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  5. OTIS ALLEN, M.D., S.C.

OTIS ALLEN, M.D., S.C.

Company Details

Entity Name: OTIS ALLEN, M.D., S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 13 Sep 1983
Company Number: CORP_53204716
File Number: 53204716
Type of Business: Business Corporations
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2018 371141678 2019-06-13 OTIS ALLEN, M.D., S.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2019-06-13
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-13
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2017 371141678 2018-07-31 OTIS ALLEN, M.D., S.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2018-07-31
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-31
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2016 371141678 2017-07-31 OTIS ALLEN, M.D., S.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2017-07-31
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-31
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2015 371141678 2016-08-16 OTIS ALLEN, M.D., S.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2016-08-16
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-08-16
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2014 371141678 2015-06-02 OTIS ALLEN, M.D., S.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2015-06-02
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-02
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2013 371141678 2014-07-22 OTIS ALLEN, M.D., S.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2014-07-22
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-22
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2012 371141678 2013-10-07 OTIS ALLEN, M.D., S.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2013-10-07
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-07
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2011 371141678 2012-10-16 OTIS ALLEN, M.D., S.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Plan administrator’s name and address
Administrator’s EIN 371141678
Plan administrator’s name OTIS ALLEN, M.D., S.C.
Plan administrator’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704
Administrator’s telephone number 3098273881

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2010 371141678 2011-07-27 OTIS ALLEN, M.D., S.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Plan administrator’s name and address
Administrator’s EIN 371141678
Plan administrator’s name OTIS ALLEN, M.D., S.C.
Plan administrator’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704
Administrator’s telephone number 3098273881

Signature of
Role Plan administrator
Date 2011-07-27
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature
OTIS ALLEN, M.D., S.C. 401(K) PROFIT-SHARING PLAN & TRUST 2009 371141678 2010-07-27 OTIS ALLEN, M.D., S.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-12-01
Business code 621111
Sponsor’s telephone number 3098273881
Plan sponsor’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704

Plan administrator’s name and address
Administrator’s EIN 371141678
Plan administrator’s name OTIS ALLEN, M.D., S.C.
Plan administrator’s address 1215 HOLIDAY LANE, BLOOMINGTON, IL, 61704
Administrator’s telephone number 3098273881

Signature of
Role Plan administrator
Date 2010-07-27
Name of individual signing OTIS ALLEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
OTIS ALLEN, 1215 HOLIDAY LANE, BLOOMINGTON, 61704, MC LEAN Agent 1999-03-02

President

Name and Address Role
OTIS ALLEN, 1015 S. MERCER AVEBLOOMINGTON, IL 61701 President

Secretary

Name and Address Role
MARGARET ALLEN, 1015 S. MERCERAVE, BLOOMINGTON, IL 61701 Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 1000 100000 No data

Related by officers

OTIS ALLEN, 1015 S. MERCER AVEBLOOMINGTON, IL 61701

INSTITUTE FOR PLASTIC SURGERY, LTD.

MARGARET ALLEN, 1015 S. MERCERAVE, BLOOMINGTON, IL 61701

INSTITUTE FOR PLASTIC SURGERY, LTD.

Related by address

No related companies by address

Date of last update: 13 Jan 2025

Sources: Illinois Office of the Secretary of State

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