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PALOS PEDIATRIC DENTISTRY, P.C.

Company Details

Entity Name: PALOS PEDIATRIC DENTISTRY, P.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 05 Aug 2013
Company Number: CORP_69120075
File Number: 69120075
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
PALOS PEDIATRIC DENTISTRY, P.C. 401(K) PLAN 2023 463356304 2024-10-14 PALOS PEDIATRIC DENTISTRY, P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 7085865851
Plan sponsor’s address 7440 W. COLLEGE DRIVE, SUITE A-200, PALOS HEIGHTS, IL, 60463

Signature of

Role Plan administrator
Date 2024-10-14
Name of individual signing RICHARD FACKO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-14
Name of individual signing RICHARD FACKO
Valid signature Filed with authorized/valid electronic signature
PALOS PEDIATRIC DENTISTRY, P.C. 401(K) PLAN 2022 463356304 2023-10-11 PALOS PEDIATRIC DENTISTRY, P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 7085865851
Plan sponsor’s address 7440 W. COLLEGE DRIVE, SUITE A-200, PALOS HEIGHTS, IL, 60463

Signature of

Role Plan administrator
Date 2023-10-11
Name of individual signing DARREN JOSSEL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-11
Name of individual signing DARREN JOSSEL
Valid signature Filed with authorized/valid electronic signature
PALOS PEDIATRIC DENTISTRY, P.C. 401(K) PLAN 2021 463356304 2022-10-13 PALOS PEDIATRIC DENTISTRY, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 7085865851
Plan sponsor’s address 7440 W. COLLEGE DRIVE, SUITE A-200, PALOS HEIGHTS, IL, 60463

Signature of

Role Plan administrator
Date 2022-10-13
Name of individual signing MICHAEL W. BLITSTEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-13
Name of individual signing MICHAEL W. BLITSTEIN
Valid signature Filed with authorized/valid electronic signature
PALOS PEDIATRIC DENTISTRY, P.C. 401(K) PLAN 2020 463356304 2021-10-12 PALOS PEDIATRIC DENTISTRY, P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 621210
Sponsor’s telephone number 7085865851
Plan sponsor’s address 7440 W. COLLEGE DRIVE, SUITE A-200, PALOS HEIGHTS, IL, 60463

Signature of

Role Plan administrator
Date 2021-10-12
Name of individual signing MICHAEL W. BLITSTEIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-12
Name of individual signing MICHAEL W. BLITSTEIN
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
RICHARD N FACKO, 6446 W 127TH STREET, PALOS HEIGHTS, 60463, COOK-NOT IN CITY OF CHICAGO Agent 2022-07-08

President

Name and Address Role
RICHARD FACKO, 6837 W HIGHLANDDR, PALOS HEIGHTS, IL 60463 President

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 10000 1000000 No data

Date of last update: 13 Feb 2025

Sources: Illinois Office of the Secretary of State