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  5. REVIVE LLC

REVIVE LLC

Company Details

Entity Name: REVIVE LLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Goodstanding
Date Formed: 15 Aug 2017
Company Number: LLC_06366511
File Number: 06366511
Type of Management: Manager Managed
Date Status Change: 23 Nov 2024
Address 4062 COUNTY ROAD 1725 E, BROUGHTON, 62817, IL
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2012 371405826 2013-03-20 SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-04-01
Business code 621111
Sponsor’s telephone number 6189989600
Plan sponsor’s address 3314 PATRIOT COURT, HERRIN, IL, 62948

Signature of
Role Plan administrator
Date 2013-03-20
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-03-20
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2011 371405826 2013-01-04 SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 6
Three-digit plan number (PN) 002
Effective date of plan 2010-04-01
Business code 621111
Sponsor’s telephone number 6189989600
Plan sponsor’s address 3314 PATRIOT COURT, HERRIN, IL, 62948

Plan administrator’s name and address
Administrator’s EIN 371405826
Plan administrator’s name SOUTHERN ILLINOIS PLASTIC SURGERY, P.C.
Plan administrator’s address 3314 PATRIOT COURT, HERRIN, IL, 62948
Administrator’s telephone number 6189989600

Signature of
Role Plan administrator
Date 2013-01-04
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-01-04
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. CASH BALANCE PENSION PLAN 2011 371405826 2012-09-13 SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 7
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2010-04-01
Business code 621111
Sponsor’s telephone number 6187512071
Plan sponsor’s address 3314 PATRIOT COURT, HERRIN, IL, 62948

Plan administrator’s name and address
Administrator’s EIN 371405826
Plan administrator’s name SOUTHERN ILLINOIS PLASTIC SURGERY, P.C.
Plan administrator’s address 3314 PATRIOT COURT, HERRIN, IL, 62948
Administrator’s telephone number 6187512071

Signature of
Role Plan administrator
Date 2012-09-13
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-09-13
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. CASH BALANCE PENSION PLAN 2011 371405826 2012-06-14 SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 9
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2010-04-01
Business code 621111
Sponsor’s telephone number 6189989600
Plan sponsor’s address 3314 PATRIOT COURT, HERRIN, IL, 62948

Plan administrator’s name and address
Administrator’s EIN 371405826
Plan administrator’s name SOUTHERN ILLINOIS PLASTIC SURGERY, P.C.
Plan administrator’s address 3314 PATRIOT COURT, HERRIN, IL, 62948
Administrator’s telephone number 6189989600

Signature of
Role Plan administrator
Date 2012-06-14
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-14
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2011 371405826 2012-06-12 SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-04-01
Business code 621111
Sponsor’s telephone number 6189989600
Plan sponsor’s address 3314 PATRIOT COURT, HERRIN, IL, 62948

Plan administrator’s name and address
Administrator’s EIN 371405826
Plan administrator’s name SOUTHERN ILLINOIS PLASTIC SURGERY, P.C.
Plan administrator’s address 3314 PATRIOT COURT, HERRIN, IL, 62948
Administrator’s telephone number 6189989600

Signature of
Role Plan administrator
Date 2012-06-12
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-12
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2010 371405826 2011-07-20 SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2010-04-01
Business code 621111
Sponsor’s telephone number 6189989600
Plan sponsor’s address 3314 PATRIOT COURT, HERRIN, IL, 62948

Plan administrator’s name and address
Administrator’s EIN 371405826
Plan administrator’s name SOUTHERN ILLINOIS PLASTIC SURGERY, P.C.
Plan administrator’s address 3314 PATRIOT COURT, HERRIN, IL, 62948
Administrator’s telephone number 6189989600

Signature of
Role Plan administrator
Date 2011-07-20
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-20
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. CASH BALANCE PENSION PLAN 2010 371405826 2011-07-20 SOUTHERN ILLINOIS PLASTIC SURGERY, P.C. 9
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2010-04-01
Business code 621111
Sponsor’s telephone number 6189989600
Plan sponsor’s address 3314 PATRIOT COURT, HERRIN, IL, 62948

Plan administrator’s name and address
Administrator’s EIN 371405826
Plan administrator’s name SOUTHERN ILLINOIS PLASTIC SURGERY, P.C.
Plan administrator’s address 3314 PATRIOT COURT, HERRIN, IL, 62948
Administrator’s telephone number 6189989600

Signature of
Role Plan administrator
Date 2011-07-20
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-20
Name of individual signing SUZANNE GAUTO
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
SAVANNAH J. DORRIS, 4062 COUNTY ROAD 1725 E, BROUGHTON, 62817 Agent 2023-07-05

Manager

Name and Address Role Appointment Date
DORRIS, SAVANNAH J., 4062 COUNTY ROAD 1725 E, BROUGHTON, IL, 62817 Manager 2024-11-23

Related by officers

No related officers

Related by address

4062 COUNTY ROAD 1725 E, BROUGHTON, 62817, IL

CHRIS DORRIS RACING LLC

Date of last update: 23 Dec 2024

Sources: Illinois Office of the Secretary of State

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