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  5. PEDIATRIC DENTAL ASSOCIATES, P.C.

PEDIATRIC DENTAL ASSOCIATES, P.C.

Company Details

Entity Name: PEDIATRIC DENTAL ASSOCIATES, P.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 01 Nov 1984
Company Number: CORP_53635865
File Number: 53635865
Type of Business: Incorporated under the Professional Service Corporation Act
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC DENTAL ASSOCIATES, P.C. 401(K) PLAN 2023 363336666 2024-07-30 PEDIATRIC DENTAL ASSOCIATES, P.C. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8475377695
Plan sponsor’s address 195 N. ARLINGTON HEIGHTS ROAD, SUITE 150, BUFFALO GROVE, IL, 60089

Signature of
Role Plan administrator
Date 2024-07-26
Name of individual signing GEORGE LIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-26
Name of individual signing GEORGE LIN
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2023 364518982 2024-08-07 PEDIATRIC DENTAL ASSOCIATES, P.C 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1996-01-01
Business code 621210
Sponsor’s telephone number 3096637339
Plan sponsor’s address 1112 TRINITY LANE, BLOOMINGTON, IL, 61704

Signature of
Role Plan administrator
Date 2024-08-07
Name of individual signing THOMAS D. HALL
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL ASSOCIATES, P.C. 401(K) PLAN 2022 363336666 2023-07-06 PEDIATRIC DENTAL ASSOCIATES, P.C. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8475377695
Plan sponsor’s address 195 N. ARLINGTON HEIGHTS ROAD, SUITE 150, BUFFALO GROVE, IL, 60089

Signature of
Role Plan administrator
Date 2023-07-06
Name of individual signing GEORGE LIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-06
Name of individual signing GEORGE LIN
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL ASSOCIATES, P.C. 401(K) PLAN 2021 363336666 2022-08-24 PEDIATRIC DENTAL ASSOCIATES, P.C. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8475377695
Plan sponsor’s address 195 N. ARLINGTON HEIGHTS ROAD, SUITE 150, BUFFALO GROVE, IL, 60089

Signature of
Role Plan administrator
Date 2022-08-23
Name of individual signing GEORGE LIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-08-23
Name of individual signing GEORGE LIN
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL ASSOCIATES, P.C. 401(K) PLAN 2020 363336666 2021-09-16 PEDIATRIC DENTAL ASSOCIATES, P.C. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8475377695
Plan sponsor’s address 195 N. ARLINGTON HEIGHTS ROAD, SUITE 150, BUFFALO GROVE, IL, 60089

Signature of
Role Plan administrator
Date 2021-09-15
Name of individual signing GEORGE LIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-09-15
Name of individual signing GEORGE LIN
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL ASSOCIATES, P.C., 401(K) PLAN 2012 363336666 2013-07-09 PEDIATRIC DENTAL ASSOCIATES, P.C. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8475377695
Plan sponsor’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089

Plan administrator’s name and address
Administrator’s EIN 363336666
Plan administrator’s name PEDIATRIC DENTAL ASSOCIATES, P.C.
Plan administrator’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089
Administrator’s telephone number 8475377695

Signature of
Role Plan administrator
Date 2013-07-09
Name of individual signing GEORGE LIN, D.D.S.
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL ASSOCIATES, P.C., 401(K) PLAN 2011 363336666 2012-07-23 PEDIATRIC DENTAL ASSOCIATES, P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8475377695
Plan sponsor’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089

Plan administrator’s name and address
Administrator’s EIN 363336666
Plan administrator’s name PEDIATRIC DENTAL ASSOCIATES, P.C.
Plan administrator’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089
Administrator’s telephone number 8475377695

Signature of
Role Plan administrator
Date 2012-07-23
Name of individual signing GEORGE LIN, D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-29
Name of individual signing ANJALI TALATI, D.M.D.
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL ASSOCIATES, P.C., 401(K) PLAN 2010 363336666 2011-04-22 PEDIATRIC DENTAL ASSOCIATES, P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8475377695
Plan sponsor’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089

Plan administrator’s name and address
Administrator’s EIN 363336666
Plan administrator’s name PEDIATRIC DENTAL ASSOCIATES, P.C.
Plan administrator’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089
Administrator’s telephone number 8475377695

Signature of
Role Plan administrator
Date 2011-04-22
Name of individual signing FRED MARGOLIS
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTAL ASSOCIATES, P.C., 401(K) PLAN 2010 363336666 2011-04-22 PEDIATRIC DENTAL ASSOCIATES, P.C. 19
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8475377695
Plan sponsor’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089

Plan administrator’s name and address
Administrator’s EIN 363336666
Plan administrator’s name PEDIATRIC DENTAL ASSOCIATES, P.C.
Plan administrator’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089
Administrator’s telephone number 8475377695

Signature of
Role Plan administrator
Date 2011-04-22
Name of individual signing FRED MARGOLIS
Valid signature Filed with incorrect/unrecognized electronic signature
PEDIATRIC DENTAL ASSOCIATES, P.C., 401(K) PLAN 2009 363336666 2010-07-27 PEDIATRIC DENTAL ASSOCIATES, P.C. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8475377695
Plan sponsor’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089

Plan administrator’s name and address
Administrator’s EIN 363336666
Plan administrator’s name PEDIATRIC DENTAL ASSOCIATES, P.C.
Plan administrator’s address 195 N. ARLINGTON HEIGHTS ROAD, BUFFALOGROVE, IL, 60089
Administrator’s telephone number 8475377695

Signature of
Role Plan administrator
Date 2010-07-27
Name of individual signing FRED MARGOLIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-27
Name of individual signing FRED MARGOLIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
BRADLEY K STAUBUS, 7055 VETERANS BLVD UNIT B, BURR RIDGE, 60527, DU PAGE Agent 2012-01-18

President

Name and Address Role
DR GEORGE LIN 195 ARLINGTON HTS RD #150 BUFFALO GROVE President

Secretary

Name and Address Role
DR ANJALI TALATI Secretary

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
BLUE CORAL PEDIATRIC DENTISTRY & ORTHODONTICS Assume Name 2023-02-06 No data No data No data
BLUE CORAL Assume Name 2023-02-06 No data No data No data
PEDIATRIC DENTAL ASSOCIATES & ORTHODONTICS Assume Name 2021-05-07 No data No data No data
YUMMY DENTAL AND ORTHODONTICS FOR KIDS Assume Name 2020-11-05 No data No data No data
YUMMY DENTAL Assume Name 2020-11-05 No data No data No data
PEDIATRIC DENTAL ASSOCIATES, P.C. No data 2001-08-30 2002-04-22 Voluntary Cancellation No data

Historical Names

Name Change Date
FRED MARGOLIS, D.D.S., P.C. 2002-04-22

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 100000 2000000 No data

Related by officers

BRADLEY K STAUBUS, 7055 VETERANS BLVD UNIT B, BURR RIDGE, 60527, DU PAGE

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Related by address

No related companies by address

Date of last update: 20 Jan 2025

Sources: Illinois Office of the Secretary of State

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