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  5. KEITH MELLOVITZ, D.D.S., P.C.

KEITH MELLOVITZ, D.D.S., P.C.

Company Details

Entity Name: KEITH MELLOVITZ, D.D.S., P.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 31 May 2000
Company Number: CORP_61068791
File Number: 61068791
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
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2023 363685183 2024-07-01 KEITH MELLOVITZ D.D.S. P.C. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 410 STANDISH DR, DEERFIELD, IL, 600154435

Signature of
Role Plan administrator
Date 2024-07-01
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2022 363685183 2023-06-17 KEITH MELLOVITZ D.D.S. P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 851 BITTERSWEET DR, NORTHBROOK, IL, 600623701

Signature of
Role Plan administrator
Date 2023-06-17
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2021 363685183 2022-07-12 KEITH MELLOVITZ D.D.S. P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 851 BITTERSWEET DR, NORTHBROOK, IL, 600623701

Signature of
Role Plan administrator
Date 2022-07-12
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2020 363685183 2021-07-06 KEITH MELLOVITZ D.D.S. P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 851 BITTERSWEET DR, NORTHBROOK, IL, 600623701

Signature of
Role Plan administrator
Date 2021-07-06
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2019 363685183 2020-07-15 KEITH MELLOVITZ D.D.S. P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 851 BITTERSWEET DR, NORTHBROOK, IL, 600623701

Signature of
Role Plan administrator
Date 2020-07-15
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2018 363685183 2019-07-15 KEITH MELLOVITZ D.D.S. P.C. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 410 STANDISH DR, DEERFIELD, IL, 600154435

Signature of
Role Plan administrator
Date 2019-07-15
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2017 363685183 2018-07-12 KEITH MELLOVITZ D.D.S. P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 410 STANDISH DR, HIGHLAND PARK, IL, 600352646

Signature of
Role Plan administrator
Date 2018-07-12
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2016 363685183 2017-07-08 KEITH MELLOVITZ D.D.S. P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 410 STANDISH DR, DEERFIELD, IL, 600154435

Signature of
Role Plan administrator
Date 2017-07-08
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2015 363685183 2016-06-30 KEITH MELLOVITZ D.D.S. P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 410 STANDISH DR, DEERFIELD, IL, 600154435

Signature of
Role Plan administrator
Date 2016-06-30
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature
KEITH MELLOVITZ D.D.S. P.C. 401(K) 2014 363685183 2015-07-15 KEITH MELLOVITZ D.D.S. P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 8474339350
Plan sponsor’s address 410 STANDISH DR, DEERFIELD, IL, 600154435

Signature of
Role Plan administrator
Date 2015-07-15
Name of individual signing KEITH MELLOVITZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
RICHARD B WEIL, 1740 MISSION HILLS RD APT 107, NORTHBROOK, 60062, COOK-NOT IN CITY OF CHICAGO Agent 2022-02-28

President

Name and Address Role
KEITH MELLOVITZ, 1893 SHERIDANRD #318 HIGHLAND PARK 60035 President

Secretary

Name and Address Role
MONICA MELLOVITZ 1893 SHERIDANRD #318 HIGHLAND PARK 60035 Secretary

Shares

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

Related by officers

RICHARD B WEIL, 1740 MISSION HILLS RD APT 107, NORTHBROOK, 60062, 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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