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  5. R. L. VAN ALSTINE, D.D.S., LTD.

R. L. VAN ALSTINE, D.D.S., LTD.

Company Details

Entity Name: R. L. VAN ALSTINE, D.D.S., LTD.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Dissolved
Date Formed: 02 Jun 1980
Date of Dissolution: 12 Jan 2005
Company Number: CORP_52073928
File Number: 52073928
Date Status Change: 12 Jan 2005
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2023 201399053 2024-07-15 NORTH STREET DENTAL CARE 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 US ROUTE 36 E, DECATUR, IL, 62521

Signature of
Role Plan administrator
Date 2024-07-15
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-15
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2022 201399053 2023-03-18 NORTH STREET DENTAL CARE 32
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521

Plan administrator’s name and address
Administrator’s EIN 201399053
Plan administrator’s name NORTH STREET DENTAL CARE
Plan administrator’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521
Administrator’s telephone number 2174232400

Signature of
Role Plan administrator
Date 2023-03-18
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2022 201399053 2023-04-21 NORTH STREET DENTAL CARE 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521

Plan administrator’s name and address
Administrator’s EIN 201399053
Plan administrator’s name NORTH STREET DENTAL CARE
Plan administrator’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521
Administrator’s telephone number 2174232400

Signature of
Role Plan administrator
Date 2023-04-21
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2021 201399053 2022-07-19 NORTH STREET DENTAL CARE 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521

Plan administrator’s name and address
Administrator’s EIN 201399053
Plan administrator’s name NORTH STREET DENTAL CARE
Plan administrator’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521
Administrator’s telephone number 2174232400

Signature of
Role Plan administrator
Date 2022-07-19
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2020 201399053 2021-08-11 NORTH STREET DENTAL CARE 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521

Plan administrator’s name and address
Administrator’s EIN 201399053
Plan administrator’s name NORTH STREET DENTAL CARE
Plan administrator’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521
Administrator’s telephone number 2174232400

Signature of
Role Plan administrator
Date 2021-08-11
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2019 201399053 2020-03-22 NORTH STREET DENTAL CARE 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521

Plan administrator’s name and address
Administrator’s EIN 201399053
Plan administrator’s name NORTH STREET DENTAL CARE
Plan administrator’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521
Administrator’s telephone number 2174232400

Signature of
Role Plan administrator
Date 2020-03-22
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2018 201399053 2019-04-10 NORTH STREET DENTAL CARE 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521

Plan administrator’s name and address
Administrator’s EIN 201399053
Plan administrator’s name NORTH STREET DENTAL CARE
Plan administrator’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521
Administrator’s telephone number 2174232400

Signature of
Role Plan administrator
Date 2019-04-10
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2017 201399053 2018-03-19 NORTH STREET DENTAL CARE 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521

Plan administrator’s name and address
Administrator’s EIN 201399053
Plan administrator’s name NORTH STREET DENTAL CARE
Plan administrator’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521
Administrator’s telephone number 2174232400

Signature of
Role Plan administrator
Date 2018-03-19
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2016 201399053 2017-06-01 NORTH STREET DENTAL CARE 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521

Plan administrator’s name and address
Administrator’s EIN 201399053
Plan administrator’s name NORTH STREET DENTAL CARE
Plan administrator’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521
Administrator’s telephone number 2174232400

Signature of
Role Plan administrator
Date 2017-06-01
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature
NORTH STREET DENTAL CARE 401(K) P/S PLAN 2015 201399053 2016-04-11 NORTH STREET DENTAL CARE 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621210
Sponsor’s telephone number 2174232400
Plan sponsor’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521

Plan administrator’s name and address
Administrator’s EIN 201399053
Plan administrator’s name NORTH STREET DENTAL CARE
Plan administrator’s address 3737 U.S. ROUTE 36 E, DECATUR, IL, 62521
Administrator’s telephone number 2174232400

Signature of
Role Plan administrator
Date 2016-04-11
Name of individual signing KELLY CLARK
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
RANDOLPH L VAN ALSTINE, 301 W NORTH, DECATUR, 62522, MACON Agent 1990-09-20

President

Name and Address Role
R L VANALSTINE, 2536 E WILLOW DR DECATUR 62521 President

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
NORTH STREET DENTAL CARE No data 1990-09-14 2005-01-12 Voluntary Cancellation No data

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 100 100000 No data

Related by officers

No related officers

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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