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Sand Mountain Dentistry, LLC

Details

Name: Sand Mountain Dentistry, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Dissolved
Date of registration: 22 Dec 2000 (24 years ago)
Date of dissolution: 15 Dec 2021
Entity Number: 000-673-274
Register Number: 000673274
Historical Names: T. Allen Kirby, D.D.S., L.L.C.
County: Marshall
Place of Formation: Marshall County
Registered Office Street Address: 627 EAST MAIN STALBERTVILLE, AL 35950
Registered Office Street Address ZIP Code: 35950

Activities PRACTICE OF DENTISTRY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1952825523 2017-07-26 2017-07-26 P O BOX 889, ALBERTVILLE, AL, 35950, US 416 MARTLING ROAD, ALBERTVILLE, AL, 35951, US

Contacts
Phone +1 256-891-1100
Fax 2568911160

Authorized person
Name THOMAS ALLEN KIRBY
Role DENTIST/OWNER
Phone 2568911100

Taxonomy
Taxonomy Code 122300000X - Dentist
License Number 4797
State AL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SAND MOUNTAIN DENTISTRY, LLC 401(K) PROFIT SHARING PLAN 2021 631264600 2022-04-25 SAND MOUNTAIN DENTISTRY, LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0
SAND MOUNTAIN DENTISTRY, LLC 401(K) PROFIT SHARING PLAN 2020 631264600 2021-02-08 SAND MOUNTAIN DENTISTRY, LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Number of participants as of the end of the plan year
Active participants 10
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 1
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 11
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0
SAND MOUNTAIN DENTISTRY, LLC 401(K) PROFIT SHARING PLAN 2019 631264600 2020-06-01 SAND MOUNTAIN DENTISTRY, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Number of participants as of the end of the plan year
Active participants 9
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 1
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 10
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0
SAND MOUNTAIN DENTISTRY, LLC 401(K) PROFIT SHARING PLAN 2018 631264600 2019-03-13 SAND MOUNTAIN DENTISTRY, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Plan administrator’s name and address
Administrator’s EIN 631264600
Plan administrator’s name SAND MOUNTAIN DENTISTRY, LLC
Plan administrator’s address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Administrator’s telephone number 2568911100

Number of participants as of the end of the plan year
Active participants 10
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0
SAND MOUNTAIN DENTISTRY, LLC 401(K) PROFIT SHARING PLAN 2017 631264600 2018-02-19 SAND MOUNTAIN DENTISTRY, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Plan administrator’s name and address
Administrator’s EIN 631264600
Plan administrator’s name SAND MOUNTAIN DENTISTRY, LLC
Plan administrator’s address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Administrator’s telephone number 2568911100

Number of participants as of the end of the plan year
Active participants 10
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 10
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0
SAND MOUNTAIN DENTISTRY, LLC 401(K) PROFIT SHARING PLAN 2016 631264600 2017-03-10 SAND MOUNTAIN DENTISTRY, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Plan administrator’s name and address
Administrator’s EIN 631264600
Plan administrator’s name SAND MOUNTAIN DENTISTRY, LLC
Plan administrator’s address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Administrator’s telephone number 2568911100

Number of participants as of the end of the plan year
Active participants 10
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 10
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0
SAND MOUNTAIN DENTISTRY, LLC 401(K) PROFIT SHARING PLAN 2015 631264600 2016-05-02 SAND MOUNTAIN DENTISTRY, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Plan administrator’s name and address
Administrator’s EIN 631264600
Plan administrator’s name SAND MOUNTAIN DENTISTRY, LLC
Plan administrator’s address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Administrator’s telephone number 2568911100

Number of participants as of the end of the plan year
Active participants 9
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 9
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0
SAND MOUNTAIN DENTISTRY, LLC 401(K) PROFIT SHARING PLAN 2014 631264600 2015-07-01 SAND MOUNTAIN DENTISTRY, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Plan administrator’s name and address
Administrator’s EIN 631264600
Plan administrator’s name SAND MOUNTAIN DENTISTRY, LLC
Plan administrator’s address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Administrator’s telephone number 2568911100

Number of participants as of the end of the plan year
Active participants 9
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 9
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2015-07-01
Name of individual signing T. ALLEN KIRBY, D.D.S.
Valid signature Filed with authorized/valid electronic signature
SAND MOUNTAIN DENTISTRY, LLC 401(K) PROFIT SHARING PLAN 2013 631264600 2014-03-21 SAND MOUNTAIN DENTISTRY, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Plan administrator’s name and address
Administrator’s EIN 631264600
Plan administrator’s name SAND MOUNTAIN DENTISTRY, LLC
Plan administrator’s address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Administrator’s telephone number 2568911100

Number of participants as of the end of the plan year
Active participants 9
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 8
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2014-03-21
Name of individual signing T. ALLEN KIRBY, D.D.S.
Valid signature Filed with authorized/valid electronic signature
T. ALLEN KIRBY, D.D.S., L.L.C. 401(K) PROFIT SHARING PLAN & TRUST 2012 631264600 2013-05-21 T. ALLEN KIRBY, D.D.S., L.L.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-04-15
Business code 621210
Sponsor’s telephone number 2568911100
Plan sponsor’s mailing address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Plan sponsor’s address 416 MARTLING ROAD, ALBERTVILLE, AL, 359517208

Plan administrator’s name and address
Administrator’s EIN 631264600
Plan administrator’s name T. ALLEN KIRBY, D.D.S., L.L.C.
Plan administrator’s address P.O. BOX 889, ALBERTVILLE, AL, 359500015
Administrator’s telephone number 2568911100

Number of participants as of the end of the plan year
Active participants 8
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 1
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 8
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2013-05-21
Name of individual signing T. ALLEN KIRBY, D.D.S.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KIRBY, THOMAS A Agent 627 EAST MAIN STALBERTVILLE, AL 35950

Member

Name Role Address
KIRBY, THOMAS A Member 627 EAST MAIN STALBERTVILLE, AL 35950

Organizer

Name Role Address
KIRBY, THOMAS ALLEN Organizer 627 EAST MAIN STALBERTVILLE, AL 35950

Events

Event Date Event Type Old Value New Value
2013-12-10 Name Change T. Allen Kirby, D.D.S., L.L.C. Sand Mountain Dentistry, LLC

Related by officers

KIRBY, THOMAS ALLEN

M & K Properties, L.L.C.

Related by address

627 EAST MAIN STALBERTVILLE, AL 35950

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Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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