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  5. CHEYENNE MOUNTAIN DENTAL GROUP, PROFESSIONAL LLC

CHEYENNE MOUNTAIN DENTAL GROUP, PROFESSIONAL LLC

Company Details

Name: CHEYENNE MOUNTAIN DENTAL GROUP, PROFESSIONAL LLC
Jurisdiction: Colorado
Legal type: Domestic limited liability company
Status: Good Standing
Date of registration: 21 Feb 1996 (29 years ago)
Entity Number: 19961024276
ZIP code: 80906
County: El Paso County
Place of Formation: COLORADO
Principal Address: 3605 Star Ranch Rd Colorado Springs CO 80906 US

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401(K) PROFIT SHARING PLAN 2023 841311019 2024-07-16 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH RD, COLORADO SPRINGS, CO, 80906

Signature of
Role Plan administrator
Date 2024-07-16
Name of individual signing STEPHEN DAVIS
Valid signature Filed with authorized/valid electronic signature
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401(K) PROFIT SHARING PLAN 2022 841311019 2023-10-11 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH RD, COLORADO SPRINGS, CO, 80906

Signature of
Role Plan administrator
Date 2023-10-11
Name of individual signing STEPHEN DAVIS
Valid signature Filed with authorized/valid electronic signature
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401(K) PROFIT SHARING PLAN 2021 841311019 2022-10-10 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH ROAD, COLORADO SPRINGS, CO, 80906

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing STEPHEN DAVIS
Valid signature Filed with authorized/valid electronic signature
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401(K) PROFIT SHARING PLAN 2020 841311019 2021-10-13 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH ROAD, COLORADO SPRINGS, CO, 80906

Signature of
Role Plan administrator
Date 2021-10-13
Name of individual signing STEPHEN DAVIS
Valid signature Filed with authorized/valid electronic signature
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401(K) PROFIT SHARING PLAN 2019 841311019 2020-10-07 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH ROAD, COLORADO SPRINGS, CO, 80906

Signature of
Role Plan administrator
Date 2020-10-07
Name of individual signing STEPHEN DAVIS
Valid signature Filed with authorized/valid electronic signature
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401(K) PROFIT SHARING PLAN 2018 841311019 2019-06-20 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH ROAD, COLORADO SPRINGS, CO, 80906

Signature of
Role Plan administrator
Date 2019-06-20
Name of individual signing WILLIAM J. BERTSCH
Valid signature Filed with authorized/valid electronic signature
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401(K) PROFIT SHARING PLAN 2017 841311019 2018-05-30 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH ROAD, COLORADO SPRINGS, CO, 80906

Signature of
Role Plan administrator
Date 2018-05-30
Name of individual signing WILLIAM J. BERTSCH
Valid signature Filed with authorized/valid electronic signature
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401(K) PROFIT SHARING PLAN 2016 841311019 2017-04-28 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH ROAD, COLORADO SPRINGS, CO, 80906

Signature of
Role Plan administrator
Date 2017-04-28
Name of individual signing WILLIAM J. BERTSCH
Valid signature Filed with authorized/valid electronic signature
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401(K) PROFIT SHARING PLAN 2015 841311019 2016-09-30 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH ROAD, COLORADO SPRINGS, CO, 80906

Signature of
Role Plan administrator
Date 2016-09-30
Name of individual signing WILLIAM J. BERTSCH
Valid signature Filed with authorized/valid electronic signature
CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 401K PROFIT SHARING PLAN 2014 841311019 2015-05-27 CHEYENNE MOUNTAIN DENTAL GROUP PROFESSIONAL LLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-06-01
Business code 621210
Sponsor’s telephone number 7195763276
Plan sponsor’s address 3605 STAR RANCH ROAD, COLORADO SPRINGS, CO, 809065980

Signature of
Role Plan administrator
Date 2015-05-27
Name of individual signing WILLIAM J. BERTSCH
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Stephen D Davis Agent 3605 Star Ranch Rd Colorado Springs CO 80906 US

Transaction History

Transaction ID Type Date Effective date Name Comment
20241586814 File Report 2024-05-28 2024-05-28 No data Principal address changed, Change in registered agent information
20231558196 File Report 2023-05-24 2023-05-24 No data Principal address changed, Change in registered agent information
20221341253 Statement Curing Delinquency 2022-03-31 2022-03-31 No data No data
20201397363 File Report 2020-05-01 2020-05-01 No data Change of Registered Agent
20191233162 File Report 2019-03-19 2019-03-19 No data No data
20181116778 File Report 2018-02-07 2018-02-07 No data No data
20171273121 File Report 2017-04-05 2017-04-05 No data No data
20161140054 File Report 2016-02-25 2016-02-25 No data No data
20151158890 File Report 2015-03-03 2015-03-03 No data No data
20141094064 File Report 2014-02-11 2014-02-11 No data Change of Registered Agent

Related by officers

No related officers

Related by address

3605 Star Ranch Rd Colorado Springs CO 80906 US

Stephen D. Davis, DDS, Inc

Date of last update: 13 Jan 2025

Sources: Colorado's Secretary of State

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