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  5. LAKE FOREST EAR NOSE THROAT, LTD.

LAKE FOREST EAR NOSE THROAT, LTD.

Company Details

Entity Name: LAKE FOREST EAR NOSE THROAT, LTD.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Dissolved
Date Formed: 20 Jan 1989
Date of Dissolution: 27 Dec 2017
Company Number: CORP_55377243
File Number: 55377243
Type of Business: Incorporated under the Medical Corporation Act
Date Status Change: 27 Dec 2017
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKE FOREST EAR NOSE & THROAT, LTD. PROFIT SHARING PLAN 2012 363622203 2013-05-07 LAKE FOREST EAR NOSE & THROAT, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-03-31
Business code 621111
Sponsor’s telephone number 8472951150
Plan sponsor’s address 700 WESTMORELAND BUILDING F, LAKE FOREST, IL, 60056

Signature of
Role Plan administrator
Date 2013-05-07
Name of individual signing LESLIE J. BLOCK, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-07
Name of individual signing LESLIE J. BLOCK, M.D.
Valid signature Filed with authorized/valid electronic signature
LAKE FOREST EAR NOSE & THROAT, LTD. PROFIT SHARING PLAN 2012 363622203 2013-09-04 LAKE FOREST EAR NOSE & THROAT, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-03-31
Business code 621111
Sponsor’s telephone number 8472951150
Plan sponsor’s address 700 WESTMORELAND BUILDING F, LAKE FOREST, IL, 60056

Signature of
Role Plan administrator
Date 2013-09-03
Name of individual signing LESLIE J. BLOCK, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-03
Name of individual signing LESLIE J. BLOCK, M.D.
Valid signature Filed with authorized/valid electronic signature
LAKE FOREST EAR NOSE & THROAT, LTD. PROFIT SHARING PLAN 2011 363622203 2012-06-04 LAKE FOREST EAR NOSE & THROAT, LTD. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-03-31
Business code 621111
Sponsor’s telephone number 8472951114
Plan sponsor’s address 700 WESTMORELAND BUILDING F, LAKE FOREST, IL, 60056

Plan administrator’s name and address
Administrator’s EIN 363622203
Plan administrator’s name LAKE FOREST EAR NOSE & THROAT, LTD.
Plan administrator’s address 700 WESTMORELAND BUILDING F, LAKE FOREST, IL, 60056
Administrator’s telephone number 8472951114

Signature of
Role Plan administrator
Date 2012-06-04
Name of individual signing LESLIE J. BLOCK, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-04
Name of individual signing LESLIE J. BLOCK, M.D.
Valid signature Filed with authorized/valid electronic signature
LAKE FOREST EAR NOSE & THROAT, LTD. PROFIT SHARING PLAN 2010 363622203 2011-05-20 LAKE FOREST EAR NOSE & THROAT, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-03-31
Business code 621111
Sponsor’s telephone number 8472951114
Plan sponsor’s address 700 WESTMORELAND BUILDING F, LAKE FOREST, IL, 60056

Plan administrator’s name and address
Administrator’s EIN 363622203
Plan administrator’s name LAKE FOREST EAR NOSE & THROAT, LTD.
Plan administrator’s address 700 WESTMORELAND BUILDING F, LAKE FOREST, IL, 60056
Administrator’s telephone number 8472951114

Signature of
Role Plan administrator
Date 2011-05-20
Name of individual signing LESLIE J. BLOCK, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-20
Name of individual signing LESLIE J. BLOCK, M.D.
Valid signature Filed with authorized/valid electronic signature
LAKE FOREST EAR NOSE & THROAT, LTD. PROFIT SHARING PLAN 2009 363622203 2010-06-22 LAKE FOREST EAR NOSE & THROAT, LTD. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-03-31
Business code 621111
Sponsor’s telephone number 8472951114
Plan sponsor’s address 700 WESTMORELAND BUILDING F, LAKE FOREST, IL, 60056

Plan administrator’s name and address
Administrator’s EIN 363622203
Plan administrator’s name LAKE FOREST EAR NOSE & THROAT, LTD.
Plan administrator’s address 700 WESTMORELAND BUILDING F, LAKE FOREST, IL, 60056
Administrator’s telephone number 8472951114

Signature of
Role Plan administrator
Date 2010-06-21
Name of individual signing LESLIE J BLOCK M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-06-21
Name of individual signing LESLIE J. BLOCK, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
BENTON C STRAUSS, 135 REVERE DR, NORTHBROOK, 60062, COOK-NOT IN CITY OF CHICAGO Agent 2003-08-07

President

Name and Address Role
LESLIE J BLOCK 2700 QUAIL LN NORTHBROOK IL 60062 President

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
MEDICAL CORP 042006538 No data No data REGISTERED MEDICAL CORPORATION No data 1989-06-13 2017-03-07 2018-01-01

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
NORTHWESTERN LAKE FOREST EAR NOSE & THROAT, LTD. No data 2010-02-16 2013-01-02 Voluntary Cancellation No data
LAKE FOREST EAR, NOSE & THROAT, LTD. No data 1992-03-20 1995-01-26 Voluntary Cancellation No data

Historical Names

Name Change Date
LESLIE J. BLOCK, M.D., S.C. 1995-01-27

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 500 500000 No data

Related by officers

BENTON C STRAUSS, 135 REVERE DR, NORTHBROOK, 60062, COOK-NOT IN CITY OF CHICAGO

CAROL M. JACOBSOHN FOUNDATION ROGER AND SUSAN STONE FAMILY FOUNDATION BRENNAN STEEL, INC. NICHOLAS BRENT CORWIN FOUNDATION BMVA LLC HENNESSY COMMUNICATIONS, LLC RBF BRIERHILL LLC AI & JL PROPERTIES, LLC HELEN V. BROWN FAMILY LLC SHIRLEY MARX FAMILY LLC

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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