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FAMILY MEDICINE OF COLUMBIA, LTD.

Company Details

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

form 5500

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
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 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
FAMILY MEDICINE OF COLUMBIA, LTD. 401K PLAN 2012 371403747 2013-07-30 FAMILY MEDICINE OF COLUMBIA, LTD. 2
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
FAMILY MEDICINE OF COLUMBIA, LTD. 401K PLAN 2011 371403747 2012-07-03 FAMILY MEDICINE OF COLUMBIA, LTD. 3
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
FAMILY MEDICINE OF COLUMBIA LTD 401K PLAN 2010 371403747 2011-06-27 FAMILY MEDICINE OF COLUMBIA LTD 3
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

Agent

Name and Address Role Appointment Date
ANDRZEJ J WASIAK, 13 RED FOX RD, BELLEVILLE, 62223, ST. CLAIR Agent 2000-11-01

President

Name and Address Role
ANDRZEJ J WASIAK 13 RED FOX ROAD BELLEVILLE 62223 President

License

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

Shares

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

Sources: Illinois Office of the Secretary of State