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  5. LALIBELA, INC.

LALIBELA, INC.

Company Details

Entity Name: LALIBELA, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Dissolved
Date Formed: 27 Dec 2000
Date of Dissolution: 11 May 2012
Company Number: CORP_61390502
File Number: 61390502
Type of Business: All Inclusive Purpose
Date Status Change: 11 May 2012
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HAROLD JAIMES, M.D., P.C. 401(K) PLAN 2012 364045357 2013-10-01 HAROLD JAIMES, M.D., P.C. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 7733954600
Plan sponsor’s address 3153 WEST FULLERTON AVENUE, CHICAGO, IL, 60647

Signature of
Role Plan administrator
Date 2013-10-01
Name of individual signing HAROLD JAIMES
Valid signature Filed with authorized/valid electronic signature
HAROLD JAIMES, M.D., P.C. 401(K) PLAN 2011 364045357 2012-06-07 HAROLD JAIMES, M.D., P.C. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 7733954600
Plan sponsor’s address 3153 WEST FULLERTON AVENUE, CHICAGO, IL, 60647

Plan administrator’s name and address
Administrator’s EIN 364045357
Plan administrator’s name HAROLD JAIMES, M.D., P.C.
Plan administrator’s address 3153 WEST FULLERTON AVENUE, CHICAGO, IL, 60647
Administrator’s telephone number 7733954600

Signature of
Role Plan administrator
Date 2012-06-07
Name of individual signing HAROLD JAIMES
Valid signature Filed with authorized/valid electronic signature
HAROLD JAIMES, M.D. P.C. 401(K) PLAN 2010 364045357 2011-07-13 HAROLD JAIMES, M.D. P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 7733954600
Plan sponsor’s address 3153 W. FULLERTON AVE., CHICAGO, IL, 606472809

Plan administrator’s name and address
Administrator’s EIN 364045357
Plan administrator’s name HAROLD JAIMES, M.D. P.C.
Plan administrator’s address 3153 W. FULLERTON AVE., CHICAGO, IL, 606472809
Administrator’s telephone number 7733954600

Signature of
Role Plan administrator
Date 2011-07-13
Name of individual signing HAROLD JAIMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-13
Name of individual signing HAROLD JAIMES
Valid signature Filed with authorized/valid electronic signature
HAROLD JAIMES, M.D. P.C. 401(K) PLAN 2009 364045357 2010-10-08 HAROLD JAIMES, M.D. P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 7733954600
Plan sponsor’s address 3153 W. FULLERTON AVE., CHICAGO, IL, 606472809

Plan administrator’s name and address
Administrator’s EIN 364045357
Plan administrator’s name HAROLD JAIMES, M.D. P.C.
Plan administrator’s address 3153 W. FULLERTON AVE., CHICAGO, IL, 606472809
Administrator’s telephone number 7733954600

Signature of
Role Plan administrator
Date 2010-10-08
Name of individual signing HAROLD JAIMES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-08
Name of individual signing HAROLD JAIMES
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
AMANUEL T YITAGESV, 1210 W GRANVILLE 107-W, CHICAGO, 60660, COOK-NOT IN CITY OF CHICAGO Agent 2010-03-17

President

Name and Address Role
TEREFE BEYENE, 1723 W THOME CHICAGO 60660 President

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 1000 100000 10

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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