| Entity Name: | NORTHERN ILLINOIS RETINA, LTD. |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Domestic BCA |
| Status: | Goodstanding |
| Date Formed: | 31 Oct 1990 |
| Company Number: | CORP_56157298 |
| File Number: | 56157298 |
| Type of Business: | Incorporated under the Medical Corporation Act |
| Place of Formation: | ILLINOIS |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTHERN ILLINOIS RETINA VIP PROFIT SHARING PLAN | 2022 | 363734974 | 2023-06-29 | NORTHERN ILLINOIS RETINA, LTD. | 17 | |||||||||||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2023-06-29 |
| Name of individual signing | SHAUNA DOWLING |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1994-01-01 |
| Business code | 525100 |
| Sponsor’s telephone number | 8152264990 |
| Plan sponsor’s address | 1235 N MULFORD RD, SUITE100, ROCKFORD, IL, 61107 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-11 |
| Name of individual signing | SHAUNA DOWLING |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1994-01-01 |
| Business code | 525100 |
| Sponsor’s telephone number | 8152264990 |
| Plan sponsor’s address | 4855 EAST STATE STREET-SUITE 20, ROCKFORD, IL, 61108 |
Plan administrator’s name and address
| Administrator’s EIN | 363734974 |
| Plan administrator’s name | NORTHERN ILLINOIS RETINA, LTD. |
| Plan administrator’s address | 4855 EAST STATE STREET-SUITE 20, ROCKFORD, IL, 61108 |
| Administrator’s telephone number | 8152264990 |
Signature of
| Role | Plan administrator |
| Date | 2011-08-24 |
| Name of individual signing | SUSAN FLOSI |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1994-01-01 |
| Business code | 525100 |
| Sponsor’s telephone number | 8152264990 |
| Plan sponsor’s address | 4855 EAST STATE STREET-SUITE 20, ROCKFORD, IL, 61108 |
Plan administrator’s name and address
| Administrator’s EIN | 363734974 |
| Plan administrator’s name | NORTHERN ILLINOIS RETINA, LTD. |
| Plan administrator’s address | 4855 EAST STATE STREET-SUITE 20, ROCKFORD, IL, 61108 |
| Administrator’s telephone number | 8152264990 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-04 |
| Name of individual signing | SUSAN FLOSI |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| SUSAN M FOWELL, 1235 N MULFORD RD, STE 100, ROCKFORD, 61107, WINNEBAGO | Agent | 2015-12-17 |
| Name and Address | Role |
|---|---|
| SUSAN M FOWELL 1235 N MULFORDRD STE 100 ROCKFORD, IL 61107 | President |
| Name and Address | Role |
|---|---|
| SUSAN M FOWELL | Secretary |
| License Type | License Number | Status | License Code | License Description | Business Activity | Date Issued | Effective Date | Expiration Date |
|---|---|---|---|---|---|---|---|---|
| MEDICAL CORP | 042006794 | No data | No data | REGISTERED MEDICAL CORPORATION | No data | 1991-01-29 | 2024-09-05 | 2025-01-01 |
| Class | Series | Voting Rights | Authorized Shares | Issued Shares | Par Value |
|---|---|---|---|---|---|
| COMM | No data | Voting Rights | 100000 | 1000000 | No data |
Date of last update: 16 Jan 2025
