| Entity Name: | FULLERTON-DRAKE MEDICAL CENTER, P.C. |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Domestic BCA |
| Status: | Goodstanding |
| Date Formed: | 01 May 2002 |
| Company Number: | CORP_62202149 |
| File Number: | 62202149 |
| Type of Business: | Incorporated under the Professional Service Corporation Act |
| Place of Formation: | ILLINOIS |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FULLERTON DRAKE MEDICAL CENTER DEFINED BENEFIT PENSION PLAN & TRUST | 2010 | 020595199 | 2011-10-18 | FULLERTON DRAKE MEDICAL CENTER | 4 | |||||||||||||||||||||||||||||||||||||||||||
|
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| Administrator’s EIN | 020595199 |
| Plan administrator’s name | FULLERTON DRAKE MEDICAL CENTER |
| Plan administrator’s address | 3518 W. FULLERTON AVE., CHICAGO, IL, 60647 |
| Administrator’s telephone number | 7732780334 |
Signature of
| Role | Plan administrator |
| Date | 2011-10-18 |
| Name of individual signing | MARK GERBER |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2011-10-18 |
| Name of individual signing | MARK GERBER |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2003-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 7732780334 |
| Plan sponsor’s address | 3518 W. FULLERTON AVE., CHICAGO, IL, 60647 |
Plan administrator’s name and address
| Administrator’s EIN | 020595199 |
| Plan administrator’s name | FULLERTON DRAKE MEDICAL CENTER |
| Plan administrator’s address | 3518 W. FULLERTON AVE., CHICAGO, IL, 60647 |
| Administrator’s telephone number | 7732780334 |
Signature of
| Role | Plan administrator |
| Date | 2011-10-17 |
| Name of individual signing | MARK GERBER |
| Valid signature | Filed with incorrect/unrecognized electronic signature |
| Role | Employer/plan sponsor |
| Date | 2011-10-17 |
| Name of individual signing | MARK GERBER |
| Valid signature | Filed with incorrect/unrecognized electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2003-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 7732780334 |
| Plan sponsor’s address | 3518 W. FULLERTON AVE., CHICAGO, IL, 60647 |
Plan administrator’s name and address
| Administrator’s EIN | 020595199 |
| Plan administrator’s name | FULLERTON DRAKE MEDICAL CENTER |
| Plan administrator’s address | 3518 W. FULLERTON AVE., CHICAGO, IL, 60647 |
| Administrator’s telephone number | 7732780334 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-14 |
| Name of individual signing | MARK GERBER |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-10-14 |
| Name of individual signing | MARK GERBER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2003-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 7732780334 |
| Plan sponsor’s mailing address | 3518 W FULLERTON AVE, CHICAGO, IL, 60647 |
| Plan sponsor’s address | 3518 W FULLERTON AVE, CHICAGO, IL, 60647 |
Plan administrator’s name and address
| Administrator’s EIN | 020595199 |
| Plan administrator’s name | FULLERTON DRAKE MEDICAL CENTER |
| Plan administrator’s address | 3518 W FULLERTON AVE, CHICAGO, IL, 60647 |
| Administrator’s telephone number | 7732780334 |
Number of participants as of the end of the plan year
| Active participants | 2 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Employer/plan sponsor |
| Date | 2010-09-21 |
| Name of individual signing | MARK GERBER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| SCOTT B. FRIEDMAN, 250 PARKWAY DR STE 150, LINCOLNSHIRE, 60069, LAKE | Agent | 2021-05-14 |
| Name and Address | Role |
|---|---|
| MARK K GERBER 3518 WEST FULLERTON CHICAGO IL 60647 | President |
| Name and Address | Role |
|---|---|
| MARK K GERBER 3518 WEST FULLERTON CHICAGO, IL, 60647 | Secretary |
| Name | Type | Effective Date | Cancellation Date | Cancellation Type | Last Renewal Date |
|---|---|---|---|---|---|
| GETWORKERCOMP.COM | Assume Name | 2023-05-19 | No data | No data | No data |
| AYUDAMEDICALEGAL.COM | Assume Name | 2023-05-19 | No data | No data | No data |
| Class | Series | Voting Rights | Authorized Shares | Issued Shares | Par Value |
|---|---|---|---|---|---|
| COMMON | No data | Voting Rights | 10000 | 1000000 | No data |
Date of last update: 23 Dec 2024
