| Entity Name: | DERMATOLOGY AND MOHS OLDCO, LTD. |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Domestic BCA |
| Status: | Merged/Consolidated |
| Date Formed: | 07 Sep 2012 |
| Company Number: | CORP_68501393 |
| File Number: | 68501393 |
| Type of Business: | Incorporated under the Medical Corporation Act |
| Date Status Change: | 13 Oct 2017 |
| Place of Formation: | ILLINOIS |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DERMATOLOGY AND MOHS SURGERY INSTITUTE, LTD. 401(K) PROFIT-SHARING PLAN & TRUST | 2017 | 461004743 | 2018-07-06 | DERMATOLOGY AND MOHS SURGERY INSTITUTE, LTD. | 34 | |||||||||||||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2018-07-06 |
| Name of individual signing | DOUGLAS LEONE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2018-07-06 |
| Name of individual signing | DOUGLAS LEONE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2015-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3094513376 |
| Plan sponsor’s address | 3024 EAST EMPIRE STREET, BLOOMINGTON, IL, 61704 |
Signature of
| Role | Plan administrator |
| Date | 2017-06-18 |
| Name of individual signing | DOUGLAS LEONE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2017-06-18 |
| Name of individual signing | DOUGLAS LEONE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2015-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3094513376 |
| Plan sponsor’s address | 3024 EAST EMPIRE STREET, BLOOMINGTON, IL, 61704 |
Signature of
| Role | Plan administrator |
| Date | 2016-07-08 |
| Name of individual signing | DOUGLAS LEONE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2016-07-08 |
| Name of individual signing | DOUGLAS LEONE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| A CLAY COX, 202 N CENTER ST, BLOOMINGTON, 61701, MC LEAN | Agent | 2012-09-07 |
| Name and Address | Role |
|---|---|
| DOUGLAS LEONE, M.D. 9159 N. 1900 E ROAD, BLOOMINGTON, IL, 61 | President |
| Name | Change Date |
|---|---|
| DERMATOLOGY AND MOHS SURGERY INSTITUTE, LTD. | 2017-10-11 |
| Class | Series | Voting Rights | Authorized Shares | Issued Shares | Par Value |
|---|---|---|---|---|---|
| COMMON | No data | Voting Rights | 1000 | 100000 | No data |
Date of last update: 16 Jan 2025
