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  5. FULLER-LEWIS GROCER & CLOTHING, INC.

FULLER-LEWIS GROCER & CLOTHING, INC.

Company Details

Entity Name: FULLER-LEWIS GROCER & CLOTHING, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Dissolved
Date Formed: 04 Aug 1994
Date of Dissolution: 10 Jan 2015
Company Number: CORP_57929871
File Number: 57929871
Type of Business: All Inclusive Purpose
Date Status Change: 10 Jan 2015
Address 3600 W 15TH ST 1ST, CHICAGO, IL, 60623
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JACK M. GIBSON, M. D., S. C. PROFIT SHARING PLAN 2012 371267441 2013-09-18 JACK M. GIBSON, M. D., S. C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-08-28
Business code 621111
Sponsor’s telephone number 3096712570
Plan sponsor’s address 900 MAIN STREET, SUITE 280, PEORIA, IL, 61602

Signature of
Role Plan administrator
Date 2013-09-18
Name of individual signing JACK M. GIBSON, M.D.
Valid signature Filed with authorized/valid electronic signature
JACK M. GIBSON, M. D., S. C. PROFIT SHARING PLAN 2011 371267441 2012-09-10 JACK M. GIBSON, M. D., S. C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-08-28
Business code 621111
Sponsor’s telephone number 3096712570
Plan sponsor’s address 900 MAIN STREET, SUITE 280, PEORIA, IL, 61602

Plan administrator’s name and address
Administrator’s EIN 371267441
Plan administrator’s name JACK M. GIBSON, M. D., S. C.
Plan administrator’s address 900 MAIN STREET, SUITE 280, PEORIA, IL, 61602
Administrator’s telephone number 3096712570

Signature of
Role Plan administrator
Date 2012-09-10
Name of individual signing JACK M. GIBSON, M.D.
Valid signature Filed with authorized/valid electronic signature
JACK M. GIBSON, M. D., S. C. PROFIT SHARING PLAN 2010 371267441 2011-10-03 JACK M. GIBSON, M. D., S. C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-08-28
Business code 621111
Sponsor’s telephone number 3096712570
Plan sponsor’s address 900 MAIN STREET, SUITE 280, PEORIA, IL, 61602

Plan administrator’s name and address
Administrator’s EIN 371267441
Plan administrator’s name JACK M. GIBSON, M. D., S. C.
Plan administrator’s address 900 MAIN STREET, SUITE 280, PEORIA, IL, 61602
Administrator’s telephone number 3096712570

Signature of
Role Plan administrator
Date 2011-10-03
Name of individual signing JACK M. GIBSON, M.D.
Valid signature Filed with authorized/valid electronic signature
JACK M. GIBSON, M. D., S. C. PROFIT SHARING PLAN 2009 371267441 2010-10-01 JACK M. GIBSON, M. D., S. C. 11
Three-digit plan number (PN) 001
Effective date of plan 1990-08-28
Business code 621111
Sponsor’s telephone number 3096712570
Plan sponsor’s address 900 MAIN STREET, SUITE 280, PEORIA, IL, 61602

Plan administrator’s name and address
Administrator’s EIN 371267441
Plan administrator’s name JACK M. GIBSON, M. D., S. C.
Plan administrator’s address 900 MAIN STREET, SUITE 280, PEORIA, IL, 61602
Administrator’s telephone number 3096712570

Signature of
Role Plan administrator
Date 2010-10-01
Name of individual signing ADRAINE CHAPMAN
Valid signature Filed with authorized/valid electronic signature
JACK M. GIBSON, M. D., S. C. PROFIT SHARING PLAN 2009 371267441 2010-10-01 JACK M. GIBSON, M. D., S. C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-08-28
Business code 621111
Sponsor’s telephone number 3096712570
Plan sponsor’s address 900 MAIN STREET, SUITE 280, PEORIA, IL, 61602

Plan administrator’s name and address
Administrator’s EIN 371267441
Plan administrator’s name JACK M. GIBSON, M. D., S. C.
Plan administrator’s address 900 MAIN STREET, SUITE 280, PEORIA, IL, 61602
Administrator’s telephone number 3096712570

Signature of
Role Plan administrator
Date 2010-10-01
Name of individual signing ADRAINE CHAPMAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
JOSEPH WILLARD EBERVEIN, 7366 N LINCOLN #400, LINCOLNWOOD, 60712, COOK-NOT IN CITY OF CHICAGO Agent 2001-08-02

President

Name and Address Role
RUBY HOOKER, 108 S MASON CHICAGO 60644 President

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM SERIES A Voting Rights 500 33000 No data
COMM SERIES B No Voting Rights 500 66000 No data

Related by officers

JOSEPH WILLARD EBERVEIN, 7366 N LINCOLN #400, LINCOLNWOOD, 60712, COOK-NOT IN CITY OF CHICAGO

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Related by address

No related companies by address

Date of last update: 27 Jan 2025

Sources: Illinois Office of the Secretary of State

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