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  5. DERMATOLOGY & DERMATOLOGIC SURGERY, LLC

DERMATOLOGY & DERMATOLOGIC SURGERY, LLC

Company Details

Entity Name: DERMATOLOGY & DERMATOLOGIC SURGERY, LLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Voluntary Diss./Terminated
Date Formed: 31 Dec 2002
Company Number: LLC_00839388
File Number: 00839388
Type of Management: Member Managed
Date Status Change: 19 Mar 2003
Address 14 CHESTNUT AVE, CLARENDEN HILLS, 60514, IL
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DERMATOLOGY & DERMATOLGIC SURGERY LTD 401(K) PLAN 2022 061685007 2023-07-31 DERMATOLOGY & DERMATOLOGIC SURGERY 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2023-07-31
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY & DERMATOLGIC SURGERY LTD 401(K) PLAN 2021 061685007 2023-07-31 DERMATOLOGY & DERMATOLOGIC SURGERY 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2023-07-31
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY & DERMATOLGIC SURGERY 2020 061685007 2021-07-22 DERMATOLOGY & DERMATOLOGIC SURGERY 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2021-07-22
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY & DERMATOLGIC SURGERY LTD 401(K) PLAN 2019 061685007 2020-07-06 DERMATOLOGY & DERMATOLOGIC SURGERY 5
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2020-07-06
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY & DERMATOLGIC SURGERY LTD 401(K) PLAN 2019 061685007 2020-07-07 DERMATOLOGY & DERMATOLOGIC SURGERY 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2020-07-07
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY & DERMATOLGIC SURGERY LTD 401(K) PLAN 2018 061685007 2019-08-06 DERMATOLOGY & DERMATOLOGIC SURGERY 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2019-08-06
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY & DERMATOLGIC SURGERY LTD 401(K) PLAN 2017 061685007 2018-10-11 DERMATOLOGY & DERMATOLOGIC SURGERY 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2018-10-11
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY & DERMATOLGIC SURGERY LTD 401(K) PLAN 2016 061685007 2017-10-11 DERMATOLOGY & DERMATOLOGIC SURGERY 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2017-10-11
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY & DERMATOLGIC SURGERY LTD 401(K) PLAN 2015 061685007 2016-08-10 DERMATOLOGY & DERMATOLOGIC SURGERY 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2016-08-10
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature
DERMATOLOGY & DERMATOLGIC SURGERY LTD 401(K) PLAN 2014 061685007 2015-10-08 DERMATOLOGY & DERMATOLOGIC SURGERY 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6303210303
Plan sponsor’s address 6825 KINGERY HWY, WILLOWBROOK, IL, 605275154

Signature of
Role Plan administrator
Date 2015-10-08
Name of individual signing JEFFREY BERTI
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
MICHAEL A. MACIEJEWSKI, 945 OAKLAWN AVENUE, ELMHURST, 60126, DU PAGE Agent 2002-12-31

Member

Name and Address Role Appointment Date
BERTI, JEFFREY M.D., 14 CHESTNUT AVE, CLARENDEN HILLS, IL, 60514 Member 2002-12-31

Related by officers

MICHAEL A. MACIEJEWSKI, 945 OAKLAWN AVENUE, ELMHURST, 60126, DU PAGE

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Related by address

No related companies by address

Date of last update: 27 Jan 2025

Sources: Illinois Office of the Secretary of State

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