AND VARIABLE TAX DEFERRED ANNUITY - VOLUNTARY 2023 370661199 2024-10-10 DECATUR MEMORIAL HOSPITAL 37
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1966-10-10
Business code 622000
Sponsor’s telephone number 2177883922
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Signature of
Role Plan administrator
Date 2024-10-10
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-10
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
FIXED TAX DEFERRED ANNUITY PLAN 2023 370661199 2024-10-10 DECATUR MEMORIAL HOSPITAL 20
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1988-02-25
Business code 622000
Sponsor’s telephone number 2177883922
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Signature of
Role Plan administrator
Date 2024-10-10
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-10
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
FIXED TAX DEFERRED ANNUITY VOLUNTARY PLAN 2022 370661199 2024-03-28 DECATUR MEMORIAL HOSPITAL 2
File View Page
Three-digit plan number (PN) 007
Effective date of plan 1992-01-01
Business code 622000
Sponsor’s telephone number 2177883922
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 62781

Signature of
Role Plan administrator
Date 2024-03-28
Name of individual signing KOREY DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-03-28
Name of individual signing KOREY DAVIS
Valid signature Filed with authorized/valid electronic signature
FIXED TAX DEFERRED ANNUITY VOLUNTEER PLAN 2022 370661199 2024-03-28 DECATUR MEMORIAL HOSPITAL 16
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1965-09-01
Business code 622000
Sponsor’s telephone number 2177883922
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 62781

Signature of
Role Plan administrator
Date 2024-03-28
Name of individual signing KOREY DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-03-28
Name of individual signing KOREY DAVIS
Valid signature Filed with authorized/valid electronic signature
FIXED AND VARIABLE TAX DEFERRED ANNUITY - VOLUNTARY 2022 370661199 2023-10-11 DECATUR MEMORIAL HOSPITAL 44
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1966-10-10
Business code 622000
Sponsor’s telephone number 2177883922
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Signature of
Role Plan administrator
Date 2023-10-11
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-11
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
FIXED TAX DEFERRED ANNUITY PLAN 2022 370661199 2023-10-11 DECATUR MEMORIAL HOSPITAL 23
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1988-02-25
Business code 622000
Sponsor’s telephone number 2177883922
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Signature of
Role Plan administrator
Date 2023-10-11
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-11
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
DECATUR MEMORIAL HOSPITAL RETIREMENT PLAN 2022 370661199 2023-10-13 DECATUR MEMORIAL HOSPITAL 389
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1956-08-31
Business code 622000
Sponsor’s telephone number 2177883922
Plan sponsor’s mailing address 701 N. FIRST STREET, SPRINGFIELD, IL, 627810001
Plan sponsor’s address 701 N. FIRST STREET, SPRINGFIELD, IL, 62781

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 that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2023-10-12
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-12
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
FIXED AND VARIABLE TAX DEFERRED ANNUITY - VOLUNTARY 2021 370661199 2022-10-14 DECATUR MEMORIAL HOSPITAL 44
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1966-10-10
Business code 622000
Sponsor’s telephone number 2177883922
Plan sponsor’s address 2300 NORTH EDWARD STREET, DECATUR, IL, 62526

Signature of
Role Plan administrator
Date 2022-10-13
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-13
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
FIXED TAX DEFERRED ANNUITY VOLUNTARY PLAN 2021 370661199 2023-01-31 DECATUR MEMORIAL HOSPITAL 3
File View Page
Three-digit plan number (PN) 007
Effective date of plan 1992-01-01
Business code 622000
Sponsor’s telephone number 2178766101
Plan sponsor’s address 2300 NORTH EDWARD STREET, DECATUR, IL, 62526

Signature of
Role Plan administrator
Date 2023-01-31
Name of individual signing KOREY DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-01-31
Name of individual signing KOREY DAVIS
Valid signature Filed with authorized/valid electronic signature
FIXED TAX DEFERRED ANNUITY PLAN 2021 370661199 2022-10-14 DECATUR MEMORIAL HOSPITAL 23
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1988-02-25
Business code 622000
Sponsor’s telephone number 2177883922
Plan sponsor’s address 2300 NORTH EDWARD STREET, DECATUR, IL, 62526

Signature of
Role Plan administrator
Date 2022-10-13
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-13
Name of individual signing KOREY A. DAVIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
ANNA EVANS, 340 W. MILLER STREET, SPRINGFIELD, 62702, SANGAMON Agent 2022-08-22

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
PHARMACY 054021411 No data No data LICENSED PHARMACY No data 2019-12-19 2024-02-02 2026-03-31
PHARMACY 054021413 No data No data LICENSED PHARMACY No data 2019-11-14 2024-02-20 2026-03-31
HME AND SERVICES PROV 203002148 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2019-10-28 2019-10-28 2021-03-31
PHARMACY 004004116 No data No data LICENSED WHOLESALE DRUG DISTRIBUTOR No data 2015-09-16 2016-11-04 2018-12-31
PHARMACY 054018327 No data No data LICENSED PHARMACY No data 2014-02-14 2016-03-15 2018-03-31
PHARMACY 054018223 No data No data LICENSED PHARMACY No data 2013-05-22 2018-02-26 2020-09-30
PHARMACY 054016997 No data No data LICENSED PHARMACY No data 2010-02-01 2018-02-15 2020-09-30
PHYSICAL THERAPY 216000080 No data No data PHYSICAL THERAPY CONTINUING EDUCATION SPONSOR No data 2003-10-02 2017-03-23 2018-09-30
PHARMACY 058002998 No data No data LICENSED DIVISION II PHARMACY No data 1997-01-01 No data 1996-03-31
PHARMACY 059002998 No data No data LICENSED DIVISION III PHARMACY No data 1997-01-01 2008-01-10 2010-03-31

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
MEMORIAL MEDICAL SPA NFP Assume Name 2022-04-20 No data No data No data
MEMORIAL OCCUPATIONAL HEALTH NFP Assume Name 2021-10-07 No data No data No data
DMH MY CHART NFP Assume Name 2021-07-29 No data No data No data
DECATUR MEMORIAL HOSPITAL AUXILIARY NFP Assume Name 2021-07-29 No data No data No data
DECATUR MEDICAL GROUP NFP Assume Name 2021-06-30 No data No data No data
THE MEDICAL SPA No data 2015-10-16 2022-04-28 Voluntary Cancellation No data
DTOWN THROWDOWN No data 2015-05-01 2020-08-19 Voluntary Cancellation No data
NATURAL NUTRITION No data 2015-05-01 2020-08-19 Voluntary Cancellation No data
NATURALLY FIT No data 2013-10-03 2020-08-19 Voluntary Cancellation No data
KENWOOD FAMILY MEDICINE NFP Assume Name 2013-09-17 No data No data No data

Awards

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
PURCHASE ORDER AWARD 61320619N0171 2019-06-17 2024-06-30 2024-06-30
Unique Award Key CONT_AWD_61320619N0171_6100_-NONE-_-NONE-
Awarding Agency Consumer Product Safety Commission
Link View Page

Award Amounts
Obligated Amount 139643.15
Current Award Amount 139643.15
Potential Award Amount 139643.15

Description
Title DATA COLLECTION ON CONSUMER PRODUCT RELATED INJURIES.
NAICS Code 518210: COMPUTING INFRASTRUCTURE PROVIDERS, DATA PROCESSING, WEB HOSTING, AND RELATED SERVICES
Product and Service Codes R702: SUPPORT- MANAGEMENT: DATA COLLECTION

Recipient Details
Recipient DECATUR MEMORIAL HOSPITAL
UEI XNLXJGLVACC9
Recipient Address UNITED STATES, 2300 N EDWARD ST, DECATUR, MACON, ILLINOIS, 625264163

Related by officers

ANNA EVANS, 340 W. MILLER STREET, SPRINGFIELD, 62702, SANGAMON

THE PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION MEMORIAL HOME SERVICES, NFP THE ABRAHAM LINCOLN MEMORIAL HOSPITAL TAYLORVILLE MEMORIAL HOSPITAL MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS MEMORIAL MEDICAL CENTER FOUNDATION MEMORIAL HEALTH SYSTEM DECATUR MEMORIAL HEALTH FOUNDATION MEMORIAL PHYSICIAN SERVICES MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC.

Related by address

No related companies by address

Date of last update: 13 Jan 2025

Sources: Illinois Office of the Secretary of State

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