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  5. NORTHERN ILLINOIS HOSPICE ASSOCIATION

NORTHERN ILLINOIS HOSPICE ASSOCIATION

Company Details

Entity Name: NORTHERN ILLINOIS HOSPICE ASSOCIATION
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 17 Aug 1979
Company Number: CORP_51831489
File Number: 51831489
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTHERN ILLINOIS HOSPICE 401(K) PLAN 2023 363041850 2024-07-08 NORTHERN ILLINOIS HOSPICE 108
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4751 HARRISON AVENUE, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2024-07-08
Name of individual signing LISA NOVAK
Valid signature Filed with authorized/valid electronic signature
NORTHERN ILLINOIS HOSPICE 401(K) PLAN 2022 363041850 2023-08-02 NORTHERN ILLINOIS HOSPICE 90
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4751 HARRISON AVENUE, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2023-08-02
Name of individual signing LISA NOVAK
Valid signature Filed with authorized/valid electronic signature
NORTHERN ILLINOIS HOSPICE 401(K) PLAN 2021 363041850 2022-10-17 NORTHERN ILLINOIS HOSPICE 91
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4751 HARRISON AVENUE, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing LISA NOVAK, CEO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-17
Name of individual signing LISA NOVAK, CEO
Valid signature Filed with authorized/valid electronic signature
NORTHERN ILLINOIS HOSPICE 401(K) PLAN 2020 363041850 2021-07-07 NORTHERN ILLINOIS HOSPICE 90
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4751 HARRISON AVENUE, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2021-07-07
Name of individual signing LISA NOVAK
Valid signature Filed with authorized/valid electronic signature
NORTHERN ILLINOIS HOSPICE 401(K) PLAN 2019 363041850 2020-08-05 NORTHERN ILLINOIS HOSPICE 78
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4751 HARRISON AVENUE, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2020-08-05
Name of individual signing LISA NOVAK
Valid signature Filed with authorized/valid electronic signature
NORTHERN ILLINOIS HOSPICE 401(K) PLAN 2018 363041850 2019-07-29 NORTHERN ILLINOIS HOSPICE 67
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4215 NEWBURG ROAD, ROCKFORD, IL, 61108
NORTHERN ILLINOIS HOSPICE 401(K) PLAN 2017 363041850 2018-07-11 NORTHERN ILLINOIS HOSPICE 60
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4215 NEWBURG ROAD, ROCKFORD, IL, 61108
NORTHERN ILLINOIS HOSPICE 401(K) PLAN 2016 363041850 2017-07-27 NORTHERN ILLINOIS HOSPICE 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4215 NEWBURG ROAD, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2017-07-27
Name of individual signing LISA NOVAK
Valid signature Filed with authorized/valid electronic signature
NORTHERN ILLINOIS HOSPICE 401(K) PLAN 2015 363041850 2016-07-27 NORTHERN ILLINOIS HOSPICE 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4215 NEWBURG ROAD, ROCKFORD, IL, 61108

Plan administrator’s name and address
Administrator’s EIN 363041850
Plan administrator’s name NORTHERN ILLINOIS HOSPICE
Plan administrator’s address 4215 NEWBURG ROAD, ROCKFORD, IL, 61108
Administrator’s telephone number 8153980500
NORTHERN ILLINOIS HOSPICE AND GRIEF CENTER 401(K) PLAN 2014 363041850 2015-04-20 NORTHERN ILLINOIS HOSPICE AND GRIEF CENTER 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-02-01
Business code 624100
Sponsor’s telephone number 8153980500
Plan sponsor’s address 4215 NEWBURG ROAD, ROCKFORD, IL, 61108

Plan administrator’s name and address
Administrator’s EIN 363041850
Plan administrator’s name NORTHERN ILLINOIS HOSPICE AND GRIEF CENTER
Plan administrator’s address 4215 NEWBURG ROAD, ROCKFORD, IL, 61108
Administrator’s telephone number 8153980500

Signature of
Role Plan administrator
Date 2015-04-20
Name of individual signing LISA NOVAK
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
LISA NOVAK, 4751 HARRISON AVE, ROCKFORD, 61108, WINNEBAGO Agent 2019-07-12

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
NORTHERN ILLINOIS PALLIATIVE CARE NFP Assume Name 2024-01-16 No data No data No data
NORTHERN ILLINOIS HOSPICE NFP Assume Name 2014-06-18 No data No data No data
NORTHERN ILLINOIS HOSPICE AND GRIEF CENTER No data 2006-02-01 2014-06-18 Voluntary Cancellation No data
THE ENCORE SHOP NFP No data 2003-04-01 2005-07-08 Expired No data

Related by officers

LISA NOVAK, 4751 HARRISON AVE, ROCKFORD, 61108, WINNEBAGO

NORTHERN ILLINOIS HOSPICE FOUNDATION

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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