| Entity Name: | PERIODONTICS OF NILES, INC. |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Domestic BCA |
| Status: | Dissolved |
| Date Formed: | 29 Sep 2003 |
| Date of Dissolution: | 03 Mar 2004 |
| Company Number: | CORP_63105546 |
| File Number: | 63105546 |
| Type of Business: | All Inclusive Purpose |
| Date Status Change: | 03 Mar 2004 |
| Place of Formation: | ILLINOIS |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PERIODONTICS OF NILES, INC, 401(K) PROFIT SHARING PLAN & TRUST | 2009 | 364300382 | 2010-04-12 | PERIODONTICS OF NILES, INC | 8 | |||||||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 364300382 |
| Plan administrator’s name | PERIODONTICS OF NILES, INC |
| Plan administrator’s address | 8216 W OAKTON ST, NILES, IL, 60714 |
| Administrator’s telephone number | 8476856686 |
Number of participants as of the end of the plan year
| Active participants | 7 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants with account balances as of the end of the plan year | 3 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Plan administrator |
| Date | 2010-04-12 |
| Name of individual signing | DOROTHY ANASINSKI |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2006-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 8476856686 |
| Plan sponsor’s mailing address | 8216 W OAKTON ST, NILES, IL, 60714 |
| Plan sponsor’s address | 8216 W OAKTON ST, NILES, IL, 60714 |
Plan administrator’s name and address
| Administrator’s EIN | 364300382 |
| Plan administrator’s name | PERIODONTICS OF NILES, INC |
| Plan administrator’s address | 8216 W OAKTON ST, NILES, IL, 60714 |
| Administrator’s telephone number | 8476856686 |
Number of participants as of the end of the plan year
| Active participants | 7 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants with account balances as of the end of the plan year | 3 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Plan administrator |
| Date | 2010-04-12 |
| Name of individual signing | DOROTHY ANASINSKI |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| SAMUEL A SMITH, 535 S WASHINGTON ST, NAPERVILLE, 60540, DU PAGE | Agent | 2003-09-29 |
| Name and Address | Role |
|---|---|
| SAMUEL A SMITH 535 S WASHINGTON ST NAPERVILLE 60540 | Incorporator |
| Class | Series | Voting Rights | Authorized Shares | Issued Shares | Par Value |
|---|---|---|---|---|---|
| COMMON A | No data | Voting Rights | 10000 | 100000 | No data |
Date of last update: 27 Jan 2025
