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  5. SIBLEY DENTAL SUITE, PLLC

SIBLEY DENTAL SUITE, PLLC

Company Details

Name: SIBLEY DENTAL SUITE, PLLC
Jurisdiction: Minnesota
Legal type: Limited Liability Company (Domestic)
Status: Active / In Good Standing
Date formed: 14 Jun 2002 (23 years ago)
Company Number: 69b16052-a5d4-e011-a886-001ec94ffe7f
File Number: 31601-LLC
Registered Office Address: 623 S Sibley Ave, Litchfield, MN 55355, USA
Principal Executive Office Address: 623 S SIBLEY AVE, LITCHFIELD, MN 55355–3339, United States
ZIP code: 55355
County: Meeker County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SIBLEY DENTAL SUITE, P.L.L.C. PROFIT SHARING PLAN 2014 411337451 2015-07-20 SIBLEY DENTAL SUITE, PLLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621210
Sponsor’s telephone number 3206938131
Plan sponsor’s address 623 SOUTH SIBLEY, LITCHFIELD, MN, 55355

Signature of
Role Plan administrator
Date 2015-07-20
Name of individual signing MICHAEL G. CZIOK, D.D.S.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-20
Name of individual signing MICHAEL G. CZIOK, D.D.S.
Valid signature Filed with authorized/valid electronic signature
SIBLEY DENTAL SUITE, P.L.L.C. PROFIT SHARING PLAN 2013 411337451 2014-07-21 SIBLEY DENTAL SUITE, PLLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621210
Sponsor’s telephone number 3206938131
Plan sponsor’s address 623 SOUTH SIBLEY, LITCHFIELD, MN, 55355

Signature of
Role Plan administrator
Date 2014-07-21
Name of individual signing MICHAEL G. CZIOK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-21
Name of individual signing MICHAEL G. CZIOK
Valid signature Filed with authorized/valid electronic signature
SIBLEY DENTAL SUITE, P.L.L.C. PROFIT SHARING PLAN 2012 411337451 2013-07-29 SIBLEY DENTAL SUITE, PLLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621210
Sponsor’s telephone number 3206938131
Plan sponsor’s address 623 SOUTH SIBLEY, LITCHFIELD, MN, 55355

Signature of
Role Plan administrator
Date 2013-07-29
Name of individual signing MICHAEL CZIOK, DDS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-29
Name of individual signing MICHAEL CZIOK, DDS
Valid signature Filed with authorized/valid electronic signature
SIBLEY DENTAL SUITE, P.L.L.C. PROFIT SHARING PLAN 2011 411337451 2012-07-17 SIBLEY DENTAL SUITE, PLLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621210
Sponsor’s telephone number 3206938131
Plan sponsor’s address 623 SOUTH SIBLEY, LITCHFIELD, MN, 55355

Plan administrator’s name and address
Administrator’s EIN 411337451
Plan administrator’s name SAME
Plan administrator’s address 623 SOUTH SIBLEY, LITCHFIELD, MN, 55355
Administrator’s telephone number 3206938131

Signature of
Role Plan administrator
Date 2012-07-17
Name of individual signing MICHAEL G. CZIOK, DDS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-17
Name of individual signing MICHAEL G. CZIOK, DDS
Valid signature Filed with authorized/valid electronic signature
SIBLEY DENTAL SUITE, P.L.L.C. PROFIT SHARING PLAN 2010 411337451 2011-07-26 SIBLEY DENTAL SUITE, PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621210
Sponsor’s telephone number 3206938131
Plan sponsor’s address 623 SOUTH SIBLEY, LITCHFIELD, MN, 55355

Plan administrator’s name and address
Administrator’s EIN 411337451
Plan administrator’s name SAME
Plan administrator’s address 623 SOUTH SIBLEY, LITCHFIELD, MN, 55355
Administrator’s telephone number 3206938131

Signature of
Role Plan administrator
Date 2011-07-26
Name of individual signing MICHAEL G. CZIOK, DDS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-26
Name of individual signing MICHAEL G. CZIOK, DDS
Valid signature Filed with authorized/valid electronic signature
SIBLEY DENTAL SUITE, P.L.L.C. PROFIT SHARING PLAN 2009 411337451 2010-07-20 SIBLEY DENTAL SUITE, PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1982-01-01
Business code 621210
Sponsor’s telephone number 3206938131
Plan sponsor’s address 623 SOUTH SIBLEY, LITCHFIELD, MN, 55355

Plan administrator’s name and address
Administrator’s EIN 411337451
Plan administrator’s name SAME
Plan administrator’s address 623 SOUTH SIBLEY, LITCHFIELD, MN, 55355
Administrator’s telephone number 3206938131

Signature of
Role Plan administrator
Date 2010-07-20
Name of individual signing MICHAEL G. CZIOK, DDS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-20
Name of individual signing MICHAEL G. CZIOK, DDS
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
Michael Cziok Manager 623 S SIBLEY AVE, LITCHFIELD, MN 55355–3339, USA

Agent

Name Role
Amber Cziok Agent

Filing

Filing Name Filing date
Registered Office and/or Agent - Limited Liability Company (Domestic) 2019-08-26
Conversion to 322C Due to Statute Mandate – Limited Liability Company (Domestic) 2018-01-01
Original Filing - Limited Liability Company (Domestic)Professional Service - Dentistry & Dental Hygiene 2002-06-14
Limited Liability Company (Domestic) Business Name (Business Name: SIBLEY DENTAL SUITE, PLLC) 2002-06-14

Related by officers

No related officers

Related by address

623 S SIBLEY AVE, LITCHFIELD, MN 55355–3339, United States

SIBLEY ANNEX, LLC

Date of last update: 01 Nov 2024

Sources: Minnesota's Official State Website

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