| Entity Name: | MENDOTA COMMUNITY HOSPITAL |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Not-for-Profit |
| Status: | Goodstanding |
| Date Formed: | 24 Mar 1944 |
| Company Number: | CORP_27770789 |
| File Number: | 27770789 |
| Type of Business: | Not for Profit |
| Place of Formation: | ILLINOIS |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| YY9JD7UNY323 | 2024-07-24 | 1401 E 12TH ST, MENDOTA, IL, 61342, 9216, USA | 1401 E 12TH ST, MENDOTA, IL, 61342, 9216, USA | |||||||||||||||||||||||||||||||||||||||||||
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| URL | www.osfhealthcare.org |
| Division Name | OSF HEALTHCARE SYSTEM |
| Congressional District | 14 |
| State/Country of Incorporation | IL, USA |
| Activation Date | 2023-07-27 |
| Initial Registration Date | 2016-02-04 |
| Entity Start Date | 1951-06-10 |
| Fiscal Year End Close Date | Sep 30 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JEFF A KLEIN |
| Role | MR |
| Address | 124 SW ADAMS STREET, PEORIA, IL, 61602, 1308, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | RYAN M SPAIN |
| Role | MR |
| Address | 124 SW ADAMS STREET, PEORIA, IL, 61602, 1308, USA |
| Past Performance | Information not Available |
|---|
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MENDOTA COMMUNITY HOSPITAL EMPLOYEES' PENSION PLAN | 2012 | 362167785 | 2013-04-12 | MENDOTA COMMUNITY HOSPITAL | 15 | |||||||||||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2013-04-12 |
| Name of individual signing | KIM KENNEDY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-04-12 |
| Name of individual signing | KIM KENNEDY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 003 |
| Effective date of plan | 1991-07-01 |
| Business code | 622000 |
| Sponsor’s telephone number | 8155397461 |
| Plan sponsor’s address | 1401 E 12TH STREET, MENDOTA, IL, 613421447 |
Plan administrator’s name and address
| Administrator’s EIN | 362167785 |
| Plan administrator’s name | MENDOTA COMMUNITY HOSPITAL |
| Plan administrator’s address | 1401 E 12TH STREET, MENDOTA, IL, 613421447 |
| Administrator’s telephone number | 8155397461 |
Signature of
| Role | Plan administrator |
| Date | 2012-07-19 |
| Name of individual signing | KIM KENNEDY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2012-07-19 |
| Name of individual signing | KIM KENNEDY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| DANIELLE MCNEAR, 124 SW ADAMS STREET, PEORIA, 61602, PEORIA | Agent | 2022-06-23 |
| License Type | License Number | Status | License Code | License Description | Business Activity | Date Issued | Effective Date | Expiration Date |
|---|---|---|---|---|---|---|---|---|
| PHARMACY | 054019366 | No data | No data | LICENSED PHARMACY | No data | 2015-07-09 | 2024-02-03 | 2026-03-31 |
| PHARMACY | 054017176 | No data | No data | LICENSED PHARMACY | No data | 2010-02-09 | 2014-01-30 | 2016-03-31 |
| PHARMACY | 059003228 | No data | No data | LICENSED DIVISION III PHARMACY | No data | 1997-01-01 | 2008-01-10 | 2010-03-31 |
| PHARMACY | 058003228 | No data | No data | LICENSED DIVISION II PHARMACY | No data | 1997-01-01 | No data | 1988-03-31 |
| Name | Type | Effective Date | Cancellation Date | Cancellation Type | Last Renewal Date |
|---|---|---|---|---|---|
| OSF HEALTHCARE - MEDICAL GROUP - OGLESBY | NFP Assume Name | 2024-04-30 | No data | No data | No data |
| OSF HEALTHCARE - MEDICAL GROUP - PLAZA | NFP Assume Name | 2024-04-30 | No data | No data | No data |
| OSF HEALTHCARE - MEDICAL GROUP - SPRING VALLEY | NFP Assume Name | 2024-04-30 | No data | No data | No data |
| OSF HEALTHCARE - MEDICAL GROUP - WASHINGTON STREET | NFP Assume Name | 2023-11-13 | No data | No data | No data |
| OSF HEALTHCARE - MEDICAL GROUP - MENDOTA | NFP Assume Name | 2023-10-16 | No data | No data | No data |
| OSF HEALTHCARE - MEDICAL GROUP - GRANVILLE | NFP Assume Name | 2023-06-26 | No data | No data | No data |
| OSF HEALTHCARE - MEDICAL GROUP - MIDTOWN | NFP Assume Name | 2023-06-26 | No data | No data | No data |
| OSF HEALTHCARE - MENDOTA MEDICAL GROUP | NFP Assume Name | 2021-07-15 | No data | No data | No data |
| OSF HEALTHCARE SAINT PAUL MEDICAL CENTER | NFP Assume Name | 2017-04-20 | No data | No data | No data |
| OSF SAINT PAUL MEDICAL CENTER | NFP Assume Name | 2015-02-19 | No data | No data | No data |
Date of last update: 13 Jan 2025
