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  5. FREEPORT MEMORIAL HOSPITAL

FREEPORT MEMORIAL HOSPITAL

Company Details

Entity Name: FREEPORT MEMORIAL HOSPITAL
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 10 Jun 1938
Company Number: CORP_25693167
File Number: 25693167
Type of Business: Not for Profit
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
CP76N37ZL2V3 2025-02-25 1045 W STEPHENSON ST, FREEPORT, IL, 61032, 4899, USA 1045 W STEPHENSON ST, FREEPORT, IL, 61032, 4864, USA

Business Information
URL fhn.org
Congressional District 17
State/Country of Incorporation IL, USA
Activation Date 2024-02-28
Initial Registration Date 2020-08-21
Entity Start Date 1938-06-10
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name ANGELA MEADE
Role DIRECTOR FINANCE
Address 1045 W STEPHENSON ST, FREEPORT, IL, 61032, 4864, USA
Government Business
Title PRIMARY POC
Name ANGELA MEADE
Role DIRECTOR FINANCE
Address 1045 W STEPHENSON ST, FREEPORT, IL, 61032, 4864, USA
Title ALTERNATE POC
Name MICHAEL CLARK
Role EVP/CFO
Address 1045 W STEPHENSON STREET, FREEPORT, IL, 61032, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEMORIAL HOPSITAL HEALTH PLAN 2019 370684691 2020-07-22 MEMORIAL HOSPITAL 133
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 2173578500
Plan sponsor’s mailing address PO BOX 160, CARTHAGE, IL, 623210160
Plan sponsor’s address 1454 N COUNTY RD 2050, CARTHAGE, IL, 62321

Plan administrator’s name and address
Administrator’s EIN 370684691
Plan administrator’s name MEMORIAL HOSPITAL
Plan administrator’s address PO BOX 160, CARTHAGE, IL, 623210160
Administrator’s telephone number 2173578500

Number of participants as of the end of the plan year
Active participants 151

Signature of
Role Plan administrator
Date 2020-07-22
Name of individual signing TERESA SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-22
Name of individual signing TERESA SMITH
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOSPITAL HEALTH PLAN 2018 370684691 2019-07-11 MEMORIAL HOSPITAL 138
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 2173578500
Plan sponsor’s mailing address PO BOX 160, CARTHAGE, IL, 623210160
Plan sponsor’s address 1454 N COUNTY ROAD 2050 E, CARTHAGE, IL, 62321

Number of participants as of the end of the plan year
Active participants 132
Retired or separated participants receiving benefits 1

Signature of
Role Plan administrator
Date 2019-07-11
Name of individual signing DANIEL SMITH
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOSPITAL HEALTH PLAN 2017 370684691 2018-06-27 MEMORIAL HOSPITAL 124
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 2173578500
Plan sponsor’s mailing address 1454 N COUNTY ROAD 2050 E, CARTHAGE, IL, 623213551
Plan sponsor’s address 1454 N COUNTY ROAD 2050 E, CARTHAGE, IL, 623213551

Number of participants as of the end of the plan year
Active participants 136
Retired or separated participants receiving benefits 2

Signature of
Role Plan administrator
Date 2018-06-27
Name of individual signing DANIEL SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-27
Name of individual signing DANIEL SMITH
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOSPITAL HEALTH PLAN 2016 370684691 2017-09-07 MEMORIAL HOSPITAL 118
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 2173578500
Plan sponsor’s mailing address 1454 N COUNTY ROAD 2050, CARTHAGE, IL, 623213551
Plan sponsor’s address 1454 N COUNTY ROAD 2050, CARTHAGE, IL, 623213551

Number of participants as of the end of the plan year
Active participants 125
Retired or separated participants receiving benefits 4

Signature of
Role Plan administrator
Date 2017-09-07
Name of individual signing KIMA BYERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-07
Name of individual signing KIMA BYERS
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOSPITAL HEALTH PLAN 2015 370684691 2016-10-04 MEMORIAL HOSPITAL 118
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 2173578500
Plan sponsor’s mailing address 1454 N COUNTY ROAD 2050, CARTHAGE, IL, 623213551
Plan sponsor’s address 1454 N COUNTY ROAD 2050, CARTHAGE, IL, 623213551

Number of participants as of the end of the plan year
Active participants 119

Signature of
Role Plan administrator
Date 2016-10-04
Name of individual signing KIMA BYERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-04
Name of individual signing KIMA BYERS
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOSPITAL HEALTH PLAN 2014 370684691 2015-07-29 MEMORIAL HOSPITAL 124
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 2173578500
Plan sponsor’s mailing address 1454 NORTH CR 2050, CARTHAGE, IL, 62321
Plan sponsor’s address 1454 NORTH CR 2050, CARTHAGE, IL, 62321

Number of participants as of the end of the plan year
Active participants 118

Signature of
Role Plan administrator
Date 2015-07-29
Name of individual signing DANIEL SMITH
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOSPITAL HEALTH PLAN 2013 370684691 2014-05-05 MEMORIAL HOSPITAL 118
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 2173578500
Plan sponsor’s mailing address 1454 NORTH CR 2050, CARTHAGE, IL, 62321
Plan sponsor’s address 1454 NORTH CR 2050, CARTHAGE, IL, 62321

Number of participants as of the end of the plan year
Active participants 122

Signature of
Role Plan administrator
Date 2014-05-05
Name of individual signing DANIEL L. SMITH
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOSPITAL HEALTH PLAN 2012 370684691 2014-05-05 MEMORIAL HOSPITAL 126
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 2173578500
Plan sponsor’s mailing address 1454 NORTH CR 2050, CARTHAGE, IL, 62321
Plan sponsor’s address 1454 NORTH CR 2050, CARTHAGE, IL, 62321

Number of participants as of the end of the plan year
Active participants 112

Signature of
Role Plan administrator
Date 2014-05-05
Name of individual signing DANIEL L. SMITH
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOSPITAL HEALTH PLAN 2011 370684691 2014-05-05 MEMORIAL HOSPITAL 157
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-01-01
Business code 622000
Sponsor’s telephone number 2173578500
Plan sponsor’s mailing address 1454 NORTH CR 2050, CARTHAGE, IL, 62321
Plan sponsor’s address 1454 NORTH CR 2050, CARTHAGE, IL, 62321

Plan administrator’s name and address
Administrator’s EIN 370684691
Plan administrator’s name MEMORIAL HOSPITAL
Plan administrator’s address 1454 NORTH CR 2050, CARTHAGE, IL, 62321
Administrator’s telephone number 2173578500

Number of participants as of the end of the plan year
Active participants 127

Signature of
Role Plan administrator
Date 2014-05-05
Name of individual signing DANIEL L. SMITH
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
MICHAEL C CLARK, 1045 W STEPHENSON ST, FREEPORT, 61032, STEPHENSON Agent 2003-10-08

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
OPTOMETRY 138000006 No data No data LICENSED OPTOMETRY CE SPONSOR No data 1989-07-15 2008-06-04 2010-03-31

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
FHN HOSPICE NFP Assume Name 2023-05-03 No data No data No data
FHN MEMORIAL HOSPICE NFP Assume Name 2023-05-03 No data No data No data
FHN LEONARD C FERGUSON CANCER CENTER NFP Assume Name 2017-09-07 No data No data No data
FHN MEMORIAL HOSPITAL NFP Assume Name 2010-11-08 No data No data No data
MEMORIAL HOSPITAL No data 2003-10-08 2010-11-08 Voluntary Cancellation No data
HOME HEALTH CARE SERVICES No data 1995-03-24 2020-09-09 Voluntary Cancellation No data

Related by officers

No related officers

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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