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  5. HEARTLAND HOME MEDICAL SUPPLY, INC.

HEARTLAND HOME MEDICAL SUPPLY, INC.

Company Details

Entity Name: HEARTLAND HOME MEDICAL SUPPLY, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Dissolved
Date Formed: 10 Sep 2004
Date of Dissolution: 14 Feb 2020
Company Number: CORP_63772003
File Number: 63772003
Type of Business: All Inclusive Purpose
Date Status Change: 14 Feb 2020
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HEARTLAND HOME MEDICAL SUPPLY 401(K) PLAN 2015 201635960 2017-11-10 HEARTLAND HOME MEDICAL SUPPLY INC 13
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 446190
Sponsor’s telephone number 3098298122
Plan sponsor’s address 716 E EMPIRE ST STE 2, BLOOMINGTON, IL, 617018613

Signature of
Role Plan administrator
Date 2017-11-10
Name of individual signing DAVID ERWIN
Valid signature Filed with authorized/valid electronic signature
HEARTLAND HOME MEDICAL SUPPLY 401(K) PLAN 2015 201635960 2017-11-10 HEARTLAND HOME MEDICAL SUPPLY INC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 446190
Sponsor’s telephone number 3098298122
Plan sponsor’s address 716 E EMPIRE ST STE 2, BLOOMINGTON, IL, 617018613

Plan administrator’s name and address
Administrator’s EIN 201635960
Plan administrator’s name HEARTLAND HOME MEDICAL SUPPLY INC
Plan administrator’s address 716 E EMPIRE ST STE 2, BLOOMINGTON, IL, 617018613
Administrator’s telephone number 3098298122

Signature of
Role Plan administrator
Date 2017-11-10
Name of individual signing DAVID ERWIN
Valid signature Filed with authorized/valid electronic signature
HEARTLAND HOME MEDICAL SUPPLY 401 (K) PLAN 2013 201635960 2017-08-24 HEARTLAND HOME MEDICAL SUPPLY, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 446190
Sponsor’s telephone number 3098298122
Plan sponsor’s address 716 E EMPIRE ST SUITE 2, BLOOMINGTON, IL, 61701

Signature of
Role Plan administrator
Date 2017-08-24
Name of individual signing DAVID ERWIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-08-24
Name of individual signing DAVID ERWIN
Valid signature Filed with authorized/valid electronic signature
HEARTLAND HOME MEDICAL SUPPLY 401(K) PLAN 2012 201635960 2013-12-16 HEARTLAND HOME MEDICAL SUPPLY, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 446190
Sponsor’s telephone number 3098298122
Plan sponsor’s address 716 E EMPIRE ST, SUITE 2, BLOOMINGTON, IL, 61701

Signature of
Role Plan administrator
Date 2013-12-16
Name of individual signing CATHERINE M. ROUSEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-12-12
Name of individual signing CATHERINE M. ROUSEY
Valid signature Filed with authorized/valid electronic signature
HEARTLAND HOME MEDICAL SUPPLY 401(K) PLAN 2011 201635960 2012-12-06 HEARTLAND HOME MEDICAL SUPPLY, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 446190
Sponsor’s telephone number 3098298122
Plan sponsor’s address 716 E EMPIRE ST, SUITE 2, BLOOMINGTON, IL, 61701

Plan administrator’s name and address
Administrator’s EIN 201635960
Plan administrator’s name HEARTLAND HOME MEDICAL SUPPLY, INC.
Plan administrator’s address 716 E EMPIRE ST, SUITE 2, BLOOMINGTON, IL, 61701
Administrator’s telephone number 3098298122

Signature of
Role Plan administrator
Date 2012-12-06
Name of individual signing CATHERINE ROUSEY
Valid signature Filed with authorized/valid electronic signature
HEARTLAND HOME MEDICAL SUPPLY 401(K) PLAN 2010 201635960 2011-11-04 HEARTLAND HOME MEDICAL SUPPLY, INC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 446190
Sponsor’s telephone number 3098298122
Plan sponsor’s address 716 E EMPIRE ST, SUITE 2, BLOOMINGTON, IL, 61701

Plan administrator’s name and address
Administrator’s EIN 201635960
Plan administrator’s name HEARTLAND HOME MEDICAL SUPPLY, INC
Plan administrator’s address 716 E EMPIRE ST, SUITE 2, BLOOMINGTON, IL, 61701
Administrator’s telephone number 3098298122

Signature of
Role Plan administrator
Date 2011-11-04
Name of individual signing CATHERINE ROUSEY
Valid signature Filed with authorized/valid electronic signature
HEARTLAND HOME MEDICAL SUPPLY 401(K) PLAN 2010 201635960 2011-11-04 HEARTLAND HOME MEDICAL SUPPLY, INC 10
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 446190
Sponsor’s telephone number 3098298122
Plan sponsor’s address 716 E EMPIRE ST, SUITE 2, BLOOMINGTON, IL, 61701

Plan administrator’s name and address
Administrator’s EIN 201635960
Plan administrator’s name HEARTLAND HOME MEDICAL SUPPLY, INC
Plan administrator’s address 716 E EMPIRE ST, SUITE 2, BLOOMINGTON, IL, 61701
Administrator’s telephone number 3098298122

Signature of
Role Plan administrator
Date 2011-11-04
Name of individual signing CATHERINE ROUSEY
Valid signature Filed with incorrect/unrecognized electronic signature
HEARTLAND HOME MEDICAL SUPPLY 401(K) PLAN 2009 201635960 2010-12-23 HEARTLAND HOME MEDICAL SUPPLY, INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 446190
Sponsor’s telephone number 3098298122
Plan sponsor’s address 716 E EMPIRE ST, SUITE 2, BLOOMINGTON, IL, 61701

Plan administrator’s name and address
Administrator’s EIN 201635960
Plan administrator’s name HEARTLAND HOME MEDICAL SUPPLY, INC
Plan administrator’s address 716 E EMPIRE ST, SUITE 2, BLOOMINGTON, IL, 61701
Administrator’s telephone number 3098298122

Signature of
Role Plan administrator
Date 2010-12-23
Name of individual signing CATHERINE ROUSEY
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
AMERICAN TAX & ACCOUNTING INC, 2206 E OAKLAND AVE, BLOOMINGTON, 61701, MC LEAN Agent 2017-01-31

President

Name and Address Role
CATHERINE M ROUSEY 312 W EMERSON BLOOMINGTON 61701 President

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
HME AND SERVICES PROV 203001732 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2015-01-30 2018-04-13 2021-03-31
HME AND SERVICES PROV 203000645 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2005-03-07 2012-02-29 2015-03-31

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 6000 1200000 No data

Related by officers

CATHERINE M ROUSEY 312 W EMERSON BLOOMINGTON 61701

HEARTLAND FITNESS CORPORATION

AMERICAN TAX & ACCOUNTING INC, 2206 E OAKLAND AVE, BLOOMINGTON, 61701, MC LEAN

MARK K. WERKING, D.C., S.C. EXTREMITY SOLUTIONS CORPORATE SERVICES INC. OOGIE'S FOOD ON WHEELS, INC. RICKS GARAGE INC.

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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