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  5. KCKC MEDICAL GROUP LLC

KCKC MEDICAL GROUP LLC

Company Details

Entity Name: KCKC MEDICAL GROUP LLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Domesticated
Date Formed: 22 Jun 2006
Company Number: LLC_01896482
File Number: 01896482
Type of Management: Member Managed
Date Status Change: 14 Sep 2021
Address 3417 S COUNTRY CLUB RD, WOODSTOCK, 60098, IL
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KCKC MEDICAL GROUP LLC RETIREMENT PLAN 2019 205336923 2020-07-23 KCKC MEDICAL GROUP LLC 3
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 811210
Sponsor’s telephone number 8775252674
Plan sponsor’s address 3417 S. COUNTRY CLUB ROAD, WOODSTOCK, IL, 60098
KCKC MEDICAL GROUP, LLC RETIREMENT PLAN 2018 205336923 2019-08-01 KCKC MEDICAL GROUP, LLC 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 811210
Sponsor’s telephone number 8157353100
Plan sponsor’s address 3417 S COUNTRY CLUB ROAD, WOODSTOCK, IL, 60098

Signature of
Role Plan administrator
Date 2019-08-01
Name of individual signing JAMES DIETERLE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-08-01
Name of individual signing JAMES DIETERLE
Valid signature Filed with authorized/valid electronic signature
KCKC MEDICAL GROUP, LLC RETIREMENT PLAN 2017 205336923 2018-10-15 KCKC MEDICAL GROUP, LLC 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 811210
Sponsor’s telephone number 8157353100
Plan sponsor’s address 3417 S COUNTRY CLUB ROAD, WOODSTOCK, IL, 60098

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing PAUL DIETERLE
Valid signature Filed with authorized/valid electronic signature
KCKC MEDICAL GROUP, LLC RETIREMENT PLAN 2016 205336923 2017-07-28 KCKC MEDICAL GROUP, LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 811210
Sponsor’s telephone number 6307502020
Plan sponsor’s address 3417 S COUNTRY CLUB ROAD, WOODSTOCK, IL, 60098

Signature of
Role Plan administrator
Date 2017-07-28
Name of individual signing JAMES DIETERLE
Valid signature Filed with authorized/valid electronic signature
KCKC MEDICAL GROUP, LLC RETIREMENT PLAN 2015 205336923 2016-05-12 KCKC MEDICAL GROUP, LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 811210
Sponsor’s telephone number 6307502020
Plan sponsor’s address 203 S. MCHENRY AVENUE, CRYSTAL LAKE, IL, 60014

Signature of
Role Plan administrator
Date 2016-05-12
Name of individual signing ANGELA MEYER
Valid signature Filed with authorized/valid electronic signature
KCKC MEDICAL GROUP, LLC RETIREMENT PLAN 2014 205336923 2015-05-11 KCKC MEDICAL GROUP, LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 811210
Sponsor’s telephone number 6307502020
Plan sponsor’s address 1448 MAGNOLIA DRIVE, SUITE 110, CRYSTAL LAKE, IL, 60014

Signature of
Role Plan administrator
Date 2015-05-11
Name of individual signing ANGELA MEYER
Valid signature Filed with authorized/valid electronic signature
KCKC MEDICAL GROUP, LLC RETIREMENT PLAN 2013 205336923 2014-04-23 KCKC MEDICAL GROUP, LLC 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 811210
Sponsor’s telephone number 6307502020
Plan sponsor’s address 1448 MAGNOLIA DRIVE, SUITE 110, CRYSTAL LAKE, IL, 60014

Signature of
Role Plan administrator
Date 2014-04-23
Name of individual signing ANGELA MEYER
Valid signature Filed with authorized/valid electronic signature
KCKC MEDICAL GROUP RETIREMENT PLAN 2012 205336923 2013-09-12 KCKC MEDICAL GROUP 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 811210
Sponsor’s telephone number 8153015819
Plan sponsor’s address 1448 MAGNOLIA DRIVE, SUITE 110, CRYSTAL LAKE, IL, 60014

Signature of
Role Plan administrator
Date 2013-09-12
Name of individual signing JAMES DIETERLE
Valid signature Filed with authorized/valid electronic signature
KCKC MEDICAL GROUP, LLC RETIREMENT PLAN 2012 205336923 2013-10-11 KCKC MEDICAL GROUP, LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 811210
Sponsor’s telephone number 6307502020
Plan sponsor’s address 1448 MAGNOLIA DRIVE, SUITE 110, CRYSTAL LAKE, IL, 60014

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing ANGELA MEYER
Valid signature Filed with authorized/valid electronic signature
KCKC MEDICAL GROUP RETIREMENT PLAN 2011 205336923 2013-09-10 KCKC MEDICAL GROUP 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 811210
Sponsor’s telephone number 8153015819
Plan sponsor’s address 1448 MAGNOLIA DRIVE, SUITE 110, CRYSTAL LAKE, IL, 60014

Plan administrator’s name and address
Administrator’s EIN 205336923
Plan administrator’s name KCKC MEDICAL GROUP
Plan administrator’s address 1448 MAGNOLIA DRIVE, SUITE 110, CRYSTAL LAKE, IL, 60014
Administrator’s telephone number 8153015819

Signature of
Role Plan administrator
Date 2013-09-10
Name of individual signing JAMES DIETERLE
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
DAVID WAGGONER, FOUR N WALKUP AVENUE, CRYSTAL LAKE, 60014 Agent 2006-06-22

Member

Name and Address Role Appointment Date
DIETERLE, JAMES, 3417 S COUNTRY CLUB RD, WOODSTOCK, IL, 60098 Member 2017-06-02

Related by officers

DAVID WAGGONER, FOUR N WALKUP AVENUE, CRYSTAL LAKE, 60014

KCKC EQUIPMENT SALES, LLC

Related by address

3417 S COUNTRY CLUB RD, WOODSTOCK, 60098, IL

ICE COMPANY HOCKEY LLC

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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