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  5. FAIRVIEW DENTAL CARE, P.C.

FAIRVIEW DENTAL CARE, P.C.

Company Details

Entity Name: FAIRVIEW DENTAL CARE, P.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Dissolved
Date Formed: 19 Oct 1988
Date of Dissolution: 10 Mar 2017
Company Number: CORP_55265453
File Number: 55265453
Type of Business: Incorporated under the Medical Corporation Act
Date Status Change: 10 Mar 2017
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FAIRVIEW DENTAL CARE 401(K) PLAN 2016 363607708 2017-01-17 FAIRVIEW DENTAL CARE, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 6308525353
Plan sponsor’s address 6317 FAIRVIEW AVE, WESTMONT, IL, 60559
FAIRVIEW DENTAL CARE 401(K) PLAN 2015 363607708 2016-10-12 FAIRVIEW DENTAL CARE, P.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 6308525353
Plan sponsor’s address 6317 FAIRVIEW AVE, WESTMONT, IL, 60559
FAIRVIEW DENTAL CARE 401(K) PLAN 2014 363607708 2015-04-29 FAIRVIEW DENTAL CARE, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 6308525353
Plan sponsor’s address 6317 FAIRVIEW AVE, WESTMONT, IL, 60559

Signature of
Role Plan administrator
Date 2015-04-29
Name of individual signing DARREN SIMPSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-29
Name of individual signing DARREN SIMPSON
Valid signature Filed with authorized/valid electronic signature
FAIRVIEW DENTAL CARE 401(K) PLAN 2013 363607708 2014-09-12 FAIRVIEW DENTAL CARE, P.C. 13
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 6308525353
Plan sponsor’s address 6317 FAIRVIEW AVE, WESTMONT, IL, 60559

Signature of
Role Plan administrator
Date 2014-09-11
Name of individual signing ROBERT RICE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-09-11
Name of individual signing ROBERT RICE
Valid signature Filed with authorized/valid electronic signature
FAIRVIEW DENTAL CARE 401(K) PLAN 2013 363607708 2014-12-09 FAIRVIEW DENTAL CARE, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 6308525353
Plan sponsor’s address 6317 FAIRVIEW AVE, WESTMONT, IL, 60559

Signature of
Role Plan administrator
Date 2014-12-09
Name of individual signing DARREN SIMPSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-12-09
Name of individual signing DARREN SIMPSON
Valid signature Filed with authorized/valid electronic signature
FAIRVIEW DENTAL CARE 401(K) PLAN 2012 363607708 2013-07-10 FAIRVIEW DENTAL CARE, P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 6308525353
Plan sponsor’s address 6317 FAIRVIEW AVE, WESTMONT, IL, 60559

Signature of
Role Plan administrator
Date 2013-07-10
Name of individual signing DARREN SIMPSON
Valid signature Filed with authorized/valid electronic signature
FAIRVIEW DENTAL CARE 401K PLAN 2010 363607708 2011-06-14 FAIRVIEW DENTAL CARE 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621210
Sponsor’s telephone number 6308525353
Plan sponsor’s address 6317 FAIRVIEW AVE., WESTMONT, IL, 60559

Plan administrator’s name and address
Administrator’s EIN 363607708
Plan administrator’s name FAIRVIEW DENTAL CARE
Plan administrator’s address 6317 FAIRVIEW AVE., WESTMONT, IL, 60559
Administrator’s telephone number 6308525353

Signature of
Role Plan administrator
Date 2011-06-14
Name of individual signing DARREN DWAIN SIMPSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-14
Name of individual signing DARREN DWAIN SIMPSON
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
THOMAS BRZOSTOWSKI, 6317 FAIRVIEW AVE, STE 6, WESTMONT, 60659, COOK-NOT IN CITY OF CHICAGO Agent 2014-09-24

President

Name and Address Role
THOMAS W BRZOSTOWSKI, 6317 FAIRVIEW STE B, WESTMONT 60559 President

Historical Names

Name Change Date
THOMAS W. BRZOSTOWSKI, D.D.S., P.C. 1993-12-20

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 50000 1282000 No data

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 13 Jan 2025

Sources: Illinois Office of the Secretary of State

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