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ARLINGTON DERMATOLOGY, S.C.

Company Details

Entity Name: ARLINGTON DERMATOLOGY, S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 25 Jun 1970
Company Number: CORP_49682093
File Number: 49682093
Type of Business: Incorporated under the Medical Corporation Act
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
J58EFLDAH4U5 2025-01-14 5301 KEYSTONE CT, ROLLING MEADOWS, IL, 60008, 3811, USA 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008, 3811, USA

Business Information

Doing Business As AFF NORTHWEST COMMUNITY HOSPITAL INC
URL www.arlingtondermatology.net
Division Name ARLINGTON DERMATOLOGY SC
Congressional District 08
State/Country of Incorporation IL, USA
Activation Date 2024-01-15
Initial Registration Date 2016-05-24
Entity Start Date 1968-05-01
Fiscal Year End Close Date Dec 31

Points of Contacts

Electronic Business
Title PRIMARY POC
Name URSULA CHOLEWA
Address 5301 KEYSTONE CT, ROLLING MEADOWS, IL, 60008, USA
Government Business
Title PRIMARY POC
Name URSULA CHOLEWA
Address 5301 KEYSTONE CT, ROLLING MEADOWS, IL, 60008, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ARLINGTON DERMATOLOGY, S.C. CASH BALANCE PENSION PLAN 2023 362696189 2024-07-08 ARLINGTON DERMATOLOGY, S.C. 22
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8473925440
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008

Signature of

Role Plan administrator
Date 2024-07-08
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-08
Name of individual signing MICHAEL BUKHALO
Valid signature Filed with authorized/valid electronic signature
ARLINGTON DERMATOLOGY, S.C. 401(K) PROFIT SHARING PLAN 2023 362696189 2024-05-10 ARLINGTON DERMATOLOGY, S.C. 38
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 2242328097
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008

Signature of

Role Plan administrator
Date 2024-05-10
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-05-10
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
ARLINGTON DERMATOLOGY, S.C. 401(K) PROFIT SHARING PLAN 2022 362696189 2023-09-11 ARLINGTON DERMATOLOGY, S.C. 34
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 2242328097
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008
ARLINGTON DERMATOLOGY, S.C. CASH BALANCE PENSION PLAN 2022 362696189 2023-10-02 ARLINGTON DERMATOLOGY, S.C. 23
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8473925440
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008

Signature of

Role Plan administrator
Date 2023-10-02
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-02
Name of individual signing MICHAEL BUKHALO
Valid signature Filed with authorized/valid electronic signature
ARLINGTON DERMATOLOGY, S.C. CASH BALANCE PENSION PLAN 2021 362696189 2022-10-04 ARLINGTON DERMATOLOGY, S.C. 25
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8473925440
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008

Signature of

Role Plan administrator
Date 2022-10-04
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-04
Name of individual signing MICHAEL BUKHALO
Valid signature Filed with authorized/valid electronic signature
ARLINGTON DERMATOLOGY, S.C. 401(K) PROFIT SHARING PLAN 2021 362696189 2022-07-15 ARLINGTON DERMATOLOGY, S.C. 33
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 2242328097
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008

Signature of

Role Plan administrator
Date 2022-07-15
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-15
Name of individual signing MICHAEL BUKHALO
Valid signature Filed with authorized/valid electronic signature
ARLINGTON DERMATOLOGY, S.C. CASH BALANCE PENSION PLAN 2020 362696189 2021-08-25 ARLINGTON DERMATOLOGY, S.C. 24
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8473925440
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008

Signature of

Role Plan administrator
Date 2021-04-10
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-10
Name of individual signing MICHAEL BUKHALO
Valid signature Filed with authorized/valid electronic signature
ARLINGTON DERMATOLOGY, S.C. CASH BALANCE PENSION PLAN 2020 362696189 2021-04-10 ARLINGTON DERMATOLOGY, S.C. 24
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8473925440
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008

Signature of

Role Plan administrator
Date 2021-04-10
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-10
Name of individual signing MICHAEL BUKHALO
Valid signature Filed with authorized/valid electronic signature
ARLINGTON DERMATOLOGY, S.C. 401(K) PROFIT SHARING PLAN 2020 362696189 2021-04-26 ARLINGTON DERMATOLOGY, S.C. 32
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2001-08-01
Business code 621111
Sponsor’s telephone number 2242328097
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008

Signature of

Role Plan administrator
Date 2021-04-26
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-26
Name of individual signing MICHAEL BUKHALO
Valid signature Filed with authorized/valid electronic signature
ARLINGTON DERMATOLOGY, S.C. CASH BALANCE PENSION PLAN 2019 362696189 2020-07-11 ARLINGTON DERMATOLOGY, S.C. 32
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8473925440
Plan sponsor’s address 5301 KEYSTONE COURT, ROLLING MEADOWS, IL, 60008

Signature of

Role Plan administrator
Date 2020-07-11
Name of individual signing MICHAEL BUKHALO, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-11
Name of individual signing MICHAEL BUKHALO
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
C T CORPORATION SYSTEM, 208 SO LASALLE ST, SUITE 814, CHICAGO, 60604, COOK-NOT IN CITY OF CHICAGO Agent 2018-03-01

President

Name and Address Role
MICHAEL BUKHALO MD 5301 KEYSTONE CT ROLLING MEADOWS IL 60008 President

Secretary

Name and Address Role
MICHAEL BUKHALO MD 5301 KEYSTONE CT ROLLING MEADOWS IL 60008 Secretary

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
ALTMAN DERMATOLOGICAL ASSOCIATES, INC. No data 1995-06-05 2001-08-16 Voluntary Cancellation No data

Historical Names

Name Change Date
ALTMAN DERMATOLOGY ASSOCIATES, S.C. 2016-02-12
ARTHUR T. ALTMAN M.D. S.C. 2001-08-16

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 5000 5000000 1

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State