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  5. KEWANEE HOSPITAL

KEWANEE HOSPITAL

Company Details

Entity Name: KEWANEE HOSPITAL
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Merged/Consolidated
Date Formed: 13 Nov 1902
Company Number: CORP_08766444
File Number: 08766444
Type of Business: Not for Profit
Date Status Change: 01 Apr 2014
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2016 362167767 2018-05-18 KEWANEE HOSPITAL 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-05-01
Business code 622000
Sponsor’s telephone number 3098527650
Plan sponsor’s address PO BOX 747, KEWANEE, IL, 61443

Signature of
Role Plan administrator
Date 2018-05-18
Name of individual signing RENEE SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-18
Name of individual signing JACKIE KERNAN
Valid signature Filed with authorized/valid electronic signature
KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2015 362167767 2017-01-11 KEWANEE HOSPITAL 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-05-01
Business code 622000
Sponsor’s telephone number 3098527650
Plan sponsor’s address PO BOX 747, KEWANEE, IL, 61443

Signature of
Role Plan administrator
Date 2017-01-11
Name of individual signing RENEE SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-01-11
Name of individual signing LYNN FULTON
Valid signature Filed with authorized/valid electronic signature
KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2014 362167767 2016-01-22 KEWANEE HOSPITAL 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-05-01
Business code 622000
Sponsor’s telephone number 3098527650
Plan sponsor’s address PO BOX 747, KEWANEE, IL, 61443

Signature of
Role Plan administrator
Date 2016-01-15
Name of individual signing RENEE A. SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-01-15
Name of individual signing LYNN A. FULTON
Valid signature Filed with authorized/valid electronic signature
KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2013 362167767 2015-01-16 KEWANEE HOSPITAL 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-05-01
Business code 622000
Sponsor’s telephone number 3098527650
Plan sponsor’s address PO BOX 747, KEWANEE, IL, 61443

Signature of
Role Plan administrator
Date 2015-01-16
Name of individual signing RENEE A. SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-01-16
Name of individual signing LYNN A. FULTON
Valid signature Filed with authorized/valid electronic signature
KEWANEE HOSPITAL SELF FUNDED HEALTH PLAN 2013 362167767 2015-05-18 KEWANEE HOSPITAL 143
File View Page
Three-digit plan number (PN) 506
Effective date of plan 1970-10-01
Business code 622000
Sponsor’s telephone number 3098527650
Plan sponsor’s mailing address PO BOX 747, 1051 W SOUTH STREET, KEWANEE, IL, 61443
Plan sponsor’s address PO BOX 747, 1051 W SOUTH STREET, KEWANEE, IL, 61443

Plan administrator’s name and address
Administrator’s EIN 362167767
Plan administrator’s name RENEE SALISBURY
Administrator’s telephone number 3098527650

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2015-05-18
Name of individual signing RENEE SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-05-18
Name of individual signing LYNN FULTON
Valid signature Filed with authorized/valid electronic signature
KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2012 362167767 2014-01-20 KEWANEE HOSPITAL 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-05-01
Business code 622000
Sponsor’s telephone number 3098527650
Plan sponsor’s address PO BOX 747, KEWANEE, IL, 61443

Signature of
Role Plan administrator
Date 2014-01-20
Name of individual signing RENEE A. SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-01-20
Name of individual signing LYNN A. FULTON
Valid signature Filed with authorized/valid electronic signature
KEWANEE HOSPITAL SELF FUNDED HEALTH PLAN 2012 362167767 2014-04-30 KEWANEE HOSPITAL 143
File View Page
Three-digit plan number (PN) 506
Effective date of plan 1970-10-01
Business code 622000
Sponsor’s telephone number 3098527650
Plan sponsor’s mailing address PO BOX 747, 1051 W SOUTH STREET, KEWANEE, IL, 61443
Plan sponsor’s address PO BOX 747, 1051 W SOUTH STREET, KEWANEE, IL, 61443

Plan administrator’s name and address
Administrator’s EIN 362167767
Plan administrator’s name RENEE SALISBURY
Plan administrator’s address PO BOX 747, KEWANEE, IL, 61443
Administrator’s telephone number 3098527650

Number of participants as of the end of the plan year
Active participants 142
Retired or separated participants receiving benefits 1

Signature of
Role Plan administrator
Date 2014-04-30
Name of individual signing RENEE SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-04-30
Name of individual signing LYNN FULTON
Valid signature Filed with authorized/valid electronic signature
KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2011 362167767 2013-01-17 KEWANEE HOSPITAL 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-05-01
Business code 623000
Sponsor’s telephone number 3098527650
Plan sponsor’s address PO BOX 747, KEWANEE, IL, 61443

Plan administrator’s name and address
Administrator’s EIN 362167767
Plan administrator’s name KEWANEE HOSPITAL
Plan administrator’s address PO BOX 747, KEWANEE, IL, 61443
Administrator’s telephone number 3098527650

Signature of
Role Plan administrator
Date 2013-01-17
Name of individual signing RENEE A. SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-01-17
Name of individual signing LYNN A. FULTON
Valid signature Filed with authorized/valid electronic signature
KEWANEE HOSPITAL SELF FUNDED HEALTH PLAN 2011 362167767 2013-03-26 KEWANEE HOSPITAL 133
File View Page
Three-digit plan number (PN) 506
Effective date of plan 1970-10-01
Business code 622000
Sponsor’s telephone number 3098527650
Plan sponsor’s mailing address PO BOX 747, 1051 W. SOUTH STREET, KEWANEE, IL, 61443
Plan sponsor’s address PO BOX 747, 1051 W. SOUTH STREET, KEWANEE, IL, 61443

Plan administrator’s name and address
Administrator’s EIN 362167767
Plan administrator’s name RENEE SALISBURY
Plan administrator’s address PO BOX 747, 1051 W. SOUTH STREET, KEWANEE, IL, 61443
Administrator’s telephone number 3098527650

Number of participants as of the end of the plan year
Active participants 142
Retired or separated participants receiving benefits 1

Signature of
Role Plan administrator
Date 2013-03-26
Name of individual signing RENEE SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-03-26
Name of individual signing LYNN FULTON
Valid signature Filed with authorized/valid electronic signature
KEWANEE HOSPITAL TAX DEFERRED ANNUITY PLAN 2010 362167767 2011-12-15 KEWANEE HOSPITAL 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1972-05-01
Business code 623000
Sponsor’s telephone number 3098527650
Plan sponsor’s address PO BOX 747, KEWANEE, IL, 61443

Plan administrator’s name and address
Administrator’s EIN 362167767
Plan administrator’s name KEWANEE HOSPITAL
Plan administrator’s address PO BOX 747, KEWANEE, IL, 61443
Administrator’s telephone number 3098527650

Signature of
Role Plan administrator
Date 2011-12-13
Name of individual signing RENEE A. SALISBURY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-12-15
Name of individual signing MARGARET M. GUSTAFSON
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
LYNN A FULTON, 1051 W, SOUTH ST, POBX 747, KEWANEE, 61443, HENRY Agent 2012-07-12

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
PHARMACY 054017368 No data No data LICENSED PHARMACY No data 2010-03-11 2014-01-23 2016-03-31
HME AND SERVICES PROV 203001068 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2009-03-12 2009-03-12 2012-03-31
PHARMACY 059013469 No data No data LICENSED DIVISION III PHARMACY No data 2006-07-24 2008-01-10 2010-03-31

Historical Names

Name Change Date
KEWANEE HOSPITAL ASSOCIATION 1996-06-18
THE KEWANEE PUBLIC HOSPITAL ASSOCIATION 1989-10-02

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 23 Dec 2024

Sources: Illinois Office of the Secretary of State

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