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  5. LAKE SHORE INTERNAL MEDICINE S.C.

LAKE SHORE INTERNAL MEDICINE S.C.

Company Details

Entity Name: LAKE SHORE INTERNAL MEDICINE S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Dissolved
Date Formed: 06 Oct 2000
Date of Dissolution: 13 Mar 2015
Company Number: CORP_61279474
File Number: 61279474
Type of Business: Incorporated under the Medical Corporation Act
Date Status Change: 13 Mar 2015
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKE SHORE INTERNAL MEDICINE P.C., PROFIT SHARING 401 (K) PLAN 2015 364396539 2016-10-11 LAKE SHORE INTERNAL MEDICINE, P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 621111
Sponsor’s telephone number 8475439600
Plan sponsor’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031
LAKE SHORE INTERNAL MEDICINE P.C., PROFIT SHARING 401 (K) PLAN 2014 364396539 2015-10-15 LAKE SHORE INTERNAL MEDICINE, P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 621111
Sponsor’s telephone number 8475439600
Plan sponsor’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031
LAKE SHORE INTERNAL MEDICINE P.C., PROFIT SHARING 401 (K) PLAN 2013 364396539 2014-10-13 LAKE SHORE INTERNAL MEDICINE, P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 621111
Sponsor’s telephone number 8475439600
Plan sponsor’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031
LAKE SHORE INTERNAL MEDICINE P.C., PROFIT SHARING 401 (K) PLAN 2012 364396539 2013-10-15 LAKE SHORE INTERNAL MEDICINE, P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 621111
Sponsor’s telephone number 8475439600
Plan sponsor’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing RAJESH K. SHARMA, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-15
Name of individual signing RAJESH K. SHARMA, M.D.
Valid signature Filed with authorized/valid electronic signature
LAKE SHORE INTERNAL MEDICINE P.C., PROFIT SHARING 401 (K) PLAN 2011 364396539 2012-10-11 LAKE SHORE INTERNAL MEDICINE, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 621111
Sponsor’s telephone number 8475439600
Plan sponsor’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031

Plan administrator’s name and address
Administrator’s EIN 364396539
Plan administrator’s name LAKE SHORE INTERNAL MEDICINE, P.C.
Plan administrator’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031
Administrator’s telephone number 8475439600

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing RAJESH K. SHARMA, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-11
Name of individual signing RAJESH K. SHARMA, M.D.
Valid signature Filed with authorized/valid electronic signature
LAKE SHORE INTERNAL MEDICINE P.C., PROFIT SHARING 401 (K) PLAN 2010 364396539 2011-10-07 LAKE SHORE INTERNAL MEDICINE, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 621111
Sponsor’s telephone number 8475439600
Plan sponsor’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031

Plan administrator’s name and address
Administrator’s EIN 364396539
Plan administrator’s name LAKE SHORE INTERNAL MEDICINE, P.C.
Plan administrator’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031
Administrator’s telephone number 8475439600

Signature of
Role Plan administrator
Date 2011-10-07
Name of individual signing RAJESH K. SHARMA, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-07
Name of individual signing RAJESH K. SHARMA, M.D.
Valid signature Filed with authorized/valid electronic signature
LAKE SHORE INTERNAL MEDICINE P.C., PROFIT SHARING 401 (K) PLAN 2009 364396539 2010-10-08 LAKE SHORE INTERNAL MEDICINE, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-07-01
Business code 621111
Sponsor’s telephone number 8475439600
Plan sponsor’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031

Plan administrator’s name and address
Administrator’s EIN 364396539
Plan administrator’s name LAKE SHORE INTERNAL MEDICINE, P.C.
Plan administrator’s address 7505 W. GRAND AVENUE, GURNEE, IL, 60031
Administrator’s telephone number 8475439600

Signature of
Role Plan administrator
Date 2010-10-08
Name of individual signing RAJESH K. SHARMA, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-08
Name of individual signing RAJESH K. SHARMA, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
PARU SHARMA, 7505 W GRAND AVE, GURNEE, 60031, LAKE Agent 2010-07-20

President

Name and Address Role
PARU SHARMA, 7505 W GRAND AVE, GURNEE, 60031 President

Historical Names

Name Change Date
LAKE SHORE INTERNAL MEDICINE, P.C. 2008-06-09
PARU K. SHARMA, M.D., P.C. 2004-12-14

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 1000 100000 No data

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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