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  5. STACY L. ROSZKOWSKI, D.D.S., PLLC

STACY L. ROSZKOWSKI, D.D.S., PLLC

Company Details

Name: STACY L. ROSZKOWSKI, D.D.S., PLLC
Jurisdiction: Minnesota
Legal type: Limited Liability Company (Domestic)
Status: Active / In Good Standing
Date formed: 12 Sep 2006 (18 years ago)
Company Number: b570c85c-8ed4-e011-a886-001ec94ffe7f
File Number: 2011452-2
Registered Office Address: 2125 Upper 55th St E, Suite 210, Inver Grove Heights, MN 55077, USA
Principal Executive Office Address: STE 210, 2125 UPPER 55TH ST E, INVER GROVE HEIGHTS, MN 55077–1732, usa
ZIP code: 55077
County: Dakota County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2023 205608204 2024-10-07 STACY L. ROSZKOWSKI, D.D.S., PLLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 2125 UPPER 55TH ST E, SUITE 210, INVER GROVE HEIGHTS, MN, 55077

Signature of
Role Plan administrator
Date 2024-10-07
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2022 205608204 2023-08-24 STACY L. ROSZKOWSKI, D.D.S., PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 1525 LIVINGSTON AVENUE, SUITE B, WEST ST. PAUL, MN, 551183430

Signature of
Role Plan administrator
Date 2023-08-24
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2021 205608204 2022-10-10 STACY L. ROSZKOWSKI, D.D.S., PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2020 205608204 2021-07-23 STACY L. ROSZKOWSKI, D.D.S., PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118

Signature of
Role Plan administrator
Date 2021-07-23
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2019 205608204 2020-07-14 STACY L. ROSZKOWSKI, D.D.S., PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118

Signature of
Role Plan administrator
Date 2020-07-14
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2018 205608204 2019-07-31 STACY L. ROSZKOWSKI, D.D.S., PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118

Signature of
Role Plan administrator
Date 2019-07-31
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2017 205608204 2018-07-16 STACY L. ROSZKOWSKI, D.D.S., PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118

Plan administrator’s name and address
Administrator’s EIN 205608204
Plan administrator’s name STACY L. ROSZKOWSKI, D.D.S., PLLC
Plan administrator’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118
Administrator’s telephone number 6514574888

Signature of
Role Plan administrator
Date 2018-07-16
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2016 205608204 2017-10-12 STACY L. ROSZKOWSKI, D.D.S., PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118

Plan administrator’s name and address
Administrator’s EIN 205608204
Plan administrator’s name STACY L. ROSZKOWSKI, D.D.S., PLLC
Plan administrator’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118
Administrator’s telephone number 6514574888

Signature of
Role Plan administrator
Date 2017-10-12
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2015 205608204 2016-09-20 STACY L. ROSZKOWSKI, D.D.S., PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118

Plan administrator’s name and address
Administrator’s EIN 205608204
Plan administrator’s name STACY L. ROSZKOWSKI, D.D.S., PLLC
Plan administrator’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118
Administrator’s telephone number 6514574888

Signature of
Role Plan administrator
Date 2016-09-20
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature
STACY L. ROSZKOWSKI, D.D.S., PLLC 401(K) PROFIT SHARING PLAN 2014 205608204 2015-06-17 STACY L. ROSZKOWSKI, D.D.S., PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 6514574888
Plan sponsor’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118

Plan administrator’s name and address
Administrator’s EIN 205608204
Plan administrator’s name STACY L. ROSZKOWSKI, D.D.S., PLLC
Plan administrator’s address 1525 LIVINGSTON AVENUE, WEST ST. PAUL, MN, 55118
Administrator’s telephone number 6514574888

Signature of
Role Plan administrator
Date 2015-06-17
Name of individual signing STACY ROSZKOWSKI
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
STACY ROSZKOWSKI Manager STE 210, 2125 UPPER 55TH ST E, INVER GROVE HEIGHTS, MN 55077–1732, usa

Filing

Filing Name Filing date
Registered Office and/or Agent - Limited Liability Company (Domestic) 2024-06-03
Conversion to 322C Due to Statute Mandate – Limited Liability Company (Domestic) 2018-01-01
Annual Reinstatement - Limited Liability Company (Domestic) 2008-05-19
Administrative Termination - Limited Liability Company (Domestic) 2008-01-07
Original Filing - Limited Liability Company (Domestic)Professional Service - Dentistry & Dental Hygiene 2006-09-12
Limited Liability Company (Domestic) Business Name (Business Name: STACY L. ROSZKOWSKI, D.D.S., PLLC) 2006-09-12

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Date of last update: 30 Nov 2024

Sources: Minnesota's Official State Website

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