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BROOK PARK MEDICAL ASSOCIATES, S.C.

Company Details

Entity Name: BROOK PARK MEDICAL ASSOCIATES, S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 06 May 2013
Company Number: CORP_69006884
File Number: 69006884
Type of Business: Incorporated under the Medical Corporation Act
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BROOK PARK MEDICAL ASSOCIATES, S.C. 401(K) PLAN 2023 800920297 2024-10-08 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2024-10-08
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-08
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
BROOK PARK MEDICAL ASSOCIATES, S.C. CASH BALANCE PLAN 2023 800920297 2024-10-08 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2024-10-08
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-08
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
BROOK PARK MEDICAL ASSOCIATES, S.C. 401(K) PLAN 2022 800920297 2023-09-23 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2023-09-23
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-09-23
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
BROOK PARK MEDICAL ASSOCIATES, S.C. CASH BALANCE PLAN 2022 800920297 2023-09-23 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2023-09-23
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-09-23
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
BROOK PARK MEDICAL ASSOCIATES, S.C. 401(K) PLAN 2021 800920297 2022-10-09 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2022-10-09
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-09
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
BROOK PARK MEDICAL ASSOCIATES, S.C. CASH BALANCE PLAN 2021 800920297 2022-10-09 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2022-10-09
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-09
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
BROOK PARK MEDICAL ASSOCIATES, S.C. 401(K) PLAN 2020 800920297 2021-10-03 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2021-10-03
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-03
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
BROOK PARK MEDICAL ASSOCIATES, S.C. CASH BALANCE PLAN 2020 800920297 2021-10-03 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2021-10-03
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-03
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
BROOK PARK MEDICAL ASSOCIATES, S.C. CASH BALANCE PLAN 2019 800920297 2020-10-04 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2020-10-04
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-10-04
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
BROOK PARK MEDICAL ASSOCIATES, S.C. 401(K) PLAN 2019 800920297 2020-10-04 BROOK PARK MEDICAL ASSOCIATES, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3128054486
Plan sponsor’s address 3101 S. MAPLE AVENUE, BROOKFIELD, IL, 60513

Signature of

Role Plan administrator
Date 2020-10-04
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-10-04
Name of individual signing SANDESH KUCHIPUDI
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
VALERIE VARNEY, 433 ASHBURY DR, HINSDALE, 60521, DU PAGE Agent 2022-12-02

President

Name and Address Role
SANDESH KUCHIPUDI 505 N LAKE SHORE DR., #5511, CHICAGO, IL 6 President

Secretary

Name and Address Role
SANDESH KUCHIPUDI 505 N LAKE SHORE DR., #5511, CHICAGO, IL 6 Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 10000 100000 No data

Date of last update: 13 Jan 2025

Sources: Illinois Office of the Secretary of State