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  5. TIESENGA SURGICAL ASSOCIATES, S.C.

TIESENGA SURGICAL ASSOCIATES, S.C.

Company Details

Entity Name: TIESENGA SURGICAL ASSOCIATES, S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 29 Dec 1970
Company Number: CORP_49763441
File Number: 49763441
Type of Business: Incorporated under the Medical Corporation Act
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SUBURBAN SURGERY CENTER 401(K) PLAN 2023 362704297 2024-10-09 TIESENGA SURGICAL ASSOCIATES, S.C. 30
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2009-02-01
Business code 541990
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707

Signature of
Role Plan administrator
Date 2024-10-09
Name of individual signing GENE RENFROE
Valid signature Filed with authorized/valid electronic signature
SUBURBAN SURGERY CENTER CASH BALANCE PENSION PLAN 2023 362704297 2024-09-03 TIESENGA SURGICAL ASSOCIATES, S.C. 36
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707
SUBURBAN SURGERY CENTER 401(K) PLAN 2023 362704297 2024-06-24 TIESENGA SURGICAL ASSOCIATES, S.C. 29
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2009-02-01
Business code 541990
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707

Signature of
Role Plan administrator
Date 2024-06-24
Name of individual signing GENE RENFROE
Valid signature Filed with authorized/valid electronic signature
SUBURBAN SURGERY CENTER CASH BALANCE PENSION PLAN 2023 362704297 2024-10-04 TIESENGA SURGICAL ASSOCIATES, S.C. 37
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707
SUBURBAN SURGERY CENTER CASH BALANCE PENSION PLAN 2022 362704297 2023-10-12 TIESENGA SURGICAL ASSOCIATES, S.C. 31
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707

Signature of
Role Plan administrator
Date 2023-10-12
Name of individual signing GENE RENFROE
Valid signature Filed with authorized/valid electronic signature
SUBURBAN SURGERY CENTER 401(K) PLAN 2022 362704297 2023-10-06 TIESENGA SURGICAL ASSOCIATES, S.C. 47
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2009-02-01
Business code 541990
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707

Signature of
Role Plan administrator
Date 2023-10-06
Name of individual signing GENE RENFROE
Valid signature Filed with authorized/valid electronic signature
SUBURBAN SURGERY CENTER CASH BALANCE PENSION PLAN 2021 362704297 2022-10-12 TIESENGA SURGICAL ASSOCIATES, S.C. 32
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707
SUBURBAN SURGERY CENTER 401(K) PLAN 2021 362704297 2022-10-17 TIESENGA SURGICAL ASSOCIATES, S.C. 43
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2009-02-01
Business code 541990
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707
SUBURBAN SURGERY CENTER 401(K) PLAN 2020 362704297 2021-10-12 TIESENGA SURGICAL ASSOCIATES, S.C. 44
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2009-02-01
Business code 621111
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707

Signature of
Role Plan administrator
Date 2021-10-12
Name of individual signing FRED TIESENGA
Valid signature Filed with authorized/valid electronic signature
SUBURBAN SURGERY CENTER CASH BALANCE PENSION PLAN 2020 362704297 2021-05-10 TIESENGA SURGICAL ASSOCIATES, S.C. 33
File View Page
Three-digit plan number (PN) 005
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 7084536800
Plan sponsor’s address 1950 N. HARLEM AVENUE, ELMWOOD PARK, IL, 60707

Signature of
Role Plan administrator
Date 2021-05-10
Name of individual signing FRED TIESENGA
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
EDWARD N TIESENGA, 1200 HARGER RD STE 830, OAK BROOK, 60523, DU PAGE Agent 2021-09-14

President

Name and Address Role
FREDERICK M. TIESENGA, 1950 N.HARLEM ELMWOOD PARK IL 60707 President

Secretary

Name and Address Role
CHARLES B. SCHUBERT, 1950 N. HARLEM ELMWOOD PARK IL 60707 Secretary

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
ILLINOIS REFLUX SOCIETY Assume Name 2022-06-20 No data No data No data
VASCULAR ASSOCIATES OF ILLINOIS No data 2018-03-08 2024-03-01 Voluntary Cancellation No data
FREDERICK M. TIESENGA, M.D., S.C. Assume Name 2013-03-12 No data No data No data
MEDICAL ASSOCIATES OF ILLINOIS No data 2012-05-16 2013-03-13 Voluntary Cancellation No data
SURGICAL ASSOCIATES OF ILLINOIS No data 2010-11-05 2019-10-22 Voluntary Cancellation No data
CENTER FOR ADVANCED VEIN CARE Assume Name 2005-02-17 No data No data No data
SUBURBAN SURGERY CENTER INCORPORATED Assume Name 2004-04-22 No data No data No data
NEW HOPE SURGICAL WEIGHT LOSS CENTER Assume Name 2004-03-26 2002-06-20 No data No data
WEST SUBURBAN BARIATRIC CENTER Assume Name 2002-04-30 No data No data No data
SUBURBAN BARIATRIC SURGERY CENTER No data 2002-04-30 2006-01-12 Expired No data

Historical Names

Name Change Date
MARVIN F. TIESENGA, M.D., S.C. 2009-02-17

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 10000 1111000 No data

Related by officers

EDWARD N TIESENGA, 1200 HARGER RD STE 830, OAK BROOK, 60523, DU PAGE

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Related by address

No related companies by address

Date of last update: 23 Dec 2024

Sources: Illinois Office of the Secretary of State

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