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  5. Maple Grove Center for Restorative Surgery LLC

Maple Grove Center for Restorative Surgery LLC

Company Details

Name: Maple Grove Center for Restorative Surgery LLC
Jurisdiction: Minnesota
Legal type: Limited Liability Company (Domestic)
Status: Inactive
Date formed: 28 Jun 2013 (12 years ago)
Company Number: 06a667e4-0be0-e211-be65-001ec94ffe7f
File Number: 679516700023
Registered Office Address: 13601 80th Cir N Ste 100, Suite 100, Maple Grove, MN 55369, USA
Principal Executive Office Address: 13601-80th Circle North, Suite 100, Maple Grove, MN 55369, USA
Mailing Address: P.O. Box 1708, Pismo Beach, CA 93448, USA
ZIP code: 55369
County: Hennepin County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC RETIREMENT PLAN 2021 463746796 2022-09-26 MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-04-01
Business code 621493
Sponsor’s telephone number 7634327655
Plan sponsor’s address 13601 80TH CIRCLE NORTH, SUITE 100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2022-09-26
Name of individual signing TRACY WILSON
Valid signature Filed with authorized/valid electronic signature
MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC RETIREMENT PLAN 2020 463746796 2021-09-08 MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-04-01
Business code 621493
Sponsor’s telephone number 7634327655
Plan sponsor’s address 13601 80TH CIRCLE NORTH, SUITE 100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2021-09-08
Name of individual signing TRACY WILSON
Valid signature Filed with authorized/valid electronic signature
MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC RETIREMENT PLAN 2019 463746796 2020-10-09 MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-04-01
Business code 621493
Sponsor’s telephone number 7634327655
Plan sponsor’s address 13601 80TH CIRCLE NORTH, SUITE 100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2020-10-09
Name of individual signing TRACY WILSON
Valid signature Filed with authorized/valid electronic signature
MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC RETIREMENT PLAN 2018 463746796 2019-07-23 MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-04-01
Business code 621493
Sponsor’s telephone number 7634327655
Plan sponsor’s address 13601 80TH CIRCLE NORTH, SUITE 100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2019-07-23
Name of individual signing BRENDA HILTON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-23
Name of individual signing BRENDA HILTON
Valid signature Filed with authorized/valid electronic signature
MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC RETIREMENT PLAN 2017 463746796 2018-09-10 MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-04-01
Business code 621493
Sponsor’s telephone number 7634327655
Plan sponsor’s address 13601 80TH CIRCLE NORTH, SUITE 100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2018-09-10
Name of individual signing BRENDA HILTON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-09-10
Name of individual signing BRENDA HILTON
Valid signature Filed with authorized/valid electronic signature
MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC RETIREMENT PLAN 2016 463746796 2017-05-18 MAPLE GROVE CENTER FOR RESTORATIVE SURGERY, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-04-01
Business code 621493
Sponsor’s telephone number 7634327655
Plan sponsor’s address 13601 80TH CIRCLE NORTH, SUITE 100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2017-05-18
Name of individual signing BRENDA HILTON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-18
Name of individual signing BRENDA HILTON
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
Amistyene Brincefiedl Manager 13601 80th Circle North, Suite 100, Maple Grove, MN 55369, USA

Agent

Name Role
Amistyene Brincefield Agent

Filing

Filing Name Filing date
Conversion to 322C Due to Statute Mandate – Limited Liability Company (Domestic) 2018-01-01
Annual Reinstatement - Limited Liability Company (Domestic) 2017-05-22
Administrative Termination - Limited Liability Company (Domestic) 2017-03-01
Registered Office and/or Agent - Limited Liability Company (Domestic) 2014-09-02
Original Filing - Limited Liability Company (Domestic) (Business Name: Maple Grove Center for Restorative Surgery LLC)Professional Service - Medicine & Surgery 2013-06-28

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Date of last update: 31 Dec 2024

Sources: Minnesota's Official State Website

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