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  5. MARK L. CIVIN, D.D.S., P.A.

MARK L. CIVIN, D.D.S., P.A.

Company Details

Entity Name: MARK L. CIVIN, D.D.S., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 02 Sep 1987 (37 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 07 Oct 2019 (5 years ago)
Document Number: J96910
FEI/EIN Number 65-0016772
Address: 5600 PGA BLVD., SUITE 102, SUITE 102, PALM BEACH GARDENS, FL 33418
Mail Address: 5600 PGA BLVD., SUITE 102, SUITE 102, PALM BEACH GARDENS, FL 33418
ZIP code: 33418
County: Palm Beach
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2020 650016772 2021-03-24 MARK L. CIVIN, D.D.S., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2021-03-24
Name of individual signing MARK L. CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-03-24
Name of individual signing MARK L. CIVIN
Valid signature Filed with authorized/valid electronic signature
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2019 650016772 2020-06-01 MARK L. CIVIN, D.D.S., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2020-06-01
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-01
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2018 650016772 2019-04-12 MARK L. CIVIN, D.D.S., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2019-04-12
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-04-12
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2017 650016772 2018-05-14 MARK L. CIVIN, D.D.S., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2018-05-14
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-14
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2016 650016772 2017-05-03 MARK L. CIVIN, D.D.S., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2017-05-03
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-03
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2015 650016772 2016-06-01 MARK L. CIVIN, D.D.S., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2016-06-01
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-01
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2014 650016772 2015-08-13 MARK L. CIVIN, D.D.S., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2015-08-13
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-08-13
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2013 650016772 2014-08-22 MARK L. CIVIN, D.D.S., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2014-08-22
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-08-22
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2012 650016772 2013-08-02 MARK L. CIVIN, D.D.S., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Signature of
Role Plan administrator
Date 2013-08-02
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-08-02
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
MARK L. CIVIN, D.D.S., P.A., 401(K) PROFIT SHARING PLAN 2011 650016772 2012-07-18 MARK L. CIVIN, D.D.S., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621210
Sponsor’s telephone number 5616242224
Plan sponsor’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418

Plan administrator’s name and address
Administrator’s EIN 650016772
Plan administrator’s name MARK L. CIVIN, D.D.S., P.A.
Plan administrator’s address 5600 P.G.A. BOULEVARD, SUITE 102, PALM BEACH GARDENS, FL, 33418
Administrator’s telephone number 5616242224

Signature of
Role Plan administrator
Date 2012-07-18
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-18
Name of individual signing MARK CIVIN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Mark L. Civin, DDS, P.A. Agent 5600 PGA BLVD, SUITE #102, PALM BCH GDNS, FL 33418

Vice President

Name Role Address
CIVIN, MARK L., D.D.S. Vice President 5600 P.G.A. BLVD #102, PALM BCH GARDENS, FL 33418

Treasurer

Name Role Address
CIVIN, MARK L., D.D.S. Treasurer 5600 P.G.A. BLVD #102, PALM BCH GARDENS, FL 33418

Director

Name Role Address
CIVIN, MARK L., D.D.S. Director 5600 P.G.A. BLVD #102, PALM BCH GARDENS, FL 33418

President

Name Role Address
CIVIN, MARK L., D.D.S. President 5600 P.G.A. BLVD #102, PALM BCH GARDENS, FL 33418

Secretary

Name Role Address
CIVIN, MARK L., D.D.S. Secretary 5600 P.G.A. BLVD #102, PALM BCH GARDENS, FL 33418

Events

Event Type Filed Date Value Description
REINSTATEMENT 2019-10-07 No data No data
REGISTERED AGENT NAME CHANGED 2019-10-07 Mark L. Civin, DDS, P.A. No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2019-09-27 No data No data
CHANGE OF MAILING ADDRESS 2011-04-26 5600 PGA BLVD., SUITE 102, SUITE 102, PALM BEACH GARDENS, FL 33418 No data
CHANGE OF PRINCIPAL ADDRESS 2010-02-16 5600 PGA BLVD., SUITE 102, SUITE 102, PALM BEACH GARDENS, FL 33418 No data
REGISTERED AGENT ADDRESS CHANGED 2010-02-16 5600 PGA BLVD, SUITE #102, PALM BCH GDNS, FL 33418 No data

Documents

Name Date
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-01-23
ANNUAL REPORT 2022-01-25
ANNUAL REPORT 2021-06-29
ANNUAL REPORT 2020-06-08
REINSTATEMENT 2019-10-07
ANNUAL REPORT 2018-04-03
ANNUAL REPORT 2017-04-05
ANNUAL REPORT 2016-01-27
ANNUAL REPORT 2015-04-21

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 04 Feb 2025

Sources: Florida Department of State

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