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  5. MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC.

MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC.

Company Details

Entity Name: MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 09 Dec 1985
Company Number: CORP_54067658
File Number: 54067658
Type of Business: Business Corporations
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2015 371190216 2016-10-14 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177887833
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Signature of
Role Plan administrator
Date 2016-10-14
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-14
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2014 371190216 2015-07-06 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177887833
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-06
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2013 371190216 2014-10-14 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177887833
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-14
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2012 371190216 2014-02-11 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177887833
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-11
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2012 371190216 2013-10-11 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 47
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177887822
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-11
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2011 371190216 2014-02-10 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 88
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177884068
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Plan administrator’s name and address
Administrator’s EIN 371190216
Plan administrator’s name MEMORIAL HOME SERVICES OF CENTRAL I
Plan administrator’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001
Administrator’s telephone number 2177884068

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-12
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2011 371190216 2012-10-12 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 88
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177884068
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Plan administrator’s name and address
Administrator’s EIN 371190216
Plan administrator’s name MEMORIAL HOME SERVICES OF CENTRAL I
Plan administrator’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001
Administrator’s telephone number 2177884068

Signature of
Role Plan administrator
Date 2012-10-12
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-12
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2009 371190216 2010-10-14 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 75
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177884068
Plan sponsor’s mailing address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Plan administrator’s name and address
Administrator’s EIN 371190216
Plan administrator’s name MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC.
Plan administrator’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001
Administrator’s telephone number 2177884068

Number of participants as of the end of the plan year
Active participants 42
Other retired or separated participants entitled to future benefits 28
Number of participants with account balances as of the end of the plan year 48

Signature of
Role Plan administrator
Date 2010-10-13
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-13
Name of individual signing ROBERT W. KAY
Valid signature Filed with authorized/valid electronic signature
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2009 371190216 2010-10-12 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 75
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177884068
Plan sponsor’s mailing address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Plan administrator’s name and address
Administrator’s EIN 371190216
Plan administrator’s name MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC.
Plan administrator’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001
Administrator’s telephone number 2177884068

Number of participants as of the end of the plan year
Active participants 42
Other retired or separated participants entitled to future benefits 28
Number of participants with account balances as of the end of the plan year 48

Signature of
Role Plan administrator
Date 2010-10-13
Name of individual signing ROBERT W. KAY
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-10-13
Name of individual signing ROBERT W. KAY
Valid signature Filed with incorrect/unrecognized electronic signature
MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS INC. EMPLOYEE SAVINGS PLAN 2009 371190216 2010-10-11 MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC. 75
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621610
Sponsor’s telephone number 2177884068
Plan sponsor’s mailing address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001
Plan sponsor’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001

Plan administrator’s name and address
Administrator’s EIN 371190216
Plan administrator’s name MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS, INC.
Plan administrator’s address 701 NORTH FIRST STREET, SPRINGFIELD, IL, 627810001
Administrator’s telephone number 2177884068

Number of participants as of the end of the plan year
Active participants 42
Other retired or separated participants entitled to future benefits 28
Number of participants with account balances as of the end of the plan year 48

Signature of
Role Plan administrator
Date 2010-10-13
Name of individual signing ROBERT W. KAY
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-10-13
Name of individual signing ROBERT W. KAY
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name and Address Role Appointment Date
ANNA EVANS, 340 W. MILLER STREET, SPRINGFIELD, 62702, SANGAMON Agent 2022-08-24

President

Name and Address Role
HENRY HURWITZ, 340 W MILLER ST, SPRINGFIELD, IL 62702 President

Secretary

Name and Address Role
KATHRYN KEIM, 701 N 1ST STREET SPRINGFIELD IL 62781 Secretary

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
HME AND SERVICES PROV 203002604 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2020-09-17 2021-02-04 2024-03-31
HME AND SERVICES PROV 203001679 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2014-10-21 2021-02-03 2024-03-31
HME AND SERVICES PROV 203000926 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2007-06-27 2012-03-06 2015-03-31
HME AND SERVICES PROV 203000241 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2001-01-10 2006-04-18 2009-03-31

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
UNIVERSITY PHARMACY, INC. No data 1994-02-01 2011-05-02 Involuntary Cancellation No data
PRACTICE CONSULTING SERVICES, INC. No data 1993-06-11 2006-01-12 Voluntary Cancellation No data
PROHEALTH SERVICES No data 1987-09-30 1991-05-01 Involuntary Cancellation No data
PROHEALTH ILLINOIS No data 1986-04-28 1991-05-01 Involuntary Cancellation No data

Historical Names

Name Change Date
ALTERNATIVE CARE SERVICES, INC. 2007-04-10
PROFESSIONAL CARE, INC. 1991-01-31

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM A No data Voting Rights 1000 222940 No data

Related by officers

ANNA EVANS, 340 W. MILLER STREET, SPRINGFIELD, 62702, SANGAMON

DECATUR MEMORIAL HOSPITAL THE PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION MEMORIAL HOME SERVICES, NFP THE ABRAHAM LINCOLN MEMORIAL HOSPITAL TAYLORVILLE MEMORIAL HOSPITAL MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS MEMORIAL MEDICAL CENTER FOUNDATION MEMORIAL HEALTH SYSTEM DECATUR MEMORIAL HEALTH FOUNDATION MEMORIAL PHYSICIAN SERVICES

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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