| Entity Name: | COMMUNITY MEMORIAL HOSPITAL |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Not-for-Profit |
| Status: | Dissolved |
| Date Formed: | 09 Nov 1946 |
| Date of Dissolution: | 30 Jun 2008 |
| Company Number: | CORP_29336725 |
| File Number: | 29336725 |
| Type of Business: | Professional, commercial, or trade association |
| Date Status Change: | 30 Jun 2008 |
| Place of Formation: | ILLINOIS |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY MEMORIAL HOSPITAL WELFARE PLAN | 2010 | 370624255 | 2012-01-03 | COMMUNITY MEMORIAL HOSPITAL | 167 | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Administrator’s EIN | 370624255 |
| Plan administrator’s name | COMMUNITY MEMORIAL HOSPITAL |
| Plan administrator’s address | 400 CALDWELL STREET, STAUNTON, IL, 62088 |
| Administrator’s telephone number | 6186352200 |
Number of participants as of the end of the plan year
| Active participants | 164 |
Signature of
| Role | Plan administrator |
| Date | 2012-01-03 |
| Name of individual signing | DONALD BRUNNWORTH |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2012-01-03 |
| Name of individual signing | DONALD BRUNNWORTH |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 003 |
| Effective date of plan | 1988-01-01 |
| Business code | 622000 |
| Sponsor’s telephone number | 6186354242 |
| Plan sponsor’s address | 400 CALDWELL, STAUNTON, IL, 620881499 |
Plan administrator’s name and address
| Administrator’s EIN | 370624255 |
| Plan administrator’s name | COMMUNITY MEMORIAL HOSPITAL |
| Plan administrator’s address | 400 CALDWELL, STAUNTON, IL, 620881499 |
| Administrator’s telephone number | 6186354242 |
Signature of
| Role | Plan administrator |
| Date | 2011-08-08 |
| Name of individual signing | DONALD BRUNNWORTH |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2011-08-08 |
| Name of individual signing | DONALD BRUNNWORTH |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 003 |
| Effective date of plan | 1988-01-01 |
| Business code | 622000 |
| Sponsor’s telephone number | 6186354242 |
| Plan sponsor’s address | 400 CALDWELL, STAUNTON, IL, 620881499 |
Plan administrator’s name and address
| Administrator’s EIN | 370624255 |
| Plan administrator’s name | COMMUNITY MEMORIAL HOSPITAL |
| Plan administrator’s address | 400 CALDWELL, STAUNTON, IL, 620881499 |
| Administrator’s telephone number | 6186354242 |
Signature of
| Role | Plan administrator |
| Date | 2010-09-22 |
| Name of individual signing | DONALD BRUNNWORTH |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-09-22 |
| Name of individual signing | DONALD BRUNNWORTH |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| STEVEN R OLSON, 525 W MONROE STREET STE 1600, CHICAGO, 60661, COOK-NOT IN CITY OF CHICAGO | Agent | 1996-06-27 |
| License Type | License Number | Status | License Code | License Description | Business Activity | Date Issued | Effective Date | Expiration Date |
|---|---|---|---|---|---|---|---|---|
| PHARMACY | 054017016 | No data | No data | LICENSED PHARMACY | No data | 2010-01-29 | 2016-03-03 | 2018-03-31 |
| PHARMACY | 059008599 | No data | No data | LICENSED DIVISION III PHARMACY | No data | 1997-01-01 | 2008-01-10 | 2010-03-31 |
| PHARMACY | 059004203 | No data | No data | LICENSED DIVISION III PHARMACY | No data | 1997-01-01 | No data | 1990-03-31 |
| PHARMACY | 059011011 | No data | No data | LICENSED DIVISION III PHARMACY | No data | 1991-05-02 | 1991-05-02 | 2000-03-31 |
| Name | Change Date |
|---|---|
| LAGRANGE MEMORIAL HOSPITAL | 1999-02-24 |
| COMMUNITY MEMORIAL GENERAL HOSPITAL | 1985-06-18 |
Date of last update: 16 Jan 2025
