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  5. SIU PHYSICIANS & SURGEONS, INC.

SIU PHYSICIANS & SURGEONS, INC.

Company Details

Entity Name: SIU PHYSICIANS & SURGEONS, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 24 Feb 1997
Company Number: CORP_59257552
File Number: 59257552
Type of Business: Not for Profit
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
JB4GU343BX68 2024-09-11 201 E MADISON ST, STE #300, SPRINGFIELD, IL, 62702, 5131, USA 201 E MADISON STE 300, SPRINGFIELD, IL, 62702, 5131, USA

Business Information
URL siumed.org
Division Name SIU PHYSICIANS AND SURGEONS, INC.
Congressional District 13
State/Country of Incorporation IL, USA
Activation Date 2023-09-14
Initial Registration Date 2017-08-15
Entity Start Date 1997-02-24
Fiscal Year End Close Date Jun 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name JODIE A CAREY
Role EXECUTIVE DIRECTOR OF CLINICAL FINANCE
Address 201 E MADISON STE. 300, SPRINGFIELD, IL, 62702, USA
Government Business
Title PRIMARY POC
Name JODIE A CAREY
Role EXECUTIVE DIRECTOR OF CLINICAL FINANCE
Address 201 E MADISON STE. 300, SPRINGFIELD, IL, 62702, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2023 364143823 2024-11-19 SIU PHYSICIANS & SURGEONS, INC 282
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-02
Business code 621112
Sponsor’s telephone number 2175452110
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131
Plan sponsor’s address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131

Number of participants as of the end of the plan year
Active participants 271

Signature of
Role Plan administrator
Date 2024-11-19
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-11-19
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2022 364143823 2024-01-05 SIU PHYSICIANS & SURGEONS, INC 285
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-02
Business code 621112
Sponsor’s telephone number 2175452110
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131
Plan sponsor’s address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131

Number of participants as of the end of the plan year
Active participants 282

Signature of
Role Plan administrator
Date 2024-01-05
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-01-05
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2021 364143823 2023-01-13 SIU PHYSICIANS & SURGEONS, INC 273
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-02
Business code 621112
Sponsor’s telephone number 2175452110
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131
Plan sponsor’s address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131

Number of participants as of the end of the plan year
Active participants 285

Signature of
Role Plan administrator
Date 2023-01-13
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-01-13
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2020 364143823 2022-02-09 SIU PHYSICIANS & SURGEONS, INC 263
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-02
Business code 621112
Sponsor’s telephone number 2175452110
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131
Plan sponsor’s address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131

Number of participants as of the end of the plan year
Active participants 273

Signature of
Role Plan administrator
Date 2022-02-09
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-02-09
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2019 364143823 2021-02-03 SIU PHYSICIANS & SURGEONS, INC 260
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-02
Business code 621112
Sponsor’s telephone number 2175456632
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131
Plan sponsor’s address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131

Number of participants as of the end of the plan year
Active participants 263

Signature of
Role Plan administrator
Date 2021-02-03
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-02-03
Name of individual signing JOHN HORVAT
Valid signature Filed with authorized/valid electronic signature
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2018 364143823 2020-01-28 SIU PHYSICIANS & SURGEONS, INC 252
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-02
Business code 621112
Sponsor’s telephone number 2175456632
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131
Plan sponsor’s address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131

Number of participants as of the end of the plan year
Active participants 260

Signature of
Role Plan administrator
Date 2020-01-24
Name of individual signing JAMES NERONE
Valid signature Filed with authorized/valid electronic signature
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2017 364143823 2019-01-25 SIU PHYSICIANS & SURGEONS, INC. 239
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-02
Business code 621112
Sponsor’s telephone number 2175456632
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131
Plan sponsor’s address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131

Number of participants as of the end of the plan year
Active participants 252

Signature of
Role Plan administrator
Date 2019-01-23
Name of individual signing ELIZABETH COLLIER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-01-23
Name of individual signing ELIZABETH COLLIER
Valid signature Filed with authorized/valid electronic signature
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2016 364143823 2018-02-26 SIU PHYSICIANS & SURGEONS, INC. 252
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-02
Business code 621112
Sponsor’s telephone number 2175456632
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131
Plan sponsor’s address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 627025131

Number of participants as of the end of the plan year
Active participants 239

Signature of
Role Plan administrator
Date 2018-02-23
Name of individual signing NELSON WEICHOLD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-02-23
Name of individual signing NELSON WEICHOLD
Valid signature Filed with authorized/valid electronic signature
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2015 364143823 2017-04-25 SIU PHYSICIANS & SURGEONS, INC. 262
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-02
Business code 621112
Sponsor’s telephone number 2175456632
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 62702
Plan sponsor’s address 201 E MADISON ST STE 300, SPRINGFIELD, IL, 62702

Number of participants as of the end of the plan year
Active participants 252

Signature of
Role Plan administrator
Date 2017-04-25
Name of individual signing NELSON WEICHOLD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-25
Name of individual signing NELSON WEICHOLD
Valid signature Filed with authorized/valid electronic signature
SIU PHYSICIANS & SURGEONS, INC. LONG TERM DISABILITY 2014 364143823 2016-06-02 SIU PHYSICIANS & SURGEONS, INC. 255
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2002-10-01
Business code 621112
Sponsor’s telephone number 2175456632
Plan sponsor’s DBA name SIU HEALTHCARE
Plan sponsor’s mailing address 201 EAST MADISON SREET, SUITE 300, SPRINGFIELD, IL, 62702
Plan sponsor’s address 201 EAST MADISON SREET, SUITE 300, SPRINGFIELD, IL, 62702

Number of participants as of the end of the plan year
Active participants 262

Signature of
Role Plan administrator
Date 2016-06-02
Name of individual signing NELSON WEICHOLD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-02
Name of individual signing NELSON WEICHOLD
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
JOHN HORVAT, 201 E MADISON STE #300, SPRINGFIELD, 62794, SANGAMON Agent 2020-10-21

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
SIMMONS CANCER INSTITUTE AT SIU PHARMACY NFP Assume Name 2020-10-16 No data No data No data
SIU HEALTHCARE NFP Assume Name 2009-10-01 No data No data No data

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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