SELECTCARE HEALTH, INC.

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

SELECTCARE HEALTH, INC.

2010

205980672

2010-06-03

SELECTCARE HEALTH, INC.

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2007-01-01
Business code	561300
Sponsor’s telephone number	8477689240
Plan sponsor’s address	1480 RENAISSANCE DRIVE SUITE 304, PARK RIDGE, IL, 600681354

Plan administrator’s name and address

Administrator’s EIN	205980672
Plan administrator’s name	SELECTCARE HEALTH, INC.
Plan administrator’s address	1480 RENAISSANCE DRIVE SUITE 304, PARK RIDGE, IL, 600681354
Administrator’s telephone number	8477689240

Signature of

Role	Plan administrator
Date	2010-06-03
Name of individual signing	JENNIFER LUEDTKE
Valid signature	Filed with authorized/valid electronic signature

SELECTCARE HEALTH EMPLOYEE SAVINGS PLAN

2009

205980672

2010-05-04

SELECTCARE HEALTH, INC.

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2007-01-01
Business code	561300
Sponsor’s telephone number	8477689240
Plan sponsor’s address	1480 RENAISSANCE DRIVE, SUITE 304, PARK RIDGE, IL, 60068

Plan administrator’s name and address

Administrator’s EIN	205980672
Plan administrator’s name	SELECTCARE HEALTH, INC.
Plan administrator’s address	1480 RENAISSANCE DRIVE, SUITE 304, PARK RIDGE, IL, 60068
Administrator’s telephone number	8477689240

Signature of

Role	Plan administrator
Date	2010-05-04
Name of individual signing	DIPEN DESAI
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2010-05-04
Name of individual signing	DIPEN DESAI
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
DIPEN DESAI, 4709 GOLF RD STE 812, SKOKIE, 60076, COOK-NOT IN CITY OF CHICAGO	Agent	2011-01-28

Name and Address	Role
ANKUR ROY, 1480 RENAISSANCE DR #304, PARK RIDGE, IL 60068	President

Class	Series	Voting Rights	Authorized Shares	Issued Shares	Par Value
COMMON STOCK	No data	Voting Rights	10000	999000	No data

Date of last update: 16 Jan 2025