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  5. LAWRENCE COUNTY MEMORIAL HOSPITAL

LAWRENCE COUNTY MEMORIAL HOSPITAL

Company Details

Entity Name: LAWRENCE COUNTY MEMORIAL HOSPITAL
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 02 Jul 2010
Company Number: CORP_67176499
File Number: 67176499
Type of Business: Not for Profit
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
KBTPRC1PJZ46 2024-11-09 2200 STATE ST, LAWRENCEVILLE, IL, 62439, 1852, USA 2200 STATE ST, LAWRENCEVILLE, IL, 62439, 1852, USA

Business Information
Congressional District 12
State/Country of Incorporation IL, USA
Activation Date 2023-11-14
Initial Registration Date 2016-06-27
Entity Start Date 2010-07-02
Fiscal Year End Close Date Jun 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name TAMARA KOCHER
Role CONTROLLER
Address 2200 STATE STREET, LAWRENCEVILLE, IL, 62439, 1899, USA
Government Business
Title PRIMARY POC
Name TAMARA KOCHER
Role CONTROLLER
Address 2200 STATE STREET, LAWRENCEVILLE, IL, 62439, 1899, USA
Past Performance
Title PRIMARY POC
Name SHANA STRANGE
Role CFO
Address 2200 STATE STREET, LAWRENCEVILLE, IL, 62439, USA
Title ALTERNATE POC
Name TAMARA KOCHER
Role CONTROLLER
Address 2200 STATE STREET, LAWRENCEVILLE, IL, 62439, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAWRENCE COUNTY MEMORIAL HOSPITAL WELFARE BENEFIT PLAN 2021 800618988 2022-07-25 LAWRENCE COUNTY MEMORIAL HOSPITAL No data
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2021-08-01
Business code 622000
Sponsor’s telephone number 6189431000
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Signature of
Role Plan administrator
Date 2022-07-25
Name of individual signing KRISTI SAFRANEK
Valid signature Filed with authorized/valid electronic signature
LAWRENCE COUNTY MEMORIAL HOSPITAL WELFARE BENEFIT PLAN 2021 800618988 2022-07-25 LAWRENCE COUNTY MEMORIAL HOSPITAL No data
Three-digit plan number (PN) 501
Effective date of plan 2021-08-01
Business code 622000
Sponsor’s telephone number 6189431000
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Signature of
Role Plan administrator
Date 2022-07-25
Name of individual signing KRISTI SAFRANEK
Valid signature Filed with authorized/valid electronic signature
LAWRENCE COUNTY MEMORIAL HOSPITAL WELFARE BENEFIT PLAN 2020 800618988 2021-07-26 LAWRENCE COUNTY MEMORIAL HOSPITAL 214
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-08-01
Business code 622000
Sponsor’s telephone number 6189437203
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Number of participants as of the end of the plan year
Active participants 209
Retired or separated participants receiving benefits 2

Signature of
Role Plan administrator
Date 2021-07-26
Name of individual signing RALEY OCHS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-26
Name of individual signing RALEY OCHS
Valid signature Filed with authorized/valid electronic signature
LAWRENCE COUNTY MEMORIAL HOSPITAL WELFARE BENEFIT PLAN 2019 800618988 2020-06-10 LAWRENCE COUNTY MEMORIAL HOSPITAL 143
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2019-08-01
Business code 622000
Sponsor’s telephone number 6189437207
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Number of participants as of the end of the plan year
Active participants 143

Signature of
Role Plan administrator
Date 2020-06-10
Name of individual signing RALEY OCHS
Valid signature Filed with authorized/valid electronic signature
GROUP LONG TERM DISABILITY PLAN FOR EMPLOYEES OF LAWRENCE COUNTY MEMORIAL HOSPITAL 2019 800618988 2020-04-22 LAWRENCE COUNTY MEMORIAL HOSPITAL 140
File View Page
Three-digit plan number (PN) 505
Effective date of plan 2011-07-01
Business code 622000
Sponsor’s telephone number 6189437207
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Signature of
Role Plan administrator
Date 2020-04-22
Name of individual signing RALEY OCHS
Valid signature Filed with authorized/valid electronic signature
GROUP LIFE AND AD & D PLAN FOR EMPLOYEES OF LAWRENCE COUNTY MEMORIAL HOSPITAL 2019 800618988 2020-04-20 LAWRENCE COUNTY MEMORIAL HOSPITAL 131
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2011-07-01
Business code 622000
Sponsor’s telephone number 6189437207
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Number of participants as of the end of the plan year
Active participants 0

Signature of
Role Plan administrator
Date 2020-04-20
Name of individual signing RALEY OCHS
Valid signature Filed with authorized/valid electronic signature
GROUP LIFE AND AD & D PLAN FOR EMPLOYEES OF LAWRENCE COUNTY MEMORIAL HOSPITAL 2019 800618988 2020-04-13 LAWRENCE COUNTY MEMORIAL HOSPITAL 131
Three-digit plan number (PN) 502
Effective date of plan 2011-07-01
Business code 622000
Sponsor’s telephone number 6189437207
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Number of participants as of the end of the plan year
Active participants 0

Signature of
Role Plan administrator
Date 2020-04-13
Name of individual signing RALEY OCHS
Valid signature Filed with authorized/valid electronic signature
GROUP LONG TERM DISABILITY FOR EMPLOYEES OF LAWRENCE COUNTY MEMORIAL HOSPITAL 2017 800618988 2019-10-24 LAWRENCE COUNTY MEMORIAL HOSPITAL 135
File View Page
Three-digit plan number (PN) 505
Effective date of plan 2011-07-01
Business code 622000
Sponsor’s telephone number 6189431000
Plan sponsor’s DBA name LAWRENCE COUNTY MEMORIAL HOSPITAL
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Number of participants as of the end of the plan year
Active participants 135

Signature of
Role Plan administrator
Date 2019-10-24
Name of individual signing KIM ALLDREDGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-24
Name of individual signing KIM ALLDREDGE
Valid signature Filed with authorized/valid electronic signature
GROUP LIFE AND AD&D PLAN FOR EMPLOYEES OF LAWRENCE COUNTY MEMORIAL HOSPITAL 2017 800618988 2019-10-24 LAWRENCE COUNTY MEMORIAL HOSPITAL 125
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2011-07-01
Business code 622000
Sponsor’s telephone number 6189431000
Plan sponsor’s DBA name LAWRENCE COUNTY MEMORIAL HOSPITAL
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Number of participants as of the end of the plan year
Active participants 125

Signature of
Role Plan administrator
Date 2019-10-24
Name of individual signing KIM ALLDREDGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-24
Name of individual signing KIM ALLDREDGE
Valid signature Filed with authorized/valid electronic signature
LAWRENCE COUNTY MEMORIAL HOSPITAL 2017 800618988 2018-10-15 LAWRENCE COUNTY MEMORIAL HOSPITAL 135
File View Page
Three-digit plan number (PN) 505
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6189431000
Plan sponsor’s DBA name LAWRENCE COUNTY MEMORIAL HOSPITAL
Plan sponsor’s mailing address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852
Plan sponsor’s address 2200 STATE ST, LAWRENCEVILLE, IL, 624391852

Number of participants as of the end of the plan year
Active participants 135

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing KIM ALLDREDGE
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
DEREK WILLIAM MCCULLOUGH, 815 TWELFTH STREET, LAWRENCEVILLE, 62439, LAWRENCE Agent 2018-07-05

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
PHARMACY 054017712 No data No data LICENSED PHARMACY No data 2012-03-12 2024-03-15 2026-03-31
PHARMACY 054016963 No data No data LICENSED PHARMACY No data 2010-02-01 2010-02-01 2012-03-31
PHARMACY 059002907 No data No data LICENSED DIVISION III PHARMACY No data 1997-01-01 2008-01-10 2010-03-31

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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