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  5. BEVERLY FARM FOUNDATION

BEVERLY FARM FOUNDATION

Company Details

Entity Name: BEVERLY FARM FOUNDATION
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 21 Jan 1957
Company Number: CORP_36670711
File Number: 36670711
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
F8HFK2FCKC32 2025-02-15 6301 HUMBERT RD, GODFREY, IL, 62035, 2163, USA 6301 HUMBERT ROAD, GODFREY, IL, 62035, 2163, USA

Business Information
URL www.beverlyfarm.org
Congressional District 15
State/Country of Incorporation IL, USA
Activation Date 2024-02-20
Initial Registration Date 2010-06-24
Entity Start Date 1957-07-01
Fiscal Year End Close Date Jun 30

Service Classifications
NAICS Codes 623210

Points of Contacts
Electronic Business
Title PRIMARY POC
Name CRYSTAL OFFICER
Address 6301 HUMBERT ROAD, GODFREY, IL, 62035, 2163, USA
Title ALTERNATE POC
Name TARA WAGENBLAST
Address 6301 HUMBERT ROAD, GODFREY, IL, 62035, USA
Government Business
Title PRIMARY POC
Name CRYSTAL OFFICER
Address 6301 HUMBERT ROAD, GODFREY, IL, 62035, 2163, USA
Title ALTERNATE POC
Name TARA WAGENBLAST
Address 6301 HUMBERT ROAD, GODFREY, IL, 62035, USA
Past Performance
Title PRIMARY POC
Name CRYSTAL OFFICER
Address 6301 HUMBERT ROAD, GODFREY, IL, 62035, USA
Title ALTERNATE POC
Name CRYSTAL OFFICER
Address 6301 HUMBERT ROAD, GODFREY, IL, 62035, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BEVERLY FARM FOUNDATION GROUP INSURANCE 2022 370765971 2024-01-16 BEVERLY FARM FOUNDATION 465
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1986-03-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 165
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2024-01-04
Name of individual signing CRYSTAL OFFICER
Valid signature Filed with authorized/valid electronic signature
BEVERLY FARM FOUNDATION HEALTH INSURANCE PLAN 2022 370765971 2024-01-16 BEVERLY FARM FOUNDATION 299
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1989-07-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 132
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2024-01-04
Name of individual signing CRYSTAL OFFICER
Valid signature Filed with authorized/valid electronic signature
BEVERLY FARM FOUNDATION HEALTH INSURANCE PLAN 2021 370765971 2023-01-31 BEVERLY FARM FOUNDATION 155
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1989-07-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 299

Signature of
Role Plan administrator
Date 2023-01-31
Name of individual signing CRYSTAL OFFICER
Valid signature Filed with authorized/valid electronic signature
BEVERLY FARM FOUNDATION GROUP INSURANCE 2021 370765971 2023-01-31 BEVERLY FARM FOUNDATION 320
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1986-03-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 465

Signature of
Role Plan administrator
Date 2023-01-31
Name of individual signing CRYSTAL OFFICER
Valid signature Filed with authorized/valid electronic signature
BEVERLY FARM FOUNDATION GROUP INSURANCE 2020 370765971 2022-04-06 BEVERLY FARM FOUNDATION 264
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1986-03-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 320

Signature of
Role Plan administrator
Date 2022-04-05
Name of individual signing CRYSTAL OFFICER
Valid signature Filed with authorized/valid electronic signature
BEVERLY FARM FOUNDATION HEALTH INSURANCE PLAN 2020 370765971 2022-04-06 BEVERLY FARM FOUNDATION 232
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1989-07-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 155

Signature of
Role Plan administrator
Date 2022-04-05
Name of individual signing CRYSTAL OFFICER
Valid signature Filed with authorized/valid electronic signature
BEVERLY FARM FOUNDATION GROUP INSURANCE 2020 370765971 2021-02-12 BEVERLY FARM FOUNDATION 193
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1986-03-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 192

Signature of
Role Plan administrator
Date 2021-02-12
Name of individual signing SANDRA FERRIS
Valid signature Filed with authorized/valid electronic signature
BEVERLY FARM FOUNDATION HEALTH INSURANCE PLAN 2020 370765971 2021-02-12 BEVERLY FARM FOUNDATION 195
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1989-07-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 255

Signature of
Role Plan administrator
Date 2021-02-12
Name of individual signing SANDRA FERRIS
Valid signature Filed with authorized/valid electronic signature
BEVERLY FARM FOUNDATION GROUP INSURANCE 2019 370765971 2021-03-01 BEVERLY FARM FOUNDATION 192
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1986-03-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 264

Signature of
Role Plan administrator
Date 2021-03-01
Name of individual signing SANDRA FERRIS
Valid signature Filed with authorized/valid electronic signature
BEVERLY FARM FOUNDATION HEALTH INSURANCE PLAN 2019 370765971 2021-03-01 BEVERLY FARM FOUNDATION 255
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1989-07-01
Business code 623000
Sponsor’s telephone number 6184660367
Plan sponsor’s mailing address 6301 HUMBERT ROAD, GODFREY, IL, 62035
Plan sponsor’s address 6301 HUMBERT ROAD, GODFREY, IL, 62035

Number of participants as of the end of the plan year
Active participants 232

Signature of
Role Plan administrator
Date 2021-03-01
Name of individual signing SANDRA FERRIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
NEVILLE M BILIMORIA, 190 SOUTH LASALLE ST STE 3700, CHICAGO, 60603, COOK-NOT IN CITY OF CHICAGO Agent 2022-01-25

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
NURSING HOME ADMIN 139000164 No data No data APPROVED NURSING HOME ADMINISTRATOR CONTINUING EDUCATION SPONSOR No data 2003-07-07 2017-11-28 2019-11-30

Related by officers

No related officers

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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