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  5. KOZIOL-THOMS EYE ASSOCIATES, S.C.

KOZIOL-THOMS EYE ASSOCIATES, S.C.

Company Details

Entity Name: KOZIOL-THOMS EYE ASSOCIATES, S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 04 Jan 1985
Company Number: CORP_53701973
File Number: 53701973
Type of Business: Business Corporations
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KOZIOL-THOMS EYE ASSOCIATES, S.C., CASH OR DEFERRED PROFIT SHARING PLAN & TRUST 2014 363338174 2016-06-14 KOZIOL-THOMS EYE ASSOCIATES, S.C. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777
KOZIOL-THOMS EYE ASSOCIATES, S.C., CASH OR DEFERRED PROFIT SHARING PLAN & TRUST 2013 363338174 2015-07-13 KOZIOL-THOMS EYE ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777

Signature of
Role Plan administrator
Date 2015-07-13
Name of individual signing JEFFREY E. KOZIOL, M.D.
Valid signature Filed with authorized/valid electronic signature
KOZIOL-THOMS EYE ASSOCIATES, S.C., CASH OR DEFERRED PROFIT SHARING PLAN & TRUST 2012 363338174 2014-06-11 KOZIOL-THOMS EYE ASSOCIATES, S.C. 27
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777

Signature of
Role Plan administrator
Date 2014-06-11
Name of individual signing JEFFREY E. KOZIOL, M.D.
Valid signature Filed with authorized/valid electronic signature
KOZIOL-THOMS EYE ASSOCIATES, S.C. RETIREMENT PLAN & TRUST 2012 363338174 2014-06-11 KOZIOL-THOMS EYE ASSOCIATES, S.C. 25
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777

Signature of
Role Plan administrator
Date 2014-06-11
Name of individual signing JEFFREY E. KOZIOL, M.D.
Valid signature Filed with authorized/valid electronic signature
KOZIOL-THOMS EYE ASSOCIATES, S.C. RETIREMENT PLAN & TRUST 2011 363338174 2013-07-03 KOZIOL-THOMS EYE ASSOCIATES, S.C. 24
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777

Signature of
Role Plan administrator
Date 2013-07-03
Name of individual signing JEFFREY E. KOZIOL, M.D.
Valid signature Filed with authorized/valid electronic signature
KOZIOL-THOMS EYE ASSOCIATES, S.C., CASH OR DEFERRED PROFIT SHARING PLAN & TRUST 2011 363338174 2013-07-03 KOZIOL-THOMS EYE ASSOCIATES, S.C. 26
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777

Signature of
Role Plan administrator
Date 2013-07-03
Name of individual signing JEFFREY E. KOZIOL, M.D.
Valid signature Filed with authorized/valid electronic signature
KOZIOL-THOMS EYE ASSOCIATES, S.C. RETIREMENT PLAN & TRUST 2010 363338174 2012-09-04 KOZIOL-THOMS EYE ASSOCIATES, S.C. 26
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777

Signature of
Role Plan administrator
Date 2012-09-04
Name of individual signing JEFFREY E. KOZIOL, M.D.
Valid signature Filed with authorized/valid electronic signature
KOZIOL-THOMS EYE ASSOCIATES, S.C., CASH OR DEFERRED PROFIT SHARING PLAN & TRUST 2010 363338174 2012-09-04 KOZIOL-THOMS EYE ASSOCIATES, S.C. 28
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777

Signature of
Role Plan administrator
Date 2012-09-04
Name of individual signing JEFFREY E. KOZIOL, M.D.
Valid signature Filed with authorized/valid electronic signature
KOZIOL-THOMS EYE ASSOCIATES, S.C. RETIREMENT PLAN & TRUST 2009 363338174 2011-09-06 KOZIOL-THOMS EYE ASSOCIATES, S.C. 28
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777

Signature of
Role Plan administrator
Date 2011-09-06
Name of individual signing JEFFREY E. KOZIOL, M.D.
Valid signature Filed with authorized/valid electronic signature
KOZIOL-THOMS EYE ASSOCIATES, S.C., CASH OR DEFERRED PROFIT SHARING PLAN & TRUST 2009 363338174 2011-09-06 KOZIOL-THOMS EYE ASSOCIATES, S.C. 28
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-12-01
Business code 621111
Sponsor’s telephone number 8472592777
Plan sponsor’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142

Plan administrator’s name and address
Administrator’s EIN 363338174
Plan administrator’s name KOZIOL-THOMS EYE ASSOCIATES, S.C.
Plan administrator’s address 1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
Administrator’s telephone number 8472592777

Signature of
Role Plan administrator
Date 2011-09-06
Name of individual signing JEFFREY E. KOZIOL, M.D.
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 2017-10-10

President

Name and Address Role
MONICA THOMS, M.D. 1211 S. ARLINGTON HEIGHTS ROAD President

Secretary

Name and Address Role
MONICA THOMS, M.D., ADDRESS ARLINGTON HEIGHTS, IL, 60005 Secretary

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
ADVANCED EYE CARE SPECIALISTS No data 1997-10-20 2009-05-28 Voluntary Cancellation No data
ADVANCED EYE CARE OPTICAL Assume Name 1997-10-20 No data No data No data

Historical Names

Name Change Date
JEFFREY E. KOZIOL, M.D., S.C. 2003-07-22
JEFFREY E. KOZIOL, LTD. 1985-02-27

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 1000 1000000 No data

Related by officers

C T CORPORATION SYSTEM, 208 SO LASALLE ST, SUITE 814, CHICAGO, 60604, COOK-NOT IN CITY OF CHICAGO

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Related by address

No related companies by address

Date of last update: 23 Jan 2025

Sources: Illinois Office of the Secretary of State

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