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FOREST SURGICAL, S.C.

Company Details

Entity Name: FOREST SURGICAL, S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Dissolved
Date Formed: 30 Sep 2004
Date of Dissolution: 30 Oct 2014
Company Number: CORP_63829226
File Number: 63829226
Type of Business: Incorporated under the Medical Corporation Act
Date Status Change: 30 Oct 2014
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FOREST SURGICAL 401K PROFIT SHARING PLAN 2011 201680843 2012-07-21 FOREST SURGICAL, S.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 7083834300
Plan sponsor’s address ONE ERIE COURT, SUITE 7160, OAK PARK, IL, 60302

Plan administrator’s name and address

Administrator’s EIN 201680843
Plan administrator’s name FOREST SURGICAL, S.C.
Plan administrator’s address ONE ERIE COURT, SUITE 7160, OAK PARK, IL, 60302
Administrator’s telephone number 7083834300

Signature of

Role Plan administrator
Date 2012-07-21
Name of individual signing MICHAEL DEHAAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-21
Name of individual signing MICHAEL DEHAAN
Valid signature Filed with authorized/valid electronic signature
FOREST SURGICAL, INC. 401K PROFIT SHARING PLAN 2010 201680843 2011-05-21 FOREST SURGICAL, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 7083834300
Plan sponsor’s address ONE ERIE COURT, SUITE 7160, OAK PARK, IL, 60302

Plan administrator’s name and address

Administrator’s EIN 201680843
Plan administrator’s name FOREST SURGICAL, INC.
Plan administrator’s address ONE ERIE COURT, SUITE 7160, OAK PARK, IL, 60302
Administrator’s telephone number 7083834300

Signature of

Role Plan administrator
Date 2011-05-21
Name of individual signing MICHAEL DEHAAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-21
Name of individual signing MICHAEL DEHAAN
Valid signature Filed with authorized/valid electronic signature
FOREST SURGICAL, INC. 401K PROFIT SHARING PLAN 2009 201680843 2010-06-21 FOREST SURGICAL, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 7083834300
Plan sponsor’s address ONE ERIE COURT, SUITE 7160, OAK PARK, IL, 60302

Plan administrator’s name and address

Administrator’s EIN 201680843
Plan administrator’s name FOREST SURGICAL, INC.
Plan administrator’s address ONE ERIE COURT, SUITE 7160, OAK PARK, IL, 60302
Administrator’s telephone number 7083834300

Signature of

Role Plan administrator
Date 2010-06-21
Name of individual signing MICHAEL DEHAAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-06-21
Name of individual signing MICHAEL DEHAAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
EDWARD N TIESENGA, 1200 HARGER ROAD SUITE 830, OAK BROOK, 60523, DU PAGE Agent 2011-07-21

President

Name and Address Role
MICHAEL R. DEHAAN, 1 ERIE COURT, # 7160, OAK PARK, IL 60302 President

Historical Names

Name Change Date
FOREST SURGICAL, INC. 2011-08-18

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
A No data Voting Rights 1000 100000 No data

Date of last update: 17 Feb 2025

Sources: Illinois Office of the Secretary of State