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  5. PALOS COMMUNITY HOSPITAL

PALOS COMMUNITY HOSPITAL

Company Details

Entity Name: PALOS COMMUNITY HOSPITAL
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 02 May 1938
Company Number: CORP_25647572
File Number: 25647572
Type of Business: Not for Profit
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
KG7GYRE41LM4 2025-03-07 12251 S 80TH AVE, PALOS HEIGHTS, IL, 60463, 0930, USA 12251 S. 80TH AVENUE, PALOS HEIGHTS, IL, 60463, USA

Business Information
Congressional District 06
State/Country of Incorporation IL, USA
Activation Date 2024-03-08
Initial Registration Date 2016-07-01
Entity Start Date 1938-05-02
Fiscal Year End Close Date Aug 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name RICHARD FRANCO
Role VP, FINANCE, NMHC
Address 12251 S. 80TH AVENUE, PALOS HEIGHTS, IL, 60463, USA
Government Business
Title PRIMARY POC
Name JENNIFER THIEL
Role FUND ACCOUNTING MANAGER
Address 541 NORTH FAIRBANKS COURT, CHICAGO, IL, 60611, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PALOS COMMUNITY HOSPITAL EMPLOYEE'S LIFE AND ADD INSUR PLAN 2016 362169179 2017-07-12 PALOS COMMUNITY HOSPITAL 3643
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1985-02-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256
Plan sponsor’s address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256

Number of participants as of the end of the plan year
Active participants 3700
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

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-12
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
PALOS COMMUNITY HOSPITAL EMPLOYEE'S VISION PLAN 2016 362169179 2017-07-12 PALOS COMMUNITY HOSPITAL 1419
File View Page
Three-digit plan number (PN) 506
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256
Plan sponsor’s address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256

Number of participants as of the end of the plan year
Active participants 1471
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

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-12
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
PALOS COMMUNITY HOSPITAL LEGAL PLAN 2016 362169179 2017-07-12 PALOS COMMUNITY HOSPITAL 256
File View Page
Three-digit plan number (PN) 507
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256
Plan sponsor’s address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256

Number of participants as of the end of the plan year
Active participants 287
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

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-12
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
PALOS COMMUNITY HOSPITAL EMPLOYEES LONG TERM DISABILITY INSUR PLAN 2016 362169179 2017-07-12 PALOS COMMUNITY HOSPITAL 1488
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1968-09-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256
Plan sponsor’s address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256

Number of participants as of the end of the plan year
Active participants 1533
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

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-12
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
PALOS COMMUNITY HOSPITAL LEGAL PLAN 2015 362169179 2016-07-28 PALOS COMMUNITY HOSPITAL 246
File View Page
Three-digit plan number (PN) 507
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256
Plan sponsor’s address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256

Number of participants as of the end of the plan year
Active participants 256
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

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
PALOS COMMUNITY HOSPITAL EMPLOYEE'S LONG TERM DISABILITY INSUR PLAN 2015 362169179 2016-07-28 PALOS COMMUNITY HOSPITAL 1501
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1968-09-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256
Plan sponsor’s address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256

Number of participants as of the end of the plan year
Active participants 1488
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

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
PALOS COMMUNITY HOSPITAL EMPLOYEE'S LIFE AND ADD INSUR PLAN 2015 362169179 2016-07-28 PALOS COMMUNITY HOSPITAL 3607
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1985-02-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256
Plan sponsor’s address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256

Number of participants as of the end of the plan year
Active participants 3643
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

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
PALOS COMMUNITY HOSPITAL EMPLOYEE'S VISION PLAN 2015 362169179 2016-07-28 PALOS COMMUNITY HOSPITAL 1376
File View Page
Three-digit plan number (PN) 506
Effective date of plan 2008-01-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256
Plan sponsor’s address 12251 S 80TH AVE, PALOS HEIGHTS, IL, 604631256

Number of participants as of the end of the plan year
Active participants 1419
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

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
PALOS COMMUNITY HOSPITAL EMPLOYEES LONG TERM DISABILITY INS PLAN 2014 362169179 2015-07-27 PALOS COMMUNITY HOSPITAL 1642
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1968-09-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S. 80TH AVENUE, PALOS HEIGHTS, IL, 60463
Plan sponsor’s address 12251 S. 80TH AVENUE, PALOS HEIGHTS, IL, 60463

Number of participants as of the end of the plan year
Active participants 1501
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

Signature of
Role Plan administrator
Date 2015-07-27
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-27
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
PALOS COMMUNITY HOSPITAL EMPLOYEES LIFE AND ADD INSURANCE PLAN 2014 362169179 2015-07-27 PALOS COMMUNITY HOSPITAL 3856
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1985-02-01
Business code 622000
Sponsor’s telephone number 7089234000
Plan sponsor’s mailing address 12251 S. 80TH AVENUE, PALOS HEIGHTS, IL, 60463
Plan sponsor’s address 12251 S. 80TH AVENUE, PALOS HEIGHTS, IL, 60463

Number of participants as of the end of the plan year
Active participants 3607
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

Signature of
Role Plan administrator
Date 2015-07-27
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-27
Name of individual signing MARY DENISIENKO
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
JULIA K. LYNCH, 211 E ONTARIO ST STE 1800, CHICAGO, 60611, COOK-NOT IN CITY OF CHICAGO Agent 2023-01-12

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
PHARMACY 054021856 No data No data LICENSED PHARMACY No data 2023-11-01 2024-03-07 2026-03-31
PHARMACY 054016989 No data No data LICENSED PHARMACY No data 2010-01-29 2022-02-27 2024-03-31
SOCIAL WORKER 159000617 No data No data REGISTERED SOCIAL WORKER CE SPONSOR No data 1998-06-10 2015-12-11 2017-11-30
PHARMACY 059004672 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
NORTHWESTERN MEDICINE PALOS HOSPICE NFP Assume Name 2024-07-30 No data No data No data
NORTHWESTERN MEDICINE PALOS HOME HEALTH NFP Assume Name 2024-07-30 No data No data No data
NORTHWESTERN MEDICINE PALOS PRIVATE DUTY NFP Assume Name 2024-07-30 No data No data No data
NORTHWESTERN MEDICINE PALOS HOME HEALTH AND HOSPICE NFP Assume Name 2024-07-30 No data No data No data
PALOS COMMUNITY HOSPITAL HOSPICE NFP Assume Name 2022-03-30 No data No data No data
NORTHWESTERN MEDICINE PALOS HOSPITAL NFP Assume Name 2021-04-28 No data No data No data
PALOS HOSPITAL NFP Assume Name 2016-09-12 No data No data No data
PALOS QUICK CARE NFP Assume Name 2014-11-03 No data No data No data
PALOS COMMUNITY HOSPITAL HOME HEALTH CARE NFP Assume Name 2011-03-04 No data No data No data
PALOS COMMUNITY HOSPITAL No data 1985-12-16 2000-07-10 Expired No data

Historical Names

Name Change Date
THE ST. GEORGE CORPORATION 2000-07-10

Related by officers

JULIA K. LYNCH, 211 E ONTARIO ST STE 1800, CHICAGO, 60611, COOK-NOT IN CITY OF CHICAGO

MEMORIAL MEDICAL CENTER-WOODSTOCK NORTHWESTERN LAKE FOREST HOSPITAL NORTHERN ILLINOIS MEDICAL CENTER CENTRAL DU PAGE HOSPITAL ASSOCIATION MARIANJOY REHABILITATION HOSPITAL & CLINICS, INC. KISHWAUKEE COMMUNITY HOSPITAL NORTHWESTERN MEMORIAL HOSPITAL NORTHWESTERN MEDICAL FACULTY FOUNDATION CENTRAL DUPAGE PHYSICIAN GROUP NORTHWESTERN MEMORIAL HEALTHCARE

Related by address

No related companies by address

Date of last update: 27 Jan 2025

Sources: Illinois Office of the Secretary of State

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