Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. Winnebago
    4. ›
  4. 61101
    5. ›
  5. AFFILIATED SURGEONS OF ROCKFORD, LLC

AFFILIATED SURGEONS OF ROCKFORD, LLC

Company Details

Entity Name: AFFILIATED SURGEONS OF ROCKFORD, LLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Involuntary Dissolution
Date Formed: 26 Nov 2001
Company Number: LLC_00629936
File Number: 00629936
Type of Management: Member Managed
Date Status Change: 12 May 2023
Address 2300 N ROCKTON AVE, #304, ROCKFORD, 61103, IL
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AFFILIATED SURGEONS OF ROCKFORD, LLC RETIREMENT 2016 364476217 2017-11-08 AFFILIATED SURGEONS OF ROCKFORD, LLC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621111
Sponsor’s telephone number 8159643333
Plan sponsor’s address PO BOX 15730, LOVES PARK, IL, 61132
AFFILIATED SURGEONS OF ROCKFORD, LLC RETIREMENT PLAN 2016 364476217 2017-07-12 AFFILIATED SURGEONS OF ROCKFORD, LLC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621111
Sponsor’s telephone number 8159643333
Plan sponsor’s address 2300 N. ROCKTON AVE. SUITE 304, ROCKFORD, IL, 61103

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing PAUL KLAZURA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED SURGEONS OF ROCKFORD, LLC RETIREMENT PLAN 2015 364476217 2016-08-15 AFFILIATED SURGEONS OF ROCKFORD, LLC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621111
Sponsor’s telephone number 8159643333
Plan sponsor’s address 2300 N. ROCKTON AVE. SUITE 304, ROCKFORD, IL, 61103

Plan administrator’s name and address
Administrator’s EIN 364476217
Plan administrator’s name AFFILIATED SURGEONS OF ROCKFORD, LLC
Plan administrator’s address 2300 N. ROCKTON AVE. SUITE 304, ROCKFORD, IL, 61103
Administrator’s telephone number 8159643333
AFFILIATED SURGEONS OF ROCKFORD, LLC RETIREMENT PLAN 2014 364476217 2015-05-06 AFFILIATED SURGEONS OF ROCKFORD, LLC 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621111
Sponsor’s telephone number 8159643333
Plan sponsor’s address 2300 N. ROCKTON AVE. SUITE 304, ROCKFORD, IL, 61103

Plan administrator’s name and address
Administrator’s EIN 364476217
Plan administrator’s name AFFILIATED SURGEONS OF ROCKFORD, LLC
Plan administrator’s address 2300 N. ROCKTON AVE. SUITE 304, ROCKFORD, IL, 61103
Administrator’s telephone number 8159643333

Signature of
Role Plan administrator
Date 2015-05-06
Name of individual signing DR. PAUL KLAZURA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED SURGEONS OF ROCKFORD, LLC RETIREMENT PLAN 2013 364476217 2014-05-05 AFFILIATED SURGEONS OF ROCKFORD, LLC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621111
Sponsor’s telephone number 8159643333
Plan sponsor’s address 2300 N. ROCKTON AVE. SUITE 304, ROCKFORD, IL, 61103

Plan administrator’s name and address
Administrator’s EIN 364476217
Plan administrator’s name AFFILIATED SURGEONS OF ROCKFORD, LLC
Plan administrator’s address 2300 N. ROCKTON AVE. SUITE 304, ROCKFORD, IL, 61103
Administrator’s telephone number 8159643333

Signature of
Role Plan administrator
Date 2014-05-05
Name of individual signing DR. PAUL KLAZURA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED SURGEONS OF ROCKFORD, LLC RETIREMENT PLAN 2012 364476217 2013-04-11 AFFILIATED SURGEONS OF ROCKFORD, LLC 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621111
Sponsor’s telephone number 8159643333
Plan sponsor’s address 2300 N. ROCKTON AVENUE STE 304, ROCKFORD, IL, 61103

Plan administrator’s name and address
Administrator’s EIN 364476217
Plan administrator’s name AFFILIATED SURGEONS OF ROCKFORD, LLC
Plan administrator’s address 2300 N. ROCKTON AVENUE STE 304, ROCKFORD, IL, 61103
Administrator’s telephone number 8159643333

Signature of
Role Plan administrator
Date 2013-04-11
Name of individual signing DR. PAUL KLAZURA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED SURGEONS OF ROCKFORD, LLC RETIREMENT PLAN 2011 364476217 2012-04-25 AFFILIATED SURGEONS OF ROCKFORD, LLC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621111
Sponsor’s telephone number 8159643333
Plan sponsor’s address 2300 N. ROCKTON AVENUE STE 304, ROCKFORD, IL, 61103

Plan administrator’s name and address
Administrator’s EIN 364476217
Plan administrator’s name AFFILIATED SURGEONS OF ROCKFORD, LLC
Plan administrator’s address 2300 N. ROCKTON AVENUE STE 304, ROCKFORD, IL, 61103
Administrator’s telephone number 8159643333

Signature of
Role Plan administrator
Date 2012-04-25
Name of individual signing DR. PAUL KLAZURA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED SURGEONS OF ROCKFORD, LLC RETIREMENT PLAN 2010 364476217 2011-04-13 AFFILIATED SURGEONS OF ROCKFORD, LLC 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621111
Sponsor’s telephone number 8159643333
Plan sponsor’s address 2300 N. ROCKTON AVENUE STE 304, ROCKFORD, IL, 61103

Plan administrator’s name and address
Administrator’s EIN 364476217
Plan administrator’s name AFFILIATED SURGEONS OF ROCKFORD, LLC
Plan administrator’s address 2300 N. ROCKTON AVENUE STE 304, ROCKFORD, IL, 61103
Administrator’s telephone number 8159643333

Signature of
Role Plan administrator
Date 2011-04-13
Name of individual signing DR. PAUL KLAZURA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED SURGEONS OF ROCKFORD, LLC RETIREMENT PLAN 2009 364476217 2010-05-07 AFFILIATED SURGEONS OF ROCKFORD, LLC 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621111
Sponsor’s telephone number 8159643333
Plan sponsor’s address 2300 N. ROCKTON AVENUE STE 304, ROCKFORD, IL, 61103

Plan administrator’s name and address
Administrator’s EIN 364476217
Plan administrator’s name AFFILIATED SURGEONS OF ROCKFORD, LLC
Plan administrator’s address 2300 N. ROCKTON AVENUE STE 304, ROCKFORD, IL, 61103
Administrator’s telephone number 8159643333

Signature of
Role Plan administrator
Date 2010-05-07
Name of individual signing DR. PAUL KLAZURA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-05-07
Name of individual signing DR. PAUL KLAZURA
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
SCOTT C SULLIVAN, 120 W STATE ST, #400, ROCKFORD, 61101 Agent 2006-10-30

Member

Name and Address Role Appointment Date
KIKTA M.D., MICHAEL J, 1728 RED OAK LANE, ROCKFORD, IL, 61107 Member 2001-11-26
BOONE M.D., KENDALL D, 1605 NATIONAL AVE, ROCKFORD, IL, 61103 Member 2001-11-26
MIJAL M.D., SARA, 4356 S JORDAN DR, MCFARLAND WI, WI, 53558 Member 2016-11-16

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
ROCKFORD VASCULAR SURGERY Assumed name 2014-04-21 2021-01-08 Involuntary cancellation 2015-10-15

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 ilorg.com, Part of Big Data Integrated