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  5. NORTHERN ILLINOIS DENTAL PARTNERS, PLLC

NORTHERN ILLINOIS DENTAL PARTNERS, PLLC

Company Details

Entity Name: NORTHERN ILLINOIS DENTAL PARTNERS, PLLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Goodstanding
Date Formed: 24 Feb 2023
Company Number: LLC_12557043
File Number: 12557043
Type of Management: Manager Managed
Date Status Change: 30 Apr 2024
Address 4903 E STATE ST, ROCKFORD, 61108, IL
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2023 363835597 2024-01-30 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 EAST STATE STREET, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2024-01-30
Name of individual signing HEATHER STEWART
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2022 363835597 2023-07-24 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 EAST STATE STREET, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2023-07-24
Name of individual signing HEATHER STEWART
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2021 363835597 2022-06-24 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 EAST STATE STREET, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2022-06-24
Name of individual signing RANDY MARTINEZ
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2020 363835597 2021-08-30 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 EAST STATE STREET, ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2021-08-30
Name of individual signing JEFFREY J. JOHNSON
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2019 363835597 2020-04-29 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 E. STATE ST., ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2020-04-29
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-04-29
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2018 363835597 2019-05-20 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 E. STATE ST., ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2019-05-20
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-20
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2017 363835597 2018-06-21 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 E. STATE ST., ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2018-05-09
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-21
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2016 363835597 2017-05-17 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 E. STATE ST., ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2017-05-17
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-17
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2015 363835597 2016-06-14 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 E. STATE ST., ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2016-06-14
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 401(K) PROFIT SHARING PLAN 2014 363835597 2015-05-14 PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621210
Sponsor’s telephone number 8153982323
Plan sponsor’s address 4903 E. STATE ST., ROCKFORD, IL, 61108

Signature of
Role Plan administrator
Date 2015-05-14
Name of individual signing JEFFREY J JOHNSON
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
JACOB DACHMAN, 5 LA QUINTA CT., LAKE IN THE HILLS, 60156 Agent 2023-02-24

Manager

Name and Address Role Appointment Date
DACHMAN, JACOB, 3878 N TRAINER RD, ROCKFORD, IL, 61114 Manager 2024-04-30
DACHMAN, ALISSA T, 3878 N TRAINER RD, ROCKFORD, IL, 61114 Manager 2024-04-30

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
PEDIATRIC DENTISTRY OF NORTHERN ILLINOIS Assumed name 2023-08-28 No data No data No data

Related by officers

DACHMAN, JACOB, 3878 N TRAINER RD, ROCKFORD, IL, 61114

BOULDER INVESTMENT GROUP, LLC

DACHMAN, ALISSA T, 3878 N TRAINER RD, ROCKFORD, IL, 61114

BOULDER INVESTMENT GROUP, LLC

Related by address

4903 E STATE ST, ROCKFORD, 61108, IL

BOULDER INVESTMENT GROUP, LLC

Date of last update: 13 Jan 2025

Sources: Illinois Office of the Secretary of State

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