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  5. PLAINFIELD SURGERY CENTER, LLC

PLAINFIELD SURGERY CENTER, LLC

Company Details

Entity Name: PLAINFIELD SURGERY CENTER, LLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Goodstanding
Date Formed: 27 Dec 2005
Company Number: LLC_01718681
File Number: 01718681
Type of Management: Member Managed
Date Status Change: 03 Dec 2024
Address 24600 W 127TH STREET BUILDING C, PLAINFIELD, 60585, IL
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PLAINFIELD SURGERY CENTER LLC 401(K) PSP & TRUST 2023 300391104 2024-10-08 PLAINFIELD SURGERY CENTER LLC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 WEST 127TH STREET, BUILDING C, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2024-10-08
Name of individual signing CAROL SCHELLHORN
Valid signature Filed with authorized/valid electronic signature
PLAINFIELD SURGERY CENTER LLC 401(K) PSP & TRUST 2022 300391104 2023-10-02 PLAINFIELD SURGERY CENTER LLC 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 WEST 127TH STREET, BUILDING C, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2023-10-02
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-02
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
PLAINFIELD SURGERY CENTER LLC 401(K) PSP & TRUST 2021 300391104 2022-05-11 PLAINFIELD SURGERY CENTER LLC 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 WEST 127TH STREET, BUILDING C, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2022-05-11
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-05-11
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
PLAINFIELD SURGERY CENTER LLC 401(K) PSP & TRUST 2020 300391104 2021-05-07 PLAINFIELD SURGERY CENTER LLC 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 WEST 127TH STREET, BUILDING C, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2021-05-07
Name of individual signing KAREN L ROUSE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-05-07
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
PLAINFIELD SURGERY CENTER LLC 401(K) PSP & TRUST 2019 300391104 2020-09-18 PLAINFIELD SURGERY CENTER LLC 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 WEST 127TH STREET, BUILDING C, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2020-06-10
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-10
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
PLAINFIELD SURGERY CENTER LLC 401K PS PLAN AND TRU ST 2018 300391104 2019-07-01 PLAINFIELD SURGERY CENTER LLC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 W 127TH ST BLDG C, PLAINFIELD, IL, 605859530

Signature of
Role Plan administrator
Date 2019-07-01
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
PLAINFIELD SURGERY CENTER LLC 401K PS PLAN AND TRU ST 2017 300391104 2018-06-27 PLAINFIELD SURGERY CENTER LLC 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 W 127TH ST BLDG C, PLAINFIELD, IL, 605859530

Signature of
Role Plan administrator
Date 2018-06-27
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
PLAINFIELD SURGERY CENTER LLC 401K PS PLAN AND TRU ST 2016 300391104 2017-05-30 PLAINFIELD SURGERY CENTER LLC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 W 127TH ST BLDG C, PLAINFIELD, IL, 605859530

Signature of
Role Plan administrator
Date 2017-05-30
Name of individual signing KAREN ROUSE
Valid signature Filed with authorized/valid electronic signature
PLAINFIELD SURGERY CENTER LLC 401K PS PLAN AND TRU ST 2015 300391104 2016-06-14 PLAINFIELD SURGERY CENTER LLC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 W 127TH ST BLDG C, PLAINFIELD, IL, 605859530

Signature of
Role Plan administrator
Date 2016-06-14
Name of individual signing DOLORES STAM
Valid signature Filed with authorized/valid electronic signature
PLAINFIELD SURGERY CENTER LLC 401K PS PLAN AND TR ST 2014 300391104 2015-06-18 PLAINFIELD SURGERY CENTER LLC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621493
Sponsor’s telephone number 8154360911
Plan sponsor’s address 24600 W 127TH ST BLDG C, PLAINFIELD, IL, 605859530

Signature of
Role Plan administrator
Date 2015-06-18
Name of individual signing CHRISTINE A CEBRZYNSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-18
Name of individual signing CHRISTINE A CEBRZYNSKI
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
CHARMIA ZIGMUND, 900 RAND RD STE 300, DES PLAINES, 60016 Agent 2023-08-07

Manager

Name and Address Role Appointment Date
ANDRE BLOM, 900 RAND RD SUITE 300, DES PLAINES, IL, 60016 Manager 2024-12-03
DAVE KANZLER, 900 RAND RD SUITE 300, DES PLAINES, IL, 60016 Manager 2024-12-03

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
PHARMACY 097001636 No data No data OTHER CONTROLLED SUBSTANCE No data 2008-06-12 2008-12-02 2010-12-31

Historical Names

Name Change Date
EDWARD PLAINFIELD SURGERY CENTER, LLC 2007-04-24

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 23 Jan 2025

Sources: Illinois Office of the Secretary of State

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