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  5. JACQUELINE ROSEN, D.D.S., M.S., P.C.

JACQUELINE ROSEN, D.D.S., M.S., P.C.

Company Details

Entity Name: JACQUELINE ROSEN, D.D.S., M.S., P.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Converted
Date Formed: 13 Jun 1990
Company Number: CORP_55996873
File Number: 55996873
Type of Business: Incorporated under the Professional Service Corporation Act
Date Status Change: 13 Dec 2019
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JACQUELINE ROSEN, D.D.S., M.S., P.C. 401(K) PROFIT SHARING PLAN 2014 363715965 2015-10-05 JACQUELINE ROSEN, D.D.S., M.S., P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 8472159971
Plan sponsor’s address 355 W. DUNDEE, SUITE 215, BUFFALO GROVE, IL, 60089

Signature of
Role Plan administrator
Date 2015-10-05
Name of individual signing JACQUELINE ROSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-05
Name of individual signing JACQUELINE ROSEN
Valid signature Filed with authorized/valid electronic signature
JACQUELINE ROSEN, D.D.S., M.S., P.C. 401(K) PROFIT SHARING PLAN 2013 363715965 2014-10-14 JACQUELINE ROSEN, D.D.S., M.S., P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 8472159971
Plan sponsor’s address 355 W. DUNDEE, SUITE 215, BUFFALO GROVE, IL, 60089

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing JACQUELINE G. ROSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-14
Name of individual signing JACQUELINE G. ROSEN
Valid signature Filed with authorized/valid electronic signature
JACQUELINE ROSEN, D.D.S., M.S., P.C. 401(K) PROFIT SHARING PLAN 2012 363715965 2013-10-14 JACQUELINE ROSEN, D.D.S., M.S., P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 8472159971
Plan sponsor’s address 355 W. DUNDEE, SUITE 215, BUFFALO GROVE, IL, 60089

Signature of
Role Plan administrator
Date 2013-10-14
Name of individual signing JACQUELINE ROSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-14
Name of individual signing JACQUELINE ROSEN
Valid signature Filed with authorized/valid electronic signature
JACQUELINE ROSEN, D.D.S., M.S., P.C. 401(K) PROFIT SHARING PLAN 2011 363715965 2012-09-10 JACQUELINE ROSEN, D.D.S., M.S., P.C. 6
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 8472159971
Plan sponsor’s address 355 W. DUNDEE, SUITE 215, BUFFALO GROVE, IL, 60089

Plan administrator’s name and address
Administrator’s EIN 363715965
Plan administrator’s name JACQUELINE ROSEN, D.D.S., M.S., P.C.
Plan administrator’s address 355 W. DUNDEE, SUITE 215, BUFFALO GROVE, IL, 60089
Administrator’s telephone number 8472159971

Signature of
Role Plan administrator
Date 2012-09-10
Name of individual signing JACQUELINE ROSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-09-10
Name of individual signing JACQUELINE ROSEN
Valid signature Filed with authorized/valid electronic signature
JACQUELINE ROSEN, D.D.S., M.S., P.C. 401(K) PROFIT SHARING PLAN 2011 363715965 2012-09-11 JACQUELINE ROSEN, D.D.S., M.S., P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 8472159971
Plan sponsor’s address 355 W. DUNDEE, SUITE 215, BUFFALO GROVE, IL, 60089

Plan administrator’s name and address
Administrator’s EIN 363715965
Plan administrator’s name JACQUELINE ROSEN, D.D.S., M.S., P.C.
Plan administrator’s address 355 W. DUNDEE, SUITE 215, BUFFALO GROVE, IL, 60089
Administrator’s telephone number 8472159971

Signature of
Role Plan administrator
Date 2012-09-11
Name of individual signing JACQUELINE ROSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-09-11
Name of individual signing JACQUELINE ROSEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
TAFT SERVICE SOLUTIONS CORP, 111 E WACKER DR STE 2800, CHICAGO, 60601, COOK-NOT IN CITY OF CHICAGO Agent 2015-07-02

President

Name and Address Role
JACQUELINE G ROSEN 355 W DUNDEE RD STE 215 BUFFALO GROVE IL President

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 1000 100000 No data

Related by officers

TAFT SERVICE SOLUTIONS CORP, 111 E WACKER DR STE 2800, CHICAGO, 60601, COOK-NOT IN CITY OF CHICAGO

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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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