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  5. FREEPORT REGIONAL HEALTH CARE FOUNDATION

FREEPORT REGIONAL HEALTH CARE FOUNDATION

Company Details

Entity Name: FREEPORT REGIONAL HEALTH CARE FOUNDATION
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 29 Jan 1984
Company Number: CORP_53327826
File Number: 53327826
Type of Business: Not for Profit
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FHN MATCHING TAX DEFERRED ANNUITY PLAN 2012 363290904 2013-10-16 FREEPORT HEALTH NETWORK 1477
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1991-01-01
Business code 622000
Sponsor’s telephone number 8155996714
Plan sponsor’s mailing address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Plan sponsor’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864

Plan administrator’s name and address
Administrator’s EIN 363290904
Plan administrator’s name FREEPORT HEALTH NETWORK
Plan administrator’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Administrator’s telephone number 8155996714

Number of participants as of the end of the plan year
Active participants 1167
Retired or separated participants receiving benefits 15
Other retired or separated participants entitled to future benefits 217
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 7
Number of participants with account balances as of the end of the plan year 1222
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 24

Signature of
Role Plan administrator
Date 2013-10-16
Name of individual signing LEN CARTER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-16
Name of individual signing LEN CARTER
Valid signature Filed with authorized/valid electronic signature
FHN MATCHING TAX DEFERRED ANNUITY PLAN 2012 363290904 2013-10-16 FREEPORT HEALTH NETWORK 1477
Three-digit plan number (PN) 002
Effective date of plan 1991-01-01
Business code 622000
Sponsor’s telephone number 8155996714
Plan sponsor’s mailing address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Plan sponsor’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864

Plan administrator’s name and address
Administrator’s EIN 363290904
Plan administrator’s name FREEPORT HEALTH NETWORK
Plan administrator’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Administrator’s telephone number 8155996714

Number of participants as of the end of the plan year
Active participants 1167
Retired or separated participants receiving benefits 15
Other retired or separated participants entitled to future benefits 217
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 7
Number of participants with account balances as of the end of the plan year 1222
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 24

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing LEN CARTER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-15
Name of individual signing LEN CARTER
Valid signature Filed with authorized/valid electronic signature
FHN MATCHING TAX DEFERRED ANNUITY PLAN 2011 363290904 2012-10-12 FREEPORT HEALTH NETWORK 1458
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1991-01-01
Business code 622000
Sponsor’s telephone number 8155996714
Plan sponsor’s mailing address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Plan sponsor’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864

Plan administrator’s name and address
Administrator’s EIN 363290904
Plan administrator’s name FREEPORT HEALTH NETWORK
Plan administrator’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Administrator’s telephone number 8155996714

Number of participants as of the end of the plan year
Active participants 1237
Retired or separated participants receiving benefits 14
Other retired or separated participants entitled to future benefits 222
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 4
Number of participants with account balances as of the end of the plan year 1281
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 30

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing LEN CARTER
Valid signature Filed with authorized/valid electronic signature
FHN MATCHING TAX DEFERRED ANNUITY PLAN 2010 363290904 2011-10-10 FREEPORT HEALTH NETWORK 2041
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1991-01-01
Business code 622000
Sponsor’s telephone number 8155996714
Plan sponsor’s mailing address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Plan sponsor’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864

Plan administrator’s name and address
Administrator’s EIN 363290904
Plan administrator’s name FREEPORT HEALTH NETWORK
Plan administrator’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Administrator’s telephone number 8155996714

Number of participants as of the end of the plan year
Active participants 1259
Retired or separated participants receiving benefits 7
Other retired or separated participants entitled to future benefits 191
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 1
Number of participants with account balances as of the end of the plan year 1249
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 29

Signature of
Role Plan administrator
Date 2011-10-10
Name of individual signing LEN CARTER
Valid signature Filed with authorized/valid electronic signature
FHN MATCHING TAX DEFERRED ANNUITY PLAN 2009 363290904 2010-10-15 FREEPORT HEALTH NETWORK 2048
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1991-01-01
Business code 622000
Sponsor’s telephone number 8155996714
Plan sponsor’s mailing address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Plan sponsor’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864

Plan administrator’s name and address
Administrator’s EIN 363290904
Plan administrator’s name FREEPORT HEALTH NETWORK
Plan administrator’s address 1045 W STEPHENSON ST, FREEPORT, IL, 610324864
Administrator’s telephone number 8155996714

Number of participants as of the end of the plan year
Active participants 1874
Retired or separated participants receiving benefits 7
Other retired or separated participants entitled to future benefits 158
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2
Number of participants with account balances as of the end of the plan year 1326
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 29

Signature of
Role Plan administrator
Date 2010-10-15
Name of individual signing LEN CARTER
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
MICHAEL C CLARK, 1045 W STEPHENSON STREET, FREEPORT, 61032, STEPHENSON Agent 2002-01-08

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
NORTHERN ILLINOIS PHYSICAL THERAPY SERVICES No data 2015-03-13 2020-06-12 Involuntary Cancellation No data
FHN FOUNDATION NFP Assume Name 2005-09-09 No data No data No data
FHN NFP Assume Name 2003-10-08 No data No data No data
FREEPORT HEALTH NETWORK NFP Assume Name 1997-09-12 No data No data No data

Historical Names

Name Change Date
FREEPORT HEALTH CARE FOUNDATION 1992-12-31

Related by officers

MICHAEL C CLARK, 1045 W STEPHENSON STREET, FREEPORT, 61032, STEPHENSON

NORTHWEST ILLINOIS HEALTH ALLIANCE, INC. FREEPORT REGIONAL HEALTH CARE SERVICES

Related by address

No related companies by address

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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