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  5. SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES, LTD.

SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES, LTD.

Company Details

Entity Name: SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES, LTD.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 25 Nov 2008
Company Number: CORP_66290077
File Number: 66290077
Type of Business: Incorporated under the Professional Service Corporation Act
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SAFEWORKS ILLINOIS 401(K) PLAN 2023 263776766 2024-06-20 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES, LTD. 25
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET ST., CHAMPAIGN, IL, 61822

Signature of
Role Plan administrator
Date 2024-06-17
Name of individual signing DR. DAVID J. FLETCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-06-17
Name of individual signing MATTHEW DILLON
Valid signature Filed with authorized/valid electronic signature
SAFEWORKS ILLINOIS 401(K) PLAN 2022 263776766 2023-06-22 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES, LTD. 28
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET ST., CHAMPAIGN, IL, 61822

Signature of
Role Plan administrator
Date 2023-06-22
Name of individual signing DR. DAVID J. FLETCHER
Valid signature Filed with authorized/valid electronic signature
SAFEWORKS ILLINOIS 401(K) PLAN 2021 263776766 2022-07-20 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES, LTD. 26
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET ST., CHAMPAIGN, IL, 61822

Signature of
Role Plan administrator
Date 2022-07-20
Name of individual signing DR. DAVID J. FLETCHER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-20
Name of individual signing MATT DILLON
Valid signature Filed with authorized/valid electronic signature
SAFEWORKS ILLINOIS 401(K) PLAN 2020 263776766 2021-06-16 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES, LTD. 31
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET ST., CHAMPAIGN, IL, 61822

Signature of
Role Plan administrator
Date 2021-06-16
Name of individual signing DR. DAVID J. FLETCHER
Valid signature Filed with authorized/valid electronic signature
SAFEWORKS ILLINOIS 401(K) PLAN 2019 263776766 2020-08-24 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES, LTD. 30
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET ST., CHAMPAIGN, IL, 61822

Signature of
Role Plan administrator
Date 2020-08-24
Name of individual signing DR. DAVID J. FLETCHER
Valid signature Filed with authorized/valid electronic signature
SAFEWORKS ILLINOIS 401(K) PLAN 2018 263776766 2019-07-17 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES, LTD. 36
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET ST., CHAMPAIGN, IL, 61822

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing DR. DAVID J. FLETCHER
Valid signature Filed with authorized/valid electronic signature
SAFEWORKS ILLINOIS 401K PLAN 2017 263776766 2018-07-24 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES LTD 35
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET STREET, CHAMPAIGN, IL, 61822

Plan administrator’s name and address
Administrator’s EIN 263776766
Plan administrator’s name SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES LTD
Plan administrator’s address 1806 N MARKET STREET, CHAMPAIGN, IL, 61822
Administrator’s telephone number 2173566150

Signature of
Role Plan administrator
Date 2018-07-24
Name of individual signing DAVID FLETCHER
Valid signature Filed with authorized/valid electronic signature
SAFEWORKS ILLINOIS 401K PLAN 2016 263776766 2017-07-28 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES LTD 25
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET STREET, CHAMPAIGN, IL, 61822

Plan administrator’s name and address
Administrator’s EIN 263776766
Plan administrator’s name SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES LTD
Plan administrator’s address 1806 N MARKET STREET, CHAMPAIGN, IL, 61822
Administrator’s telephone number 2173566150

Signature of
Role Plan administrator
Date 2017-07-28
Name of individual signing DAVID FLETCHER
Valid signature Filed with authorized/valid electronic signature
SAFEWORKS ILLINOIS 401K PLAN 2015 263776766 2016-07-08 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES LTD 28
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET STREET, CHAMPAIGN, IL, 61822

Plan administrator’s name and address
Administrator’s EIN 263776766
Plan administrator’s name SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES LTD
Plan administrator’s address 1806 N MARKET STREET, CHAMPAIGN, IL, 61822
Administrator’s telephone number 2173566150

Signature of
Role Plan administrator
Date 2016-07-08
Name of individual signing DAVID FLETCHER
Valid signature Filed with authorized/valid electronic signature
SAFEWORKS ILLINOIS 401K PLAN 2014 263776766 2015-07-13 SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES LTD 27
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 2173566150
Plan sponsor’s address 1806 N MARKET STREET, CHAMPAIGN, IL, 61822

Plan administrator’s name and address
Administrator’s EIN 263776766
Plan administrator’s name SAFEWORKS ILLINOIS OCCUPATIONAL HEALTH SERVICES LTD
Plan administrator’s address 1806 N MARKET STREET, CHAMPAIGN, IL, 61822
Administrator’s telephone number 2173566150

Signature of
Role Plan administrator
Date 2015-07-13
Name of individual signing DAVID FLETCHER
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
O'BYRNE STANKO KEPLEY & JEFFER, 201 W SPRINGFIELD, 1012 PO 800, CHAMPAIGN, 61824, CHAMPAIGN Agent 2015-10-15

President

Name and Address Role
DAVID FLETCHER, 1806 N MARKETST., CHAMPAIGN, IL, 61822 President

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 500 100000 No data

Related by officers

O'BYRNE STANKO KEPLEY & JEFFER, 201 W SPRINGFIELD, 1012 PO 800, CHAMPAIGN, 61824, CHAMPAIGN

ASSOCIATION OF ENVIRONMENTAL ENGINEERING AND SCIENCE PROFESSORS HIGHDIVE, INC. SOMA ULTRALOUNGE INC. DAVID P. WICKNESS, DMD, P.C. G.F. FARMS, INC.

Related by address

No related companies by address

Date of last update: 13 Jan 2025

Sources: Illinois Office of the Secretary of State

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