Entity Name: | FAMILY MEDICINE OF COLUMBIA, LTD. |
Jurisdiction: | Illinois |
Entity Type: | Corporation - Domestic BCA |
Status: | Dissolved |
Date Formed: | 01 Nov 2000 |
Date of Dissolution: | 26 Oct 2011 |
Company Number: | CORP_61316299 |
File Number: | 61316299 |
Type of Business: | Incorporated under the Medical Corporation Act |
Date Status Change: | 26 Oct 2011 |
Place of Formation: | ILLINOIS |
Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
FAMILY MEDICINE OF COLUMBIA, LTD. 401K PLAN | 2013 | 371403747 | 2014-07-22 | FAMILY MEDICINE OF COLUMBIA, LTD. | 2 | |||||||||||||||||||||||||||||||||||||||||
|
Role | Plan administrator |
Date | 2014-07-22 |
Name of individual signing | KRYSTYNA WASIAK |
Valid signature | Filed with authorized/valid electronic signature |
Role | Employer/plan sponsor |
Date | 2014-07-22 |
Name of individual signing | KRYSTYNA WASIAK |
Valid signature | Filed with authorized/valid electronic signature |
File | View Page |
Three-digit plan number (PN) | 001 |
Effective date of plan | 2008-06-01 |
Business code | 621111 |
Sponsor’s telephone number | 6182812233 |
Plan sponsor’s address | 13 RED FOX ROAD, BELLEVILLE, IL, 62223 |
Signature of
Role | Plan administrator |
Date | 2013-07-30 |
Name of individual signing | KRYSTYNA WASIAK |
Valid signature | Filed with authorized/valid electronic signature |
Role | Employer/plan sponsor |
Date | 2013-07-30 |
Name of individual signing | KRYSTYNA WASIAK |
Valid signature | Filed with authorized/valid electronic signature |
File | View Page |
Three-digit plan number (PN) | 001 |
Effective date of plan | 2008-06-01 |
Business code | 621111 |
Sponsor’s telephone number | 6182812233 |
Plan sponsor’s address | 13 RED FOX ROAD, BELLEVILLE, IL, 62223 |
Plan administrator’s name and address
Administrator’s EIN | 371403747 |
Plan administrator’s name | FAMILY MEDICINE OF COLUMBIA, LTD. |
Plan administrator’s address | 13 RED FOX ROAD, BELLEVILLE, IL, 62223 |
Administrator’s telephone number | 6182812233 |
Signature of
Role | Plan administrator |
Date | 2012-07-03 |
Name of individual signing | KRYSTYNA WASIAK |
Valid signature | Filed with authorized/valid electronic signature |
Role | Employer/plan sponsor |
Date | 2012-07-03 |
Name of individual signing | KRYSTYNA WASIAK |
Valid signature | Filed with authorized/valid electronic signature |
File | View Page |
Three-digit plan number (PN) | 001 |
Effective date of plan | 2008-06-01 |
Business code | 621111 |
Sponsor’s telephone number | 6182812233 |
Plan sponsor’s address | 123 WEDGEWOOD DRIVE, COLUMBIA, IL, 622362561 |
Plan administrator’s name and address
Administrator’s EIN | 371403747 |
Plan administrator’s name | FAMILY MEDICINE OF COLUMBIA LTD |
Plan administrator’s address | 123 WEDGEWOOD DRIVE, COLUMBIA, IL, 622362561 |
Administrator’s telephone number | 6182812233 |
Signature of
Role | Plan administrator |
Date | 2011-06-27 |
Name of individual signing | ANDRZEJ J. WASIAK |
Valid signature | Filed with authorized/valid electronic signature |
Role | Employer/plan sponsor |
Date | 2011-06-27 |
Name of individual signing | ANDRZEJ J. WASIAK |
Valid signature | Filed with authorized/valid electronic signature |
Name and Address | Role | Appointment Date |
---|---|---|
ANDRZEJ J WASIAK, 13 RED FOX RD, BELLEVILLE, 62223, ST. CLAIR | Agent | 2000-11-01 |
Name and Address | Role |
---|---|
ANDRZEJ J WASIAK 13 RED FOX ROAD BELLEVILLE 62223 | President |
License Type | License Number | Status | License Code | License Description | Business Activity | Date Issued | Effective Date | Expiration Date |
---|---|---|---|---|---|---|---|---|
MEDICAL CORP | 042617235 | No data | No data | REGISTERED MEDICAL CORPORATION | No data | 2000-11-17 | 2010-09-17 | 2012-01-01 |
Class | Series | Voting Rights | Authorized Shares | Issued Shares | Par Value |
---|---|---|---|---|---|
COMMON | No data | Voting Rights | 1000 | 100000 | No data |
Date of last update: 23 Jan 2025