| Entity Name: | VITALSKIN PHYSICIAN MANAGEMENT, LLC |
| Jurisdiction: | Illinois |
| Entity Type: | Limited Liability Company |
| Status: | Goodstanding |
| Date Formed: | 11 Dec 2020 |
| Company Number: | LLC_09457275 |
| File Number: | 09457275 |
| Type of Management: | Manager Managed |
| Date Status Change: | 12 Dec 2024 |
| Address | 1111 WEST KENYON ROAD, URBANA, 61801, IL |
| Place of Formation: | DELAWARE |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VITALSKIN DERMATOLOGY 401(K) PLAN | 2021 | 843822747 | 2022-09-21 | VITALSKIN PHYSICIAN MANAGEMENT, LLC | 107 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-09-21 |
| Name of individual signing | TODD A PETERSEN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2022-09-21 |
| Name of individual signing | TODD A PETERSEN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 541600 |
| Sponsor’s telephone number | 6304185591 |
| Plan sponsor’s address | 1111 WEST KENYON ROAD, URBANA, IL, 61801 |
Signature of
| Role | Plan administrator |
| Date | 2021-06-30 |
| Name of individual signing | TAMARA S LEMKE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| ILLINOIS CORPORATION SERVICE COMPANY, 801 ADLAI STEVENSON DRIVE, SPRINGFIELD, 62703, SANGAMON | Agent | 2020-12-11 |
| Name and Address | Role | Appointment Date |
|---|---|---|
| VITALSKIN INTERMEDIATE HOLDINGS, LLC (), 100 W. UNIVERSITY AVE. STE 401, CHAMPAIGN, IL, 68120 | Manager | 2024-12-12 |
Date of last update: 16 Jan 2025
