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IMPORTANT INFORMATION

DO NOT USE THIS APPLICATION IF:

 The corporation is formed to practice law. Contact the Illinois Supreme Court, Clerk's Ofﬁ ce at 217/782-2035 for an application.

 The corporation is formed to practice the profession of real estate. Contact the Department of Financial and Professional Regulation,

Division of Professional Regulation for an application. The application is also available on the Department's Web Site at: www.

. Upon accessing the Web Site, click on the Division of Professional Regulation.

 The corporation provides architectural, professional engineering, structural engineering and/or land surveying services. After

ﬁ ling your Articles of Incorporation with the Illinois Secretary of State, you must ﬁ le a Design Firm Application with the Illinois

Department of Financial and Professional Regulation, Division of Professional Regulation. The application is available on the

Department's Web Site at: Upon accessing the Web Site, click on the Division of Professional Regulation.

 If you are an Out of State Professional Service Corporation seeking to do business in Illinois and all ofﬁ cers, directors and share-

holders are NOT individually licensed in Illinois, you must obtain a letter of compliance from the Illinois Department of Financial

and Professional Regulation, Division of Professional Regulation. The letter of compliance concerns the Illinois licensure of those

persons from the corporation who will perform the professional services in Illinois. The letter of compliance must be ﬁ led with the

Illinois Secretary of State along with their Foreign Corporation Application.

STATUTORY REQUIREMENTS - Medical Corporation

Only physicians and surgeons and chiropractors licensed under the Illinois Medical Practice Act may apply for a Medical Corpo-

ration Registration. All ofﬁ cers, directors and shareholders of the Medical Corporation MUST hold an active Illinois physicians

and surgeons or chiropractor license.

The corporation name must end with the word "chartered" or "limited" or the abbreviation "Ltd." or the words "Service Corporation

or the abbreviation "S.C." The Medical Corporation Registration will be issued in the same name as on the Articles of Incorpora-

tion as ﬁ led with the Illinois Secretary of State. The purpose clause must specify "medical corporation."

3. A separate application must be submitted for each business location in Illinois.

4. If the company is using more than one d/b/a and the address is different than that of the parent company, then a new application is

required for each additional d/b/a ﬁ led with the Illinois Secretary of State.

STATUTORY REQUIREMENTS - Professional Service Corporation

A Professional Service Corporation is a corporation organized solely for the purpose of rendering ONE CATEGORY of profession-

al service or related professional services. All shareholders, directors, ofﬁ cers, agents and employees (other than ancillary person-

nel and/or the secretary of the corporation) MUST BE LICENSED under the same professional licensure act.

EXCEPTION: A combination of the following services may be provided by a Professional Service Corporation: (a) the practice of

medicine in all of its branches, (b) the practice of podiatry (c) the practice of dentistry (d) the practice of optometry.

The corporate name must end with the word "chartered" or Limited" or the abbreviation "Ltd." or with the words "Professional

Corporation" or the abbreviation "Prof. Corp." or the initials "P.C." The Professional Service Corporation Registration will be

issued in the same name as appears on the Articles of Incorporation as ﬁ led with the Illinois Secretary of State.

A separate application must be submitted for each business location in Illinois.

If the company is using more than one d/b/a and the address is different than that of the parent company, then a new application is

required for each additional d/b/a ﬁ led with the Illinois Secretary of State.

INSTRUCTIONS/CHECKLIST FOR COMPLETING THE APPLICATION

All Medical Corporation and Professional Service Corporation registrations expire on December 31 of each year, regardless of the date

on which the registration was issued by the Department of Financial and Professional Regulation, Division of Professional Regulation.

 Complete all information on the Application for a Medical or Professional Service Corporation Registration. Make sure the appli-

cation bears the same name that appears on the Articles of Incorporation as ﬁ led with the Illinois Secretary of State.

 Sign and date the application.

 Submit a complete copy of the Articles of Incorporation as ﬁ led with the Illinois Secretary of State.

 Submit a registration fee of $50 made payable to the Illinois Department of Financial and Professional Regulation. Fees are not

refundable.

 Mail the original application, copy of the Articles of Incorporation and/or a copy of the Assumed Name document as issued by the

Illinois Secretary of State if using a d/b/a, and fee payment to: Illinois Department of Financial and Professional Regulation,

Division of Professional Regulation, P.O. Box 7007, Springﬁ eld, IL 62791.

If assistance is needed, direct your request to the following telephone number:

Department of Financial and Professional Regulation 1-800-560-6420

TTY 1-866-325-4949

When an operator answers, state the profession for which you are applying and that you need assistance with your application.

The Illinois Department of Financial and Professional Regulation, Division of Professional Regulation, maintains a Web Site at www.

. You may accomplish a number of tasks via the Web Site including: License Look-up; download and print professional

licensure acts and rules and application materials; disciplines imposed by the Department; etc.

IL486-0513 2/16 (CORP)

Form Il486-0513 - Application For A Medical Or Professional Corporation Registration

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