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  5. HEARTLAND HEALTH SYSTEM, INC.

HEARTLAND HEALTH SYSTEM, INC.

Company Details

Entity Name: HEARTLAND HEALTH SYSTEM, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 01 Jul 2019
Company Number: CORP_72051548
File Number: 72051548
Type of Business: Not for Profit
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FAYETTE COUNTY HOSPITAL CONSOLIDATE HEALTH AND WELFARE BENEFIT PROGRAM 2021 201890414 2022-08-01 HEARTLAND HEALTH SYSTEM 234
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2005-01-01
Business code 622000
Sponsor’s telephone number 6182835552
Plan sponsor’s DBA name FAYETTE COUNTY HOSPITAL
Plan sponsor’s mailing address 650 W TAYLOR ST, VANDALIA, IL, 624711227
Plan sponsor’s address 650 W TAYLOR ST, VANDALIA, IL, 624711227

Number of participants as of the end of the plan year
Active participants 233

Signature of
Role Plan administrator
Date 2022-08-01
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-08-01
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
FAYETTE COUNTY HOSPITAL CONSOLIDATED HEALTH AND WELFARE BENEFIT PROGRAM 2020 201890414 2021-08-02 HEARTLAND HEALTH SYSTEM 235
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2005-01-01
Business code 622000
Sponsor’s telephone number 6182835552
Plan sponsor’s DBA name FAYETTE COUNTY HOSPITAL
Plan sponsor’s mailing address 650 W TAYLOR ST, VANDALIA, IL, 624711227
Plan sponsor’s address 650 W TAYLOR ST, VANDALIA, IL, 624711227

Number of participants as of the end of the plan year
Active participants 226

Signature of
Role Plan administrator
Date 2021-08-02
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-08-02
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
FAYETTE COUNTY HOSPITAL CONSOLIDATED HEALTH AND WELFARE BENEFIT PROGRAM 2019 201890414 2021-08-02 HEARTLAND HEALTH SYSTEM 237
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2005-01-01
Business code 622000
Sponsor’s telephone number 6182835552
Plan sponsor’s DBA name FAYETTE COUNTY HOSPITAL
Plan sponsor’s mailing address 650 W TAYLOR ST, VANDALIA, IL, 624711227
Plan sponsor’s address 650 W TAYLOR ST, VANDALIA, IL, 624711227

Number of participants as of the end of the plan year
Active participants 238

Signature of
Role Plan administrator
Date 2021-08-02
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-08-02
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
FAYETTE COUNTY HOSPITAL CONSOLIDATED HEALTH AND WELFARE BENEFIT PROGRAM 2018 201890414 2019-07-04 HEARTLAND HEALTH SYSTEM 233
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2005-01-01
Business code 622000
Sponsor’s telephone number 6182835552
Plan sponsor’s DBA name FAYETTE COUNTY HOSPITAL
Plan sponsor’s mailing address 650 W TAYLOR ST, VANDALIA, IL, 624711227
Plan sponsor’s address 650 W TAYLOR ST, VANDALIA, IL, 624711227

Number of participants as of the end of the plan year
Active participants 230

Signature of
Role Plan administrator
Date 2019-07-04
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-04
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
FAYETTE COUNTY HOSPITAL CONSOLIDATED HEALTH AND WELFARE BENEFIT PROGRAM 2016 201890414 2017-07-31 HEARTLAND HEALTH SYSTEM 239
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2005-01-01
Business code 622000
Sponsor’s telephone number 6182835551
Plan sponsor’s DBA name FAYETTE COUNTY HOSPITAL
Plan sponsor’s mailing address 650 W TAYLOR ST, VANDALIA, IL, 624711227
Plan sponsor’s address 650 W TAYLOR ST, VANDALIA, IL, 624711227

Number of participants as of the end of the plan year
Active participants 238

Signature of
Role Plan administrator
Date 2017-07-31
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-31
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
FAYETTE COUNTY HOSPITAL CONSOLIDATED HEALTH AND WELFARE BENEFIT PROGRAM 2015 201890414 2016-03-23 HEARTLAND HEALTH SYSTEM 248
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2005-01-01
Business code 622000
Sponsor’s telephone number 6182835551
Plan sponsor’s DBA name FAYETTE COUNTY HOSPITAL
Plan sponsor’s mailing address 650 W TAYLOR ST, VANDALIA, IL, 624711227
Plan sponsor’s address 650 W TAYLOR ST, VANDALIA, IL, 624711227

Number of participants as of the end of the plan year
Active participants 235

Signature of
Role Plan administrator
Date 2016-03-23
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-03-23
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
FAYETTE COUNTY HOSPITAL CONSOLIDATED HEALTH AND WELFARE BENEFIT PROGRAM 2014 201890414 2016-03-23 HEARTLAND HEALTH SYSTEM 217
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2005-01-01
Business code 622000
Sponsor’s telephone number 6182835551
Plan sponsor’s DBA name FAYETTE COUNTY HOSPITAL
Plan sponsor’s mailing address 650 WEST TAYLOR ST, VANDALIA, IL, 62471
Plan sponsor’s address 650 WEST TAYLOR ST, VANDALIA, IL, 62471

Number of participants as of the end of the plan year
Active participants 227

Signature of
Role Plan administrator
Date 2016-03-23
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-03-23
Name of individual signing SUSAN CRAWFORD
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
KIMBERLY UPHOFF, 1000 HEALTH CENTER DRIVE, MATTOON, 61938, COLES Agent 2023-07-18

Related by officers

KIMBERLY UPHOFF, 1000 HEALTH CENTER DRIVE, MATTOON, 61938, COLES

SARAH BUSH LINCOLN HEALTH CENTER SARAH BUSH LINCOLN HEALTH FOUNDATION

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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