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TOM CLANCY, LLC

TOM CLANCY, LLC

Company Details

Entity Name:	TOM CLANCY, LLC
Jurisdiction:	Illinois
Entity Type:	Limited Liability Company
Status:	Goodstanding
Date Formed:	17 Feb 2005
Company Number:	LLC_01427725
File Number:	01427725
Type of Management:	Member Managed
Date Status Change:	19 Jan 2024
Address	1010 S. MADISON AVE., LAGRANGE, 60525, IL
Place of Formation:	ILLINOIS

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

SMILE CENTER ORTHODONTICS, LLC 401(K) PLAN

2011

562622825

2012-07-03

SMILE CENTER ORTHODONTICS, LLC

5

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-09-29
Business code	621210
Sponsor’s telephone number	6182887000
Plan sponsor’s address	18 SOUTH STATE ROUTE 159, SUITE 1, GLEN CARBON, IL, 62034

Plan administrator’s name and address

Administrator’s EIN	562622825
Plan administrator’s name	SMILE CENTER ORTHODONTICS, LLC
Plan administrator’s address	18 SOUTH STATE ROUTE 159, SUITE 1, GLEN CARBON, IL, 62034
Administrator’s telephone number	6182887000

Signature of

Role	Plan administrator
Date	2012-07-03
Name of individual signing	RENATA REGALADO
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2012-07-03
Name of individual signing	RENATA REGALADO
Valid signature	Filed with authorized/valid electronic signature

SMILE CENTER ORTHODONTICS LLC 401K PLAN

2010

562622825

2011-07-26

SMILE CENTER ORTHODONTICS LLC

3

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2008-09-29
Business code	621210
Sponsor’s telephone number	6182887000
Plan sponsor’s address	18 SOUTH STATE ROUTE 159, SUITE 1, GLEN CARBON, IL, 62034

Plan administrator’s name and address

Administrator’s EIN	562622825
Plan administrator’s name	SMILE CENTER ORTHODONTICS LLC
Plan administrator’s address	18 SOUTH STATE ROUTE 159, SUITE 1, GLEN CARBON, IL, 62034
Administrator’s telephone number	6182887000

Signature of

Role	Plan administrator
Date	2011-07-26
Name of individual signing	RENATA REGALADO
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2011-07-26
Name of individual signing	RENATA REGALADO
Valid signature	Filed with authorized/valid electronic signature

Agent

Name and Address	Role	Appointment Date
THOMAS K. CLANCY, 1010 S. MADISON AVE., LAGRANGE, 60525, COOK-NOT IN CITY OF CHICAGO	Agent	2005-02-17

Member

Name and Address	Role	Appointment Date
CLANCY, THOMAS K., 1010 S. MADISON AVE., LAGRANGE, IL, 60525	Member	2005-02-17

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State