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  5. Dvorak Eye Clinic

Dvorak Eye Clinic

Company Details

Name: Dvorak Eye Clinic
Jurisdiction: Minnesota
Legal type: Assumed Name
Status: Active / In Good Standing
Date formed: 07 Oct 2016 (8 years ago)
Company Number: 01412ccb-cb8c-e611-816f-00155d01c56d
File Number: 907394100028
Principal Place of Business Address: 4914 45th Street NE, Sauk Rapids, MN 56379, USA
ZIP code: 56379
County: Benton County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DVORAK EYE CLINIC 401(K) PLAN 2023 813755769 2024-07-08 DVORAK EYE CLINIC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-02-01
Business code 621210
Sponsor’s telephone number 3207743666
Plan sponsor’s address 1311 2ND ST. N SUITE 105, SAUK RAPIDS, MN, 563792582

Signature of
Role Plan administrator
Date 2024-07-08
Name of individual signing JOHN DVORAK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-08
Name of individual signing JOHN DVORAK
Valid signature Filed with authorized/valid electronic signature
DVORAK EYE CLINIC 401(K) PLAN 2022 813755769 2023-07-31 DVORAK EYE CLINIC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-02-01
Business code 621210
Sponsor’s telephone number 3207743666
Plan sponsor’s address 1311 2ND ST. N SUITE 105, SAUK RAPIDS, MN, 563792582

Signature of
Role Plan administrator
Date 2023-07-31
Name of individual signing JOHN DVORAK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-31
Name of individual signing JOHN DVORAK
Valid signature Filed with authorized/valid electronic signature
DVORAK EYE CLINIC 401(K) PLAN 2021 813755769 2022-08-31 DVORAK EYE CLINIC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-02-01
Business code 621210
Sponsor’s telephone number 3207743666
Plan sponsor’s address 1311 2ND ST. N SUITE 105, SAUK RAPIDS, MN, 563792582

Signature of
Role Plan administrator
Date 2022-08-31
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-08-31
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature
DVORAK EYE CLINIC 401(K) PLAN 2020 813755769 2021-10-01 DVORAK EYE CLINIC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-02-01
Business code 621210
Sponsor’s telephone number 3207743666
Plan sponsor’s address 1311 2ND ST. N SUITE 105, SAUK RAPIDS, MN, 563792582

Signature of
Role Plan administrator
Date 2021-10-01
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-01
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature
DVORAK EYE CLINIC 401(K) PLAN 2019 813755769 2020-07-20 DVORAK EYE CLINIC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-02-01
Business code 621210
Sponsor’s telephone number 3207743666
Plan sponsor’s address 1311 2ND ST. N SUITE 105, SAUK RAPIDS, MN, 563792582

Signature of
Role Plan administrator
Date 2020-07-20
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-20
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature
DVORAK EYE CLINIC 401(K) PLAN 2018 813755769 2019-05-22 DVORAK EYE CLINIC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-02-01
Business code 621210
Sponsor’s telephone number 3207743666
Plan sponsor’s address 1311 2ND ST. N SUITE 105, SAUK RAPIDS, MN, 563872582

Signature of
Role Plan administrator
Date 2019-05-22
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-22
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature
DVORAK EYE CLINIC 401(K) PLAN 2017 813755769 2018-07-09 DVORAK EYE CLINIC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-02-01
Business code 621210
Sponsor’s telephone number 3207743666
Plan sponsor’s address 1311 2ND ST. N SUITE 105, SAUK RAPIDS, MN, 563872582

Signature of
Role Plan administrator
Date 2018-07-09
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-09
Name of individual signing AUDREY BERG
Valid signature Filed with authorized/valid electronic signature

Aplicant

Name Role Address
Dvorak Cataract and Eye Laser Clinic, P.A. Aplicant 4914 45th Street NE, Sauk Rapids, MN 56379

Filing

Filing Name Filing date
Original Filing - Assumed Name (Business Name: Dvorak Eye Clinic) 2016-10-07

Related by officers

No related officers

Related by address

4914 45th Street NE, Sauk Rapids, MN 56379, USA

Dvorak Properties, LLC

Date of last update: 01 Oct 2024

Sources: Minnesota's Official State Website

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