5712 WEST 128TH STREET CORPORATION

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

NORTH SUBURBAN PERIODONTICS LTD. 401K/PROFIT SHARING PLAN

2012

362710984

2013-07-25

NORTH SUBURBAN PERIODONTICS, LTD.

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1971-05-01
Business code	621210
Sponsor’s telephone number	8473626650
Plan sponsor’s address	755 S MILWAUKEE AVE STE 120, LIBERTYVILLE, IL, 600483267

Plan administrator’s name and address

Administrator’s EIN	362710984
Plan administrator’s name	NORTH SUBURBAN PERIODONTICS, LTD.
Plan administrator’s address	755 S MILWAUKEE AVE STE 120, LIBERTYVILLE, IL, 600483267
Administrator’s telephone number	8473626650

Signature of

Role	Plan administrator
Date	2013-07-25
Name of individual signing	DAVID MCCLENAHAN
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
BARBARA E CROMBIE, 5712 W 128TH ST, CRESTWOOD, 60445, COOK-NOT IN CITY OF CHICAGO	Agent	1999-06-30

Name and Address	Role
DEBORAH GAMBON 5712 W. 128TH ST. CRESTWOOD,IL 60418	President

Name and Address	Role
MARY FRYSTAK 5712 W. 128TH ST. CRESTWOOD,IL 60418	Secretary

Date of last update: 13 Jan 2025