KIRBY MEDICAL CENTER

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

JOHN AND MARY E KIRBY HOSPITAL EMPLOYEE VISION PLAN

2009

370661216

2010-07-15

THE JOHN AND MARY E KIRBY HOSPITAL

282

File	View Page
Three-digit plan number (PN)	514
Effective date of plan	2002-12-01
Business code	622000
Sponsor’s telephone number	2177622115
Plan sponsor’s mailing address	PO BOX 20, MONTICELLO, IL, 618560020
Plan sponsor’s address	1111 NORTH STATE ST., MONTICELLO, IL, 61856

Plan administrator’s name and address

Administrator’s EIN	370661216
Plan administrator’s name	THE JOHN AND MARY E KIRBY HOSPITAL
Plan administrator’s address	PO BOX 20, MONTICELLO, IL, 618560020
Administrator’s telephone number	2177622115

Number of participants as of the end of the plan year

Active participants	315
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	0

Signature of

Role	Plan administrator
Date	2010-07-15
Name of individual signing	CANDICE WOODRUM
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
STEVEN D TENHOUSE, 1000 MEDICAL CENTER DR, MONTICELLO, 61856, PIATT	Agent	2011-10-24

Name	Type	Effective Date	Cancellation Date	Cancellation Type	Last Renewal Date
KIRBY RX - STORE #2	NFP Assume Name	2020-08-10	No data	No data	No data
KIRBY RX	NFP Assume Name	2019-06-25	No data	No data	No data
CROSSFIT KMC	No data	2017-03-01	2020-09-16	Voluntary Cancellation	No data

Name	Change Date
THE JOHN AND MARY E. KIRBY HOSPITAL	2011-10-14

Date of last update: 23 Dec 2024