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  5. ILLINOIS RETINA ASSOCIATES, INC.

ILLINOIS RETINA ASSOCIATES, INC.

Company Details

Entity Name: ILLINOIS RETINA ASSOCIATES, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Converted
Date Formed: 02 Jun 1978
Company Number: CORP_51467566
File Number: 51467566
Type of Business: All Inclusive Purpose
Date Status Change: 02 Nov 2022
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ILLINOIS RETINA ASSOCIATES, S.C. 401K PLAN 2016 362970624 2017-07-11 ILLINOIS RETINA ASSOCIATES, S.C. 110
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1993-10-01
Business code 812990
Sponsor’s telephone number 7085968710
Plan sponsor’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265
ILLINOIS RETINA ASSOCIATES, S.C. 401K PLAN 2015 362970624 2016-09-09 ILLINOIS RETINA ASSOCIATES, S.C. 102
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1993-10-01
Business code 812990
Sponsor’s telephone number 7085968710
Plan sponsor’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265
ILLINOIS RETINA ASSOCIATES, S.C. 401K PLAN 2014 362970624 2015-07-16 ILLINOIS RETINA ASSOCIATES, S.C. 95
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1993-10-01
Business code 812990
Sponsor’s telephone number 7085968710
Plan sponsor’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265

Signature of
Role Plan administrator
Date 2015-07-16
Name of individual signing DAVID J. BACZEWSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-16
Name of individual signing DAVID H. ORTH
Valid signature Filed with authorized/valid electronic signature
ILLINOIS RETINA ASSOCIATES, S.C. 401K PLAN 2013 362970624 2014-04-01 ILLINOIS RETINA ASSOCIATES, S.C. 92
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1993-10-01
Business code 812990
Sponsor’s telephone number 7085968710
Plan sponsor’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265

Signature of
Role Plan administrator
Date 2014-04-01
Name of individual signing DAVID J. BACZEWSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-04-01
Name of individual signing DAVID H. ORTH
Valid signature Filed with authorized/valid electronic signature
ILLINOIS RETINA ASSOCIATES, S.C. 401K PLAN 2012 362970624 2013-07-30 ILLINOIS RETINA ASSOCIATES, S.C. 92
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1993-10-01
Business code 812990
Sponsor’s telephone number 7085968710
Plan sponsor’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265

Plan administrator’s name and address
Administrator’s EIN 362970624
Plan administrator’s name ILLINOIS RETINA ASSOCIATES, S.C.
Plan administrator’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265
Administrator’s telephone number 7085968710

Signature of
Role Plan administrator
Date 2013-07-30
Name of individual signing DAVID J. BACZEWSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-30
Name of individual signing DAVID H. ORTH
Valid signature Filed with authorized/valid electronic signature
ILLINOIS RETINA ASSOCIATES, S.C. 401K PLAN 2011 362970624 2012-04-05 ILLINOIS RETINA ASSOCIATES, S.C. 95
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1993-10-01
Business code 812990
Sponsor’s telephone number 7085968710
Plan sponsor’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265

Plan administrator’s name and address
Administrator’s EIN 362970624
Plan administrator’s name ILLINOIS RETINA ASSOCIATES, S.C.
Plan administrator’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265
Administrator’s telephone number 7085968710

Signature of
Role Plan administrator
Date 2012-04-05
Name of individual signing DAVID J. BACZEWSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-04-05
Name of individual signing DAVID H. ORTH
Valid signature Filed with authorized/valid electronic signature
ILLINOIS RETINA ASSOCIATES, S.C. 401K PLAN 2010 362970624 2011-05-24 ILLINOIS RETINA ASSOCIATES, S.C. 89
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1993-10-01
Business code 812990
Sponsor’s telephone number 7085968710
Plan sponsor’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265

Plan administrator’s name and address
Administrator’s EIN 362970624
Plan administrator’s name ILLINOIS RETINA ASSOCIATES, S.C.
Plan administrator’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265
Administrator’s telephone number 7085968710

Signature of
Role Plan administrator
Date 2011-05-24
Name of individual signing DAVID J. BACZEWSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-24
Name of individual signing DAVID H. ORTH
Valid signature Filed with authorized/valid electronic signature
ILLINOIS RETINA ASSOCIATES, S.C. 401K PLAN 2009 362970624 2010-07-01 ILLINOIS RETINA ASSOCIATES, S.C. 90
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1993-10-01
Business code 812990
Sponsor’s telephone number 7085968710
Plan sponsor’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265

Plan administrator’s name and address
Administrator’s EIN 362970624
Plan administrator’s name ILLINOIS RETINA ASSOCIATES, S.C.
Plan administrator’s address 71 WEST 156TH STREET, SUITE 400, HARVEY, IL, 604264265
Administrator’s telephone number 7085968710

Signature of
Role Plan administrator
Date 2010-07-01
Name of individual signing DAVID J. BACZEWSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-01
Name of individual signing DAVID H. ORTH
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
C T CORPORATION SYSTEM, 208 SO LASALLE ST, SUITE 814, CHICAGO, 60604, COOK-NOT IN CITY OF CHICAGO Agent 2017-01-27

President

Name and Address Role
JOSEPH M CIVANTOS 71 WEST 156TH ST #400, HARVEY IL 60426 President

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
THE RETINA CENTER No data 1994-08-05 2022-11-02 Voluntary Cancellation No data

Historical Names

Name Change Date
ILLINOIS RETINA ASSOCIATES, S.C. 2022-11-02
DAVID H. ORTH, M.D., S.C. 1985-07-10

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 10000 1000000 1

Related by officers

C T CORPORATION SYSTEM, 208 SO LASALLE ST, SUITE 814, CHICAGO, 60604, COOK-NOT IN CITY OF CHICAGO

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Related by address

No related companies by address

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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