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  5. MAPLE LEAF MEDICAL SERVICES, LLC

MAPLE LEAF MEDICAL SERVICES, LLC

Company Details

Entity Name: MAPLE LEAF MEDICAL SERVICES, LLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Goodstanding
Date Formed: 02 Mar 2010
Company Number: LLC_03239969
File Number: 03239969
Type of Management: Member Managed
Date Status Change: 01 Feb 2024
Address 127A S. STATE ST., GENESEO, 61254, IL
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
CL3DPMLDK1M3 2024-12-26 127 S STATE ST STE A, GENESEO, IL, 61254, 1361, USA 127A SOUTH STATE ST, GENESEO, IL, 61254, 1347, USA

Business Information
Doing Business As MAPLE LEAF SERVICES
URL http://www.mapleleafmedicalservices.com
Congressional District 16
State/Country of Incorporation IL, USA
Activation Date 2023-12-29
Initial Registration Date 2019-05-16
Entity Start Date 2010-03-02
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 339112, 339113, 423450, 611699
Product and Service Codes 6515

Points of Contacts
Electronic Business
Title PRIMARY POC
Name HEATHER DEBROCK
Address 127A S STATE ST, GENESEO, IL, 61254, USA
Government Business
Title PRIMARY POC
Name HEATHER DEBROCK
Address 127A S STATE ST, GENESEO, IL, 61254, USA
Title ALTERNATE POC
Name STACEY L BROWN
Address 127A S STATE ST, GENESEO, IL, 61254, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MAPLE LEAF MEDICAL SERVICES 401(K) PLAN 2022 272783119 2023-02-22 MAPLE LEAF MEDICAL SERVICES 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 339110
Sponsor’s telephone number 3099441190
Plan sponsor’s address 127A S. STATE STREET, GENESEO, IL, 61254

Signature of
Role Plan administrator
Date 2023-02-22
Name of individual signing HEATHER DEBROCK
Valid signature Filed with authorized/valid electronic signature
MAPLE LEAF MEDICAL SERVICES 401(K) PLAN 2021 272783119 2022-10-14 MAPLE LEAF MEDICAL SERVICES 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 339110
Sponsor’s telephone number 3099441190
Plan sponsor’s address 127A S. STATE STREET, GENESEO, IL, 61254

Signature of
Role Plan administrator
Date 2022-10-14
Name of individual signing HEATHER DEBROCK
Valid signature Filed with authorized/valid electronic signature
MAPLE LEAF MEDICAL SERVICES 401(K) PLAN 2021 272783119 2023-02-21 MAPLE LEAF MEDICAL SERVICES 1
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 339110
Sponsor’s telephone number 3099441190
Plan sponsor’s address 127A S. STATE STREET, GENESEO, IL, 61254

Signature of
Role Plan administrator
Date 2023-02-21
Name of individual signing HEATHER DEBROCK
Valid signature Filed with authorized/valid electronic signature
MAPLE LEAF MEDICAL SERVICES 401(K) PLAN 2020 272783119 2021-05-13 MAPLE LEAF MEDICAL SERVICES 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 339110
Sponsor’s telephone number 3099441190
Plan sponsor’s address 127A S. STATE STREET, GENESEO, IL, 61254
MAPLE LEAF MEDICAL SERVICES 401(K) PLAN 2019 272783119 2020-04-27 MAPLE LEAF MEDICAL SERVICES 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 339110
Sponsor’s telephone number 3099441190
Plan sponsor’s address 127A S. STATE STREET, GENESEO, IL, 61254
MAPLE LEAF MEDICAL SERVICES 401(K) PLAN 2018 272783119 2019-05-29 MAPLE LEAF MEDICAL SERVICES 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 339110
Sponsor’s telephone number 3099441190
Plan sponsor’s address 127A S. STATE STREET, GENESEO, IL, 61254

Signature of
Role Plan administrator
Date 2019-05-29
Name of individual signing HEATHER DEBROCK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-29
Name of individual signing HEATHER DEBROCK
Valid signature Filed with authorized/valid electronic signature
MAPLE LEAF MEDICAL SERVICES 401(K) PLAN 2017 272783119 2018-05-17 MAPLE LEAF MEDICAL SERVICES 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 339110
Sponsor’s telephone number 3099441190
Plan sponsor’s address 111 S. STATE STREET, GENESEO, IL, 61254

Signature of
Role Plan administrator
Date 2018-05-17
Name of individual signing HEATHER DEBROCK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-17
Name of individual signing HEATHER DEBROCK
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
HEATHER DE BROCK, 127A S. STATE ST., GENESEO, 61254, HENRY Agent 2019-03-07

Manager

Name and Address Role Appointment Date
DEBROCK, HEATHER, 23878 GRANGE ROAD, GENESEO, IL, 61254 Manager 2024-02-01

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
HME AND SERVICES PROV 203001223 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2010-07-23 2024-01-04 2027-03-31

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
313 DIVINE WELLNESS Assumed name 2023-10-27 No data No data No data
MAPLE LEAF SERVICES Assumed name 2023-01-31 No data No data No data

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 23 Dec 2024

Sources: Illinois Office of the Secretary of State

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