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  5. POLK DENTAL CENTER, PLLC

POLK DENTAL CENTER, PLLC

Company Details

Name: POLK DENTAL CENTER, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 27 Aug 2002 (22 years ago)
Business ID: 721861
ZIP code: 39170
County: Hinds
State of Incorporation: MISSISSIPPI
Principal Office Address: 5590 Parsons RoadTerry, MS 39170-7273

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
POLK DENTAL CENTER PLLC 401(K) PROFIT SHARING PLAN & TRUST 2023 134208890 2024-06-11 POLK DENTAL CENTER PLLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address PO BOX 180607, RICHLAND, MS, 392180607

Signature of
Role Plan administrator
Date 2024-06-11
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
POLK DENTAL CENTER PLLC 401(K) PROFIT SHARING PLAN & TRUST 2022 134208890 2023-06-01 POLK DENTAL CENTER PLLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address PO BOX 180607, RICHLAND, MS, 392180607

Signature of
Role Plan administrator
Date 2023-06-01
Name of individual signing LEXI A POLK
Valid signature Filed with authorized/valid electronic signature
POLK DENTAL CENTER PLLC 401(K) PROFIT SHARING PLAN & TRUST 2021 134208890 2022-06-28 POLK DENTAL CENTER PLLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address PO BOX 180607, RICHLAND, MS, 392180607

Signature of
Role Plan administrator
Date 2022-06-28
Name of individual signing JASON L. POLK
Valid signature Filed with authorized/valid electronic signature
POLK DENTAL CENTER PLLC 401(K) PROFIT SHARING PLAN & TRUST 2021 134208890 2022-06-13 POLK DENTAL CENTER PLLC 12
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address PO BOX 180607, RICHLAND, MS, 392180607

Signature of
Role Plan administrator
Date 2022-06-13
Name of individual signing JASON L. POLK
Valid signature Filed with authorized/valid electronic signature
POLK DENTAL CENTER PLLC 401(K) PROFIT SHARING PLAN & TRUST 2020 134208890 2021-04-19 POLK DENTAL CENTER PLLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address PO BOX 180607, RICHLAND, MS, 392180607

Signature of
Role Plan administrator
Date 2021-04-19
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
POLK DENTAL CENTER PLLC 401(K) PROFIT SHARING PLAN & TRUST 2019 134208890 2020-05-29 POLK DENTAL CENTER PLLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address PO BOX 180607, RICHLAND, MS, 392180607

Signature of
Role Plan administrator
Date 2020-05-29
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
POLK DENTAL CENTER PLLC 401 K PROFIT SHARING PLAN TRUST 2018 134208890 2019-07-18 POLK DENTAL CENTER PLLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address PO BOX 180607, RICHLAND, MS, 392180607

Signature of
Role Plan administrator
Date 2019-07-18
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
POLK DENTAL CENTER PLLC 401 K PROFIT SHARING PLAN TRUST 2017 134208890 2018-04-05 POLK DENTAL CENTER PLLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address PO BOX 180607, RICHLAND, MS, 392180607

Signature of
Role Plan administrator
Date 2018-04-05
Name of individual signing LEXI POLK
Valid signature Filed with authorized/valid electronic signature
POLK DENTAL CENTER PLLC 401 K PROFIT SHARING PLAN TRUST 2016 134208890 2017-06-27 POLK DENTAL CENTER PLLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address 1201 HWY 49 SOUTH STE 3, RICHLAND, MS, 39218

Signature of
Role Plan administrator
Date 2017-06-27
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
POLK DENTAL CENTER PLLC 401 K PROFIT SHARING PLAN TRUST 2015 134208890 2016-06-20 POLK DENTAL CENTER PLLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address 1201 HWY 49 SOUTH STE 3, RICHLAND, MS, 39218

Signature of
Role Plan administrator
Date 2016-06-20
Name of individual signing LEXI POLK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/06/23/20150623154028P030071271201001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 6019320606
Plan sponsor’s address 1201 HWY 49 SOUTH STE 3, RICHLAND, MS, 39218

Signature of
Role Plan administrator
Date 2015-06-23
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/20/20130520112809P040286547745001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6019320606
Plan sponsor’s address 1201 HIGHWAY 49 S, MEDICAL SUITE 3, RICHLAND, MS, 392189425

Signature of
Role Plan administrator
Date 2013-05-20
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-20
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/07/20120607155153P040098514224001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6019320606
Plan sponsor’s address 120 SCARBROUGH ST STE B, RICHLAND, MS, 392189770

Plan administrator’s name and address
Administrator’s EIN 134208890
Plan administrator’s name POLK DENTAL CENTER
Plan administrator’s address 120 SCARBROUGH ST STE B, RICHLAND, MS, 392189770
Administrator’s telephone number 6019320606

Signature of
Role Plan administrator
Date 2012-06-07
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-07
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/13/20110613161843P030012497110001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6019320606
Plan sponsor’s address 120 SCARBROUGH ST STE B, RICHLAND, MS, 392189770

Plan administrator’s name and address
Administrator’s EIN 134208890
Plan administrator’s name POLK DENTAL CENTER
Plan administrator’s address 120 SCARBROUGH ST STE B, RICHLAND, MS, 392189770
Administrator’s telephone number 6019320606

Signature of
Role Plan administrator
Date 2011-06-13
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/08/24/20100824100041P030025168372001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6019320606
Plan sponsor’s address 120 SCARBROUGH ST STE B, RICHLAND, MS, 392189770

Plan administrator’s name and address
Administrator’s EIN 134208890
Plan administrator’s name POLK DENTAL CENTER
Plan administrator’s address 120 SCARBROUGH ST STE B, RICHLAND, MS, 392189770
Administrator’s telephone number 6019320606

Signature of
Role Plan administrator
Date 2010-08-24
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-24
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 6019320606
Plan sponsor’s address 120 SCARBROUGH ST STE B, RICHLAND, MS, 392189770

Plan administrator’s name and address
Administrator’s EIN 134208890
Plan administrator’s name POLK DENTAL CENTER
Plan administrator’s address 120 SCARBROUGH ST STE B, RICHLAND, MS, 392189770
Administrator’s telephone number 6019320606

Signature of
Role Plan administrator
Date 2010-08-24
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-24
Name of individual signing JASON POLK
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LEXI A POLK Agent 120 SCARBROUGH STREET_SUITE B, PO BOX 180607, RICHLAND, MS 39212

Member

Name Role Address
JASON L POLK Member 120 SCARBROUGH STREET, RICHLAND, MS 39212
LEXI A POLK Member 120 SCARBROUGH STREET SUITE B, Richland, MS 39218

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2024-01-16 Annual Report For POLK DENTAL CENTER, PLLC
Annual Report LLC Filed 2023-02-01 Annual Report For POLK DENTAL CENTER, PLLC
Annual Report LLC Filed 2022-03-09 Annual Report For POLK DENTAL CENTER, PLLC
Annual Report LLC Filed 2021-02-11 Annual Report For POLK DENTAL CENTER, PLLC
Annual Report LLC Filed 2020-05-21 Annual Report For POLK DENTAL CENTER, PLLC
Annual Report LLC Filed 2019-06-13 Annual Report For POLK DENTAL CENTER, PLLC
Annual Report LLC Filed 2018-07-12 Annual Report For POLK DENTAL CENTER, PLLC
Annual Report LLC Filed 2017-01-25 Annual Report For POLK DENTAL CENTER, PLLC
Annual Report LLC Filed 2016-01-15 Annual Report For POLK DENTAL CENTER, PLLC
Annual Report LLC Filed 2015-06-30 Annual Report For POLK DENTAL CENTER, PLLC

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 28 Dec 2024

Sources: Mississippi Secretary of State

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