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  5. HERITAGE GROVE FAMILY DENTAL, P.C.

HERITAGE GROVE FAMILY DENTAL, P.C.

Company Details

Entity Name: HERITAGE GROVE FAMILY DENTAL, P.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 21 Jan 2014
Company Number: CORP_69316484
File Number: 69316484
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
HERITAGE GROVE FAMILY DENTAL 401(K) PLAN 2023 464602905 2024-04-26 HERITAGE GROVE FAMILY DENTAL 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8152546700
Plan sponsor’s address 12426 S. VAN DYKE ROAD, STE. B, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2024-04-26
Name of individual signing PETE GALLOS
Valid signature Filed with authorized/valid electronic signature
HERITAGE GROVE FAMILY DENTAL 401(K) PLAN 2022 464602905 2023-07-26 HERITAGE GROVE FAMILY DENTAL 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8152546700
Plan sponsor’s address 12426 S. VAN DYKE ROAD, STE. B, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing PETE GALLOS
Valid signature Filed with authorized/valid electronic signature
HERITAGE GROVE FAMILY DENTAL 401(K) PLAN 2021 464602905 2022-06-03 HERITAGE GROVE FAMILY DENTAL 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8152546700
Plan sponsor’s address 12426 S. VAN DYKE ROAD, STE. B, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2022-06-03
Name of individual signing PETE GALLOS
Valid signature Filed with authorized/valid electronic signature
HERITAGE GROVE FAMILY DENTAL 401(K) PLAN 2020 464602905 2021-06-25 HERITAGE GROVE FAMILY DENTAL 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8152546700
Plan sponsor’s address 12426 S. VAN DYKE ROAD, STE. B, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2021-06-25
Name of individual signing PETE GALLOS
Valid signature Filed with authorized/valid electronic signature
HERITAGE GROVE FAMILY DENTAL 401(K) PLAN 2019 464602905 2020-04-21 HERITAGE GROVE FAMILY DENTAL 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8152546700
Plan sponsor’s address 12426 S VAN DYKE RD, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2020-04-21
Name of individual signing PETE GALLOS
Valid signature Filed with authorized/valid electronic signature
HERITAGE GROVE FAMILY DENTAL 401(K) PLAN 2018 464602905 2019-05-22 HERITAGE GROVE FAMILY DENTAL 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8152546700
Plan sponsor’s address 12426 S VAN DYKE RD, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2019-05-22
Name of individual signing PETE GALLOS
Valid signature Filed with authorized/valid electronic signature
HERITAGE GROVE FAMILY DENTAL 401(K) PLAN 2017 464602905 2018-06-19 HERITAGE GROVE FAMILY DENTAL 11
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 8152546700
Plan sponsor’s address 12426 S VAN DYKE RD, PLAINFIELD, IL, 60585

Signature of
Role Plan administrator
Date 2018-06-18
Name of individual signing PETE GALLOS
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
TODD L. ERDMAN, 127 S WHEELING RD, WHEELING, 60090, COOK-NOT IN CITY OF CHICAGO Agent 2014-01-21

President

Name and Address Role
PETER GALLOS 12426 S. VAN DYKERD STE B PLAINFIELD, IL 60585 President

Secretary

Name and Address Role
PETER GALLOS 12426 S. VAN DYKERD STE B PLAINFIELD, IL 60585 Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON 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: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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