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  5. VINE STREET CLINIC, LLC

VINE STREET CLINIC, LLC

Company Details

Entity Name: VINE STREET CLINIC, LLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Involuntary Dissolution
Date Formed: 29 Dec 2003
Company Number: LLC_01071238
File Number: 01071238
Type of Management: Member Managed
Date Status Change: 14 Jun 2013
Expiration Date: 31 Dec 2038
Address 3225 HEDLEY ROAD, SPRINGFIELD, 62791, IL
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
VINE STREET CLINIC 401(K) PROFIT SHARING PLAN 2011 370900614 2012-09-12 VINE STREET CLINIC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621112
Sponsor’s telephone number 2177267300
Plan sponsor’s address 3225 HEDLEY ROAD, PO BOX 13484, SPRINGFIELD, IL, 627913484

Plan administrator’s name and address
Administrator’s EIN 370900614
Plan administrator’s name VINE STREET CLINIC
Plan administrator’s address 3225 HEDLEY ROAD, PO BOX 13484, SPRINGFIELD, IL, 627913484
Administrator’s telephone number 2177267300

Signature of
Role Plan administrator
Date 2012-09-12
Name of individual signing RICHARD ALEXANDER
Valid signature Filed with authorized/valid electronic signature
VINE STREET CLINIC 401(K) PROFIT SHARING PLAN 2010 370900614 2011-06-29 VINE STREET CLINIC 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621112
Sponsor’s telephone number 2177267300
Plan sponsor’s address 3255 HEDLEY ROAD, PO BOX 13484, SPRINGFIELD, IL, 627913484

Plan administrator’s name and address
Administrator’s EIN 370900614
Plan administrator’s name VINE STREET CLINIC
Plan administrator’s address 3255 HEDLEY ROAD, PO BOX 13484, SPRINGFIELD, IL, 627913484
Administrator’s telephone number 2177267300

Signature of
Role Plan administrator
Date 2011-06-29
Name of individual signing RICHARD ALEXANDER
Valid signature Filed with authorized/valid electronic signature
VINE STREET CLINIC 401(K) PROFIT SHARING PLAN 2009 370900614 2010-07-28 VINE STREET CLINIC 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621112
Sponsor’s telephone number 2177267300
Plan sponsor’s address 3255 HEDLEY ROAD, PO BOX 13484, SPRINGFIELD, IL, 627913484

Plan administrator’s name and address
Administrator’s EIN 370900614
Plan administrator’s name VINE STREET CLINIC
Plan administrator’s address 3255 HEDLEY ROAD, PO BOX 13484, SPRINGFIELD, IL, 627913484
Administrator’s telephone number 2177267300

Signature of
Role Plan administrator
Date 2010-07-28
Name of individual signing RICHARD ALEXANDER
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
DAVID O EDWARDS, 4340 ACER GROVE DR STE B, SPRINGFIELD, 62711, SANGAMON Agent 2009-08-07

Member

Name and Address Role Appointment Date
ALEXANDER M.D., RICHARD B, 3225 HEDLEY RD, SPRINGFIELD, IL, 62711 Member 2007-11-01
TABATABAI M.D., FAREED, 3225 HEDLEY ROAD, SPRINGFIELD, IL, 62711 Member 2007-11-01
BRISAN, M.D., RODICA, 3225 HEDLEY RD, SPRINGFIELD, IL, 62711 Member 2008-12-02

Related by officers

DAVID O EDWARDS, 4340 ACER GROVE DR STE B, SPRINGFIELD, 62711, SANGAMON

HEDLEY ROAD LLC

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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