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  5. CUSTOM CLINIC, P.A.

CUSTOM CLINIC, P.A.

Company Details

Name: CUSTOM CLINIC, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 05 Oct 2006 (18 years ago)
Company Number: b0be9e80-8ed4-e011-a886-001ec94ffe7f
File Number: 2043975-2
Registered Office Address: 400 S State Str #55, Fairmont, MN 56031, USA
Principal Executive Office Address: STE 3, 401 E 2ND ST, FAIRMONT, MN 56031, United States
ZIP code: 56031
County: Martin County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CUSTOM CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2013 205690193 2014-01-31 CUSTOM CLINIC, P.A. 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6512244930
Plan sponsor’s address 5 LAKE CENTRE, 322 SOUTH STATE STREET, FAIRMONT, MN, 56031
CUSTOM CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2012 205690193 2013-09-23 CUSTOM CLINIC, P.A. 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6512244930
Plan sponsor’s address 5 LAKE CENTRE, 322 SOUTH STATE STREET, FAIRMONT, MN, 56031

Signature of
Role Plan administrator
Date 2013-09-23
Name of individual signing TIMOTHY BACHENBERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-23
Name of individual signing TIMOTHY BACHENBERG
Valid signature Filed with authorized/valid electronic signature
CUSTOM CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2011 205690193 2012-10-08 CUSTOM CLINIC, P.A. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6512244930
Plan sponsor’s address 5 LAKE CENTRE, 322 SOUTH STATE STREET, FAIRMONT, MN, 56031

Plan administrator’s name and address
Administrator’s EIN 205690193
Plan administrator’s name CUSTOM CLINIC, P.A.
Plan administrator’s address 5 LAKE CENTRE, 322 SOUTH STATE STREET, FAIRMONT, MN, 56031
Administrator’s telephone number 6512244930

Signature of
Role Plan administrator
Date 2012-10-08
Name of individual signing TIMOTHY C. BACHENBERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-08
Name of individual signing TIMOTHY C. BACHENBERG
Valid signature Filed with authorized/valid electronic signature
CUSTOM CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2010 205690193 2011-02-03 CUSTOM CLINIC, P.A. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6512244930
Plan sponsor’s address 5 LAKE CENTRE, 322 SOUTH STATE STREET, FAIRMONT, MN, 56031

Plan administrator’s name and address
Administrator’s EIN 205690193
Plan administrator’s name CUSTOM CLINIC, P.A.
Plan administrator’s address 5 LAKE CENTRE, 322 SOUTH STATE STREET, FAIRMONT, MN, 56031
Administrator’s telephone number 6512244930

Signature of
Role Plan administrator
Date 2011-02-03
Name of individual signing TIMOTHY BACHENBERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-02-03
Name of individual signing TIMOTHY BACHENBERG
Valid signature Filed with authorized/valid electronic signature
CUSTOM CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2009 205690193 2010-06-30 CUSTOM CLINIC, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6512244930
Plan sponsor’s address 5 LAKE CENTRE, 322 SOUTH STATE STREET, FAIRMONT, MN, 56031

Plan administrator’s name and address
Administrator’s EIN 205690193
Plan administrator’s name CUSTOM CLINIC, P.A.
Plan administrator’s address 5 LAKE CENTRE, 322 SOUTH STATE STREET, FAIRMONT, MN, 56031
Administrator’s telephone number 6512244930

Signature of
Role Plan administrator
Date 2010-06-25
Name of individual signing TIMOTHY BACHENBERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-06-25
Name of individual signing TIMOTHY BACHENBERG
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Timothy Bachenberg Chief Executive Officer STE 3, 401 E 2ND ST, FAIRMONT, MN 56031, USA

Filing

Filing Name Filing date
Administrative Dissolution Name Hold Release - Business Corporation (Domestic) 2014-02-25
Annual Reinstatement - Business Corporation (Domestic) 2009-07-16
Administrative Dissolution - Business Corporation (Domestic) 2009-01-07
Registered Office and/or Agent - Business Corporation (Domestic) 2006-10-11
Original Filing - Business Corporation (Domestic) 2006-10-05
Business Corporation (Domestic) Business Name (Business Name: CUSTOM CLINIC, P.A.) 2006-10-05

Related by officers

Timothy Bachenberg

SMART Clinic, P.A.

Related by address

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Date of last update: 01 Oct 2024

Sources: Minnesota's Official State Website

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