| Entity Name: | LAUREEN L. AMBROSE, M.D., S.C. |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Domestic BCA |
| Status: | Dissolved |
| Date Formed: | 01 Oct 1984 |
| Date of Dissolution: | 13 Mar 2015 |
| Company Number: | CORP_53596819 |
| File Number: | 53596819 |
| Type of Business: | Incorporated under the Medical Corporation Act |
| Date Status Change: | 13 Mar 2015 |
| Place of Formation: | ILLINOIS |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAUREEN L. AMBROSE M.D. S.C. PENSION PLAN & TRUST | 2011 | 363320772 | 2013-01-25 | LAUREEN L. AMBROSE M.D. S.C. | 6 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 363320772 |
| Plan administrator’s name | LAUREEN L. AMBROSE M.D. S.C. |
| Plan administrator’s address | 15300 WEST AVE. STE 205, ORLAND PARK, IL, 60462 |
| Administrator’s telephone number | 7084606100 |
Signature of
| Role | Plan administrator |
| Date | 2013-01-25 |
| Name of individual signing | LAUREEN L. AMBROSE, M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1984-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7084606100 |
| Plan sponsor’s address | 15300 WEST AVE. STE 205, ORLAND PARK, IL, 60462 |
Plan administrator’s name and address
| Administrator’s EIN | 363320772 |
| Plan administrator’s name | LAUREEN L. AMBROSE M.D. S.C. |
| Plan administrator’s address | 15300 WEST AVE. STE 205, ORLAND PARK, IL, 60462 |
| Administrator’s telephone number | 7084606100 |
Signature of
| Role | Plan administrator |
| Date | 2011-12-07 |
| Name of individual signing | LAUREEN L. AMBROSE, M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1984-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7084606100 |
| Plan sponsor’s address | 15300 WEST AVE. STE 205, ORLAND PARK, IL, 60462 |
Plan administrator’s name and address
| Administrator’s EIN | 363320772 |
| Plan administrator’s name | LAUREEN L. AMBROSE M.D. S.C. |
| Plan administrator’s address | 15300 WEST AVE. STE 205, ORLAND PARK, IL, 60462 |
| Administrator’s telephone number | 7084606100 |
Signature of
| Role | Plan administrator |
| Date | 2011-06-15 |
| Name of individual signing | LAUREEN L. AMBROSE, M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| RICHARD E BURKE, 14475 JOHN HUMPHREY DR STE 200, ORLAND PARK, 60462, COOK-NOT IN CITY OF CHICAGO | Agent | 2010-08-06 |
| Name and Address | Role |
|---|---|
| LAUREEN L AMBROSE, 15300 W AVE ORLAND PARK 60463 | President |
| Class | Series | Voting Rights | Authorized Shares | Issued Shares | Par Value |
|---|---|---|---|---|---|
| COMMON | No data | Voting Rights | 10000 | 1000000 | No data |
Date of last update: 20 Jan 2025
