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BARRY E. BOOTH, D.D.S., M.S., P.C.

BARRY E. BOOTH, D.D.S., M.S., P.C.

Company Details

Entity Name:	BARRY E. BOOTH, D.D.S., M.S., P.C.
Jurisdiction:	Illinois
Entity Type:	Corporation - Domestic BCA
Status:	Dissolved
Date Formed:	11 Jan 1993
Date of Dissolution:	10 Jun 2022
Company Number:	CORP_57139811
File Number:	57139811
Type of Business:	Incorporated under the Medical Corporation Act
Date Status Change:	10 Jun 2022
Place of Formation:	ILLINOIS

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

BARRY E. BOOTH, D.D.S., M.S., P.C. 401(K) PLAN

2018

363864313

2019-09-10

BARRY E. BOOTH, D.D.S., M.S., P.C.

14

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	7083010005
Plan sponsor’s address	12635 WEST 143RD STREET, HOMER GLEN, IL, 60491

Signature of

Role	Plan administrator
Date	2019-09-09
Name of individual signing	BARRY BOOTH
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2019-09-09
Name of individual signing	BARRY BOOTH
Valid signature	Filed with authorized/valid electronic signature

BARRY E. BOOTH, D.D.S., M.S., P.C. 401(K) PLAN

2017

363864313

2018-06-18

BARRY E. BOOTH, D.D.S., M.S., P.C.

13

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	7083010005
Plan sponsor’s address	12635 WEST 143RD STREET, HOMER GLEN, IL, 60491

Signature of

Role	Plan administrator
Date	2018-06-18
Name of individual signing	BARRY BOOTH
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2018-06-18
Name of individual signing	BARRY BOOTH
Valid signature	Filed with authorized/valid electronic signature

BARRY E. BOOTH, DDS, MS, PC 401(K) PLAN

2016

363864313

2017-05-25

BARRY E. BOOTH, D.D.S., M.S., P.C.

13

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	7083010005
Plan sponsor’s address	12635 W. 143RD STREET, HOMER GLEN, IL, 60491

Signature of

Role	Plan administrator
Date	2017-05-25
Name of individual signing	BARRY E. BOOTH
Valid signature	Filed with authorized/valid electronic signature

BARRY E. BOOTH, DDS, MS, PC 401(K) PLAN

2015

363864313

2016-05-04

BARRY E. BOOTH, D.D.S., M.S., P.C.

12

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	7083010005
Plan sponsor’s address	12635 W. 143RD STREET, HOMER GLEN, IL, 60491

Signature of

Role	Plan administrator
Date	2016-05-04
Name of individual signing	BARRY E. BOOTH
Valid signature	Filed with authorized/valid electronic signature

BARRY E. BOOTH, DDS, MS, PC 401(K) PLAN

2014

363864313

2015-06-08

BARRY E. BOOTH, D.D.S., M.S., P.C.

12

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1994-01-01
Business code	621210
Sponsor’s telephone number	7083010005
Plan sponsor’s address	12635 W. 143RD STREET, HOMER GLEN, IL, 60491

Signature of

Role	Plan administrator
Date	2015-06-08
Name of individual signing	BARRY E. BOOTH
Valid signature	Filed with authorized/valid electronic signature

Agent

Name and Address	Role	Appointment Date
BARRY E BOOTH, 12635 W 143RD ST, HOMER GLEN, 60491, WILL	Agent	2004-07-19

President

Name and Address	Role
BARRY E BOOTH, 439 SUNSET AVE, LAGRANGE 60525	President

Shares

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

Date of last update: 13 Mar 2025

Sources: Illinois Office of the Secretary of State