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  5. MOON DENTAL, PLLC

MOON DENTAL, PLLC

Company Details

Entity Name: MOON DENTAL, PLLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Goodstanding
Date Formed: 05 Dec 2012
Company Number: LLC_04212533
File Number: 04212533
Type of Management: Member Managed
Date Status Change: 28 Oct 2024
Address 334 SOUTH 8TH STREET, QUINCY, 62301, IL
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CORNERSTONE DENTAL HEALTH PROFIT SHARING PLAN 2022 461508377 2023-06-08 CORNERSTONE DENTAL HEALTH 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2176175542
Plan sponsor’s address 334 S 8TH ST, QUINCY, IL, 623014106

Signature of
Role Plan administrator
Date 2023-06-08
Name of individual signing BRENDEN MOON
Valid signature Filed with authorized/valid electronic signature
CORNERSTONE DENTAL HEALTH PROFIT SHARING PLAN 2022 461508377 2023-09-18 CORNERSTONE DENTAL HEALTH 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2176175542
Plan sponsor’s address 334 S 8TH ST, QUINCY, IL, 623014106

Signature of
Role Plan administrator
Date 2023-09-18
Name of individual signing BRENDEN MOON
Valid signature Filed with authorized/valid electronic signature
CORNERSTONE DENTAL HEALTH PROFIT SHARING PLAN 2021 461508377 2022-06-02 CORNERSTONE DENTAL HEALTH 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2176175542
Plan sponsor’s address 334 S 8TH ST, QUINCY, IL, 623014106

Signature of
Role Plan administrator
Date 2022-06-02
Name of individual signing BRENDEN MOON
Valid signature Filed with authorized/valid electronic signature
CORNERSTONE DENTAL HEALTH PROFIT SHARING PLAN 2020 461508377 2021-05-12 CORNERSTONE DENTAL HEALTH 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2176175542
Plan sponsor’s address 334 S 8TH ST, QUINCY, IL, 623014106

Signature of
Role Plan administrator
Date 2021-05-12
Name of individual signing BRENDEN MOON
Valid signature Filed with authorized/valid electronic signature
CORNERSTONE DENTAL HEALTH PROFIT SHARING PLAN 2019 461508377 2020-05-11 CORNERSTONE DENTAL HEALTH 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2176175542
Plan sponsor’s address 334 S 8TH ST, QUINCY, IL, 623014106

Signature of
Role Plan administrator
Date 2020-05-11
Name of individual signing BRENDEN MOON
Valid signature Filed with authorized/valid electronic signature
CORNERSTONE DENTAL HEALTH PROFIT SHARING PLAN 2018 461508377 2019-05-22 CORNERSTONE DENTAL HEALTH 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2176175542
Plan sponsor’s address 334 S 8TH ST, QUINCY, IL, 623014106

Signature of
Role Plan administrator
Date 2019-05-22
Name of individual signing BRENDEN MOON
Valid signature Filed with authorized/valid electronic signature
CORNERSTONE DENTAL HEALTH PROFIT SHARING PLAN 2017 461508377 2018-06-13 CORNERSTONE DENTAL HEALTH 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2176175542
Plan sponsor’s address 334 S 8TH ST, QUINCY, IL, 623014106

Signature of
Role Plan administrator
Date 2018-06-13
Name of individual signing BRENDEN MOON
Valid signature Filed with authorized/valid electronic signature
CORNERSTONE DENTAL HEALTH PROFIT SHARING PLAN 2016 461508377 2017-11-17 CORNERSTONE DENTAL HEALTH 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2176175542
Plan sponsor’s address 334 S 8TH ST, QUINCY, IL, 623014106

Signature of
Role Plan administrator
Date 2017-11-17
Name of individual signing BRENDEN MOON
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
JUSTIN PUCKETT, 334 S 8TH ST, QUINCY, 62301 Agent 2023-11-14

Manager

Name and Address Role Appointment Date
MOON, BRENDEN, 334 SOUTH 8TH STREET, QUINCY, IL, 62301 Manager 2024-10-28

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
CORNERSTONE DENTAL HEALTH Assumed name 2012-12-17 No data No data 2020-10-23

Historical Names

Name Change Date
MOON DENTAL, LLC 2022-11-21

Related by officers

No related officers

Related by address

334 SOUTH 8TH STREET, QUINCY, 62301, IL

334 SOUTH 8TH STREET, LLC

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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