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  5. PINE DENTAL CARE, P.C.

PINE DENTAL CARE, P.C.

Company Details

Entity Name: PINE DENTAL CARE, P.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 27 Mar 2000
Company Number: CORP_60970963
File Number: 60970963
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
PINE DENTAL CARE 401(K) PLAN 2023 363441852 2024-09-20 PINE DENTAL CARE, P.C. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 7738805455
Plan sponsor’s address 1460 NORTH HALSTED STREET,, SUITE 403, CHICAGO, IL, 60642

Signature of
Role Plan administrator
Date 2024-09-20
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
PINE DENTAL CARE 401(K) PLAN 2022 363441852 2023-10-16 PINE DENTAL CARE, P.C. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 7738805455
Plan sponsor’s address 1460 NORTH HALSTED STREET,, SUITE 403, CHICAGO, IL, 60642

Signature of
Role Plan administrator
Date 2023-10-16
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
PINE DENTAL CARE 401(K) PLAN 2021 363441852 2022-10-10 PINE DENTAL CARE, P.C. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 7738805455
Plan sponsor’s address 1460 NORTH HALSTED STREET,, SUITE 403, CHICAGO, IL, 60642

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-10
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
PINE DENTAL CARE 401(K) PLAN 2020 363441852 2021-09-22 PINE DENTAL CARE, P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 7738805455
Plan sponsor’s address 1460 NORTH HALSTED STREET, SUITE 40, CHICAGO, IL, 60642

Signature of
Role Plan administrator
Date 2021-09-22
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-09-22
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
PINE DENTAL CARE 401(K) PLAN 2019 363441852 2020-09-28 PINE DENTAL CARE, P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 7738805455
Plan sponsor’s address 1460 NORTH HALSTED STREET, SUITE 40, CHICAGO, IL, 60642

Signature of
Role Plan administrator
Date 2020-09-28
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-09-28
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
PINE DENTAL CARE 401(K) PLAN 2018 363441852 2019-10-10 PINE DENTAL CARE, P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 7738805455
Plan sponsor’s address 1460 NORTH HALSTED STREET, SUITE 40, CHICAGO, IL, 60642

Signature of
Role Plan administrator
Date 2019-10-10
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-10-10
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature
PINE DENTAL CARE 401(K) PLAN 2017 363441852 2018-10-11 PINE DENTAL CARE, P.C. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 7738805455
Plan sponsor’s address 1460 NORTH HALSTED STREET, SUITE 40, CHICAGO, IL, 60642

Signature of
Role Plan administrator
Date 2018-10-11
Name of individual signing CHARLES CZEREPAK
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
KENNETH R SIEGAN, 1266 RIDGE RD, NORTHBROOK, 60062, COOK-NOT IN CITY OF CHICAGO Agent 2017-01-03

President

Name and Address Role
CHARLES CZEREPAK, 1 SALEM CIRCLE EVANSTON 60203 President

Secretary

Name and Address Role
NANCY HIJJAWI 816 N LATHROP RIVER FOREST 60305 Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMOC No data Voting Rights 10000 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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