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  5. Riverside Dental Office, PLLC

Riverside Dental Office, PLLC

Company Details

Name: Riverside Dental Office, PLLC
Jurisdiction: Minnesota
Legal type: Limited Liability Company (Domestic)
Status: Inactive
Date formed: 07 Nov 2007 (17 years ago)
Company Number: 1fdf72c4-90d4-e011-a886-001ec94ffe7f
File Number: 2578881-2
Registered Office Address: 101 7th Str N, Sartell, MN 56377, USA
Principal Executive Office Address: 101 7th street north, sartell, MN 56377, USA
ZIP code: 56377
County: Stearns County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RIVERSIDE DENTAL OFFICE, PLLC 401K PROFIT SHARING PLAN 2011 411418075 2012-03-05 RIVERSIDE DENTAL OFFICE, PLLC 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1991-05-01
Business code 621210
Sponsor’s telephone number 3202550896
Plan sponsor’s address 101 7TH STREET NORTH, SARTELL, MN, 56377

Plan administrator’s name and address
Administrator’s EIN 411418075
Plan administrator’s name RIVERSIDE DENTAL OFFICE, PLLC
Plan administrator’s address 101 7TH STREET NORTH, SARTELL, MN, 56377
Administrator’s telephone number 3202550896

Signature of
Role Plan administrator
Date 2012-03-04
Name of individual signing KEVIN COSTLEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-03-04
Name of individual signing KEVIN COSTLEY
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE DENTAL OFFICE, PLLC 401K PROFIT SHARING PLAN 2011 411418075 2012-11-26 RIVERSIDE DENTAL OFFICE, PLLC 6
Three-digit plan number (PN) 002
Effective date of plan 1991-05-01
Business code 621210
Sponsor’s telephone number 3202538241
Plan sponsor’s address 3810 RIVIERA ROAD, SARTELL, MN, 56377

Plan administrator’s name and address
Administrator’s EIN 411418075
Plan administrator’s name RIVERSIDE DENTAL OFFICE, PLLC
Plan administrator’s address 3810 RIVIERA ROAD, SARTELL, MN, 56377
Administrator’s telephone number 3202538241

Signature of
Role Plan administrator
Date 2012-11-25
Name of individual signing KEVIN COSTLEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-11-25
Name of individual signing KEVIN COSTLEY
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE DENTAL OFFICE, PLLC 401K PROFIT SHARING PLAN 2010 411418075 2011-06-28 RIVERSIDE DENTAL OFFICE, PLLC 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1991-05-01
Business code 621210
Sponsor’s telephone number 3202550896
Plan sponsor’s address 101 7TH STREET NORTH, SARTELL, MN, 56377

Plan administrator’s name and address
Administrator’s EIN 411418075
Plan administrator’s name RIVERSIDE DENTAL OFFICE, PLLC
Plan administrator’s address 101 7TH STREET NORTH, SARTELL, MN, 56377
Administrator’s telephone number 3202550896

Signature of
Role Plan administrator
Date 2011-06-27
Name of individual signing KEVIN COSTLEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-27
Name of individual signing KEVIN COSTLEY
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE DENTAL OFFICE, PLLC 401K PROFIT SHARING PLAN 2009 411418075 2010-06-23 RIVERSIDE DENTAL OFFICE, PLLC 6
Three-digit plan number (PN) 002
Effective date of plan 1991-05-01
Business code 621210
Sponsor’s telephone number 3202550896
Plan sponsor’s address 101 7TH STREET NORTH, SARTELL, MN, 56377

Plan administrator’s name and address
Administrator’s EIN 411418075
Plan administrator’s name RIVERSIDE DENTAL OFFICE, PLLC
Plan administrator’s address 101 7TH STREET NORTH, SARTELL, MN, 56377
Administrator’s telephone number 3202550896

Signature of
Role Plan administrator
Date 2010-06-23
Name of individual signing KEVIN COSTLEY
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-06-23
Name of individual signing KEVIN COSTLEY
Valid signature Filed with incorrect/unrecognized electronic signature
RIVERSIDE DENTAL OFFICE, PLLC 401K PROFIT SHARING PLAN 2009 411418075 2010-06-23 RIVERSIDE DENTAL OFFICE, PLLC 6
Three-digit plan number (PN) 002
Effective date of plan 1991-05-01
Business code 621210
Sponsor’s telephone number 3202550896
Plan sponsor’s address 101 7TH STREET NORTH, SARTELL, MN, 56377

Plan administrator’s name and address
Administrator’s EIN 411418075
Plan administrator’s name RIVERSIDE DENTAL OFFICE, PLLC
Plan administrator’s address 101 7TH STREET NORTH, SARTELL, MN, 56377
Administrator’s telephone number 3202550896

Signature of
Role Plan administrator
Date 2010-06-23
Name of individual signing KEVIN COSTLEY
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-06-23
Name of individual signing KEVIN COSTLEY
Valid signature Filed with incorrect/unrecognized electronic signature
RIVERSIDE DENTAL OFFICE, PLLC 401K PROFIT SHARING PLAN 2009 411418075 2010-06-23 RIVERSIDE DENTAL OFFICE, PLLC 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1991-05-01
Business code 621210
Sponsor’s telephone number 3202550896
Plan sponsor’s address 101 7TH STREET NORTH, SARTELL, MN, 56377

Plan administrator’s name and address
Administrator’s EIN 411418075
Plan administrator’s name RIVERSIDE DENTAL OFFICE, PLLC
Plan administrator’s address 101 7TH STREET NORTH, SARTELL, MN, 56377
Administrator’s telephone number 3202550896

Signature of
Role Plan administrator
Date 2010-06-23
Name of individual signing KEVIN COSTLEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-06-23
Name of individual signing KEVIN COSTLEY
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
Kevin Costley Manager 101 7th Str. N, Sartell, MN 56377, USA

Filing

Filing Name Filing date
Conversion to 322C Due to Statute Mandate – Limited Liability Company (Domestic) 2018-01-01
Termination - Limited Liability Company (Domestic) 2013-01-28
Original Filing - Limited Liability Company (Domestic) 2007-11-07
Limited Liability Company (Domestic) Business Name (Business Name: Riverside Dental Office, PLLC) 2007-11-07

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No related officers

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101 7th Str N, Sartell, MN 56377, USA

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Date of last update: 30 Sep 2024

Sources: Minnesota's Official State Website

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