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  5. EXCELLERE ANESTHESIA, INC.

EXCELLERE ANESTHESIA, INC.

Company Details

Entity Name: EXCELLERE ANESTHESIA, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Reinstated
Date Formed: 15 Aug 2013
Company Number: CORP_69004288
File Number: 69004288
Type of Business: All Inclusive Purpose
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EXCELLERE ANESTHESIA, INC. 401K PLAN 2023 463533176 2024-06-26 EXCELLERE ANESTHESIA, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 2197657400
Plan sponsor’s address 8523 HEATHER DRIVE, BURR RIDGE, IL, 60527

Signature of
Role Plan administrator
Date 2024-06-26
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature
EXCELLERE ANESTHESIA, INC. 401K PLAN 2022 463533176 2023-10-20 EXCELLERE ANESTHESIA, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 2197657400
Plan sponsor’s address 8532 HEATHER DRIVE, BURR RIDGE, IL, 60527

Signature of
Role Plan administrator
Date 2023-10-20
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature
EXCELLERE ANESTHESIA, INC. 401K PLAN 2021 463533176 2022-07-21 EXCELLERE ANESTHESIA, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 2197657400
Plan sponsor’s address 8532 HEATHER DR, BURR RIDGE, IL, 60527

Signature of
Role Plan administrator
Date 2022-07-21
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature
EXCELLERE ANESTHESIA, INC. 401K PLAN 2020 463533176 2021-09-11 EXCELLERE ANESTHESIA, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 2197657400
Plan sponsor’s address 340 E NORTH WATER ST UNIT 1801, CHICAGO, IL, 60611

Signature of
Role Plan administrator
Date 2021-09-11
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature
EXCELLERE ANESTHESIA, INC. 401K PLAN 2019 463533176 2020-07-07 EXCELLERE ANESTHESIA, INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 2197657400
Plan sponsor’s address 850 LAKESHORE DR UNIT 1410, CHICAGO, IL, 60611

Signature of
Role Plan administrator
Date 2020-07-07
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature
EXCELLERE ANESTHESIA, INC. 401K PLAN 2018 463533176 2019-06-24 EXCELLERE ANESTHESIA, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 2197657400
Plan sponsor’s address 850 LAKESHORE DR UNIT 1410, CHICAGO, IL, 60611

Signature of
Role Plan administrator
Date 2019-06-24
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature
EXCELLERE ANESTHESIA, INC. 401K PLAN 2017 463533176 2018-09-27 EXCELLERE ANESTHESIA, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 2197657400
Plan sponsor’s address 850 LAKESHORE DR UNIT 1410, CHICAGO, IL, 60611

Signature of
Role Plan administrator
Date 2018-09-27
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature
EXCELLERE ANESTHESIA, INC. 401K PLAN 2016 463533176 2017-07-11 EXCELLERE ANESTHESIA, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 2197657400
Plan sponsor’s address 850 LAKESHORE DR UNIT 1410, CHICAGO, IL, 60611

Signature of
Role Plan administrator
Date 2017-07-11
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature
EXCELLERE ANESTHESIA, INC. 401K PLAN 2015 463533176 2016-06-01 EXCELLERE ANESTHESIA, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 7733307103
Plan sponsor’s address 500 LAKESHORE DR UNIT 4101, CHICAGO, IL, 60611

Signature of
Role Plan administrator
Date 2016-06-01
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature
EXCELLERE ANESTHESIA, INC. 401K PLAN 2014 463533176 2015-06-21 EXCELLERE ANESTHESIA, INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621399
Sponsor’s telephone number 7733307103
Plan sponsor’s address 500 LAKESHORE DR UNIT 4101, CHICAGO, IL, 60611

Signature of
Role Plan administrator
Date 2015-06-21
Name of individual signing JASON KISH
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
JASON KISH, 1801 EASTLAND DR, BLOOMINGTON, 61704, MC LEAN Agent 2013-08-15

President

Name and Address Role
JASON KISH 8532 HEATHER DR BURR RIDGE IL, 60527 President

Secretary

Name and Address Role
ANA KISH 8532 HEATHER DR BURR RIDGE IL, 60527 Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 200 200000 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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