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  5. ANNA M. PELAK, P.C.

ANNA M. PELAK, P.C.

Company Details

Entity Name: ANNA M. PELAK, P.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 12 Apr 1994
Company Number: CORP_57767707
File Number: 57767707
Type of Business: Incorporated under the Medical Corporation Act
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TOTAL DENTISTRY 401(K) PS PLAN 2010 364107331 2011-08-17 ANNA M. PELAK, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8473581134
Plan sponsor’s address 647 FIRST BANK DR., PALATINE, IL, 60067

Plan administrator’s name and address
Administrator’s EIN 364107331
Plan administrator’s name ANNA M. PELAK, P.C.
Plan administrator’s address 647 FIRST BANK DR., PALATINE, IL, 60067
Administrator’s telephone number 8473581134

Signature of
Role Plan administrator
Date 2011-08-17
Name of individual signing ANNA PELAK
Valid signature Filed with authorized/valid electronic signature
TOTAL DENTISTRY 401(K) PS PLAN 2009 364107331 2010-07-19 ANNA M. PELAK, P.C. 8
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8473581134
Plan sponsor’s address 647 FIRST BANK DR., PALATINE, IL, 60067

Plan administrator’s name and address
Administrator’s EIN 364107331
Plan administrator’s name ANNA M. PELAK, P.C.
Plan administrator’s address 647 FIRST BANK DR., PALATINE, IL, 60067
Administrator’s telephone number 8473581134

Signature of
Role Plan administrator
Date 2010-07-19
Name of individual signing ANNA PELAK
Valid signature Filed with incorrect/unrecognized electronic signature
TOTAL DENTISTRY 401(K) PS PLAN 2009 364107331 2010-07-19 ANNA M. PELAK, P.C. 8
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8473581134
Plan sponsor’s address 647 FIRST BANK DR., PALATINE, IL, 60067

Plan administrator’s name and address
Administrator’s EIN 364107331
Plan administrator’s name ANNA M. PELAK, P.C.
Plan administrator’s address 647 FIRST BANK DR., PALATINE, IL, 60067
Administrator’s telephone number 8473581134

Signature of
Role Plan administrator
Date 2010-07-19
Name of individual signing ANNA PELAK
Valid signature Filed with incorrect/unrecognized electronic signature
TOTAL DENTISTRY 401(K) PS PLAN 2009 364107331 2010-07-14 ANNA M. PELAK, P.C. 8
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8473581134
Plan sponsor’s address 647 FIRST BANK DR., PALATINE, IL, 60067

Plan administrator’s name and address
Administrator’s EIN 364107331
Plan administrator’s name ANNA M. PELAK, P.C.
Plan administrator’s address 647 FIRST BANK DR., PALATINE, IL, 60067
Administrator’s telephone number 8473581134

Signature of
Role Plan administrator
Date 2010-07-14
Name of individual signing ANNA PELAK
Valid signature Filed with incorrect/unrecognized electronic signature
TOTAL DENTISTRY 401(K) PS PLAN 2009 364107331 2010-07-19 ANNA M. PELAK, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 8473581134
Plan sponsor’s address 647 FIRST BANK DR., PALATINE, IL, 60067

Plan administrator’s name and address
Administrator’s EIN 364107331
Plan administrator’s name ANNA M. PELAK, P.C.
Plan administrator’s address 647 FIRST BANK DR., PALATINE, IL, 60067
Administrator’s telephone number 8473581134

Signature of
Role Plan administrator
Date 2010-07-19
Name of individual signing ANNA PELAK
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
ANNA M PELAK, 647 FIRST BANK DRIVE, PALATINE, 60067, COOK-NOT IN CITY OF CHICAGO Agent 1994-04-12

President

Name and Address Role
ANNA M. PELAK, D.D.S. 647 FIRST BANK DR., PALATINE, IL 60067 President

Secretary

Name and Address Role
ANNA M. PELAK, D.D.S. 647 FIRST BANK DR., PALATINE, IL 60067 Secretary

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
TOTAL DENTISTRY - PALATINE Assume Name 2014-06-11 No data No data No data

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 1000 1000000 No data

Related by officers

No related officers

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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