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  5. GOOD SAMARITAN HOME

GOOD SAMARITAN HOME

Company Details

Entity Name: GOOD SAMARITAN HOME
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Dissolved
Date Formed: 07 Mar 1973
Date of Dissolution: 01 Aug 1988
Company Number: CORP_50194558
File Number: 50194558
Date Status Change: 01 Aug 1988
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GOOD SAMARITAN HOME OF QUINCY IL VISION PLAN 2014 370724112 2015-03-23 GOOD SAMARITAN HOME 145
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2009-04-01
Business code 623000
Sponsor’s telephone number 2172238717
Plan sponsor’s mailing address 2130 HARRISON STREET, QUINCY, IL, 62301
Plan sponsor’s address 2130 HARRISON STREET, QUINCY, IL, 62301

Number of participants as of the end of the plan year
Active participants 155
Retired or separated participants receiving benefits 0
GOOD SAMARITAN HOME OF QUINCY IL VISION PLAN 2014 370724112 2015-03-23 GOOD SAMARITAN HOME 140
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2009-04-01
Business code 623000
Sponsor’s telephone number 2172238717
Plan sponsor’s mailing address 2130 HARRISON STREET, QUINCY, IL, 62301
Plan sponsor’s address 2130 HARRISON STREET, QUINCY, IL, 62301

Number of participants as of the end of the plan year
Active participants 145
Retired or separated participants receiving benefits 0
GOOD SAMARITAN HOME OF QUINCY IL SELF-FUNDED MEDICAL AND DENTAL PLAN 2014 370724112 2015-03-13 GOOD SAMARITAN HOME 140
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1992-03-01
Business code 623000
Sponsor’s telephone number 2172238717
Plan sponsor’s mailing address 2130 HARRISON STREET, QUINCY, IL, 62301
Plan sponsor’s address 2130 HARRISON STREET, QUINCY, IL, 62301

Number of participants as of the end of the plan year
Active participants 145
Retired or separated participants receiving benefits 2
GOOD SAMARITAN HOME OF QUINCY IL SELF-FUNDED MEDICAL AND DENTAL PLAN 2014 370724112 2015-03-13 GOOD SAMARITAN HOME 131
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1992-03-01
Business code 623000
Sponsor’s telephone number 2172238717
Plan sponsor’s mailing address 2130 HARRISON STREET, QUINCY, IL, 62301
Plan sponsor’s address 2130 HARRISON STREET, QUINCY, IL, 62301

Number of participants as of the end of the plan year
Active participants 140
Retired or separated participants receiving benefits 0
GOOD SAMARITAN HOME OF QUINCY IL SELF-FUNDED MEDICAL AND DENTAL PLAN 2014 370724112 2015-03-13 GOOD SAMARITAN HOME 133
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1992-03-01
Business code 623000
Sponsor’s telephone number 2172238717
Plan sponsor’s mailing address 2130 HARRISON STREET, QUINCY, IL, 62301
Plan sponsor’s address 2130 HARRISON STREET, QUINCY, IL, 62301

Number of participants as of the end of the plan year
Active participants 131
Retired or separated participants receiving benefits 0
GOOD SAMARITAN HOME OF QUINCY IL SHORT TERM DISABILITY PLAN 2014 370724112 2015-03-24 GOOD SAMARITAN HOME 133
File View Page
Three-digit plan number (PN) 504
Effective date of plan 2005-05-01
Business code 623000
Sponsor’s telephone number 2172238717
Plan sponsor’s mailing address 2130 HARRISON STREET, QUINCY, IL, 62301
Plan sponsor’s address 2130 HARRISON STREET, QUINCY, IL, 62301

Number of participants as of the end of the plan year
Active participants 137
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Agent

Name and Address Role Appointment Date
TAI KANG, 635 SOUTH CLINTON AVE, OAK PARK, 60304, COOK-NOT IN CITY OF CHICAGO Agent 1981-02-25

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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