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  5. ERIC N. BLOOM, D.D.S., LTD.

ERIC N. BLOOM, D.D.S., LTD.

Company Details

Entity Name: ERIC N. BLOOM, D.D.S., LTD.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 28 Mar 2003
Company Number: CORP_62809272
File Number: 62809272
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
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2023 364528590 2024-09-04 ERIC N. BLOOM D.D.S. LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2024-09-04
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2022 364528590 2023-09-06 ERIC N. BLOOM D.D.S. LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2023-09-06
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2021 364528590 2022-10-11 ERIC N. BLOOM D.D.S. LTD. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2020 364528590 2021-10-14 ERIC N. BLOOM D.D.S. LTD. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2019 364528590 2020-10-10 ERIC N. BLOOM D.D.S. LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2020-10-09
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2018 364528590 2019-10-07 ERIC N. BLOOM D.D.S. LTD. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2019-10-07
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2017 364528590 2018-10-12 ERIC N. BLOOM D.D.S. LTD. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2018-10-12
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2016 364528590 2017-10-10 ERIC N. BLOOM D.D.S. LTD. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2017-10-10
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2015 364528590 2016-10-10 ERIC N. BLOOM D.D.S. LTD. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2016-10-07
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature
ERIC N. BLOOM DDS LTD PROFIT SHARING PLAN 2014 364528590 2015-10-12 ERIC N. BLOOM D.D.S. LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-02-17
Business code 621210
Sponsor’s telephone number 8479980155
Plan sponsor’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025

Plan administrator’s name and address
Administrator’s EIN 364528590
Plan administrator’s name ERIC N. BLOOM D.D.S. LTD.
Plan administrator’s address 2300 LEHIGH SUITE 145, GLENVIEW, IL, 60025
Administrator’s telephone number 8479980155

Signature of
Role Plan administrator
Date 2015-10-12
Name of individual signing ERIC BLOOM
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
CHARLES R GRYLL, 6703 N CICERO AVE, LINCOLNWOOD, 60712, COOK-NOT IN CITY OF CHICAGO Agent 2003-03-28

President

Name and Address Role
ERIC BLOOM, 2300 LEIHIGH GLENVIEW IL 60026 President

Secretary

Name and Address Role
ERIC BLOOM Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 100000 10000000 No data

Related by officers

CHARLES R GRYLL, 6703 N CICERO AVE, LINCOLNWOOD, 60712, COOK-NOT IN CITY OF CHICAGO

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Related by address

No related companies by address

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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