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  5. Rice Lake Dental, P.A.

Rice Lake Dental, P.A.

Company Details

Name: Rice Lake Dental, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 16 Dec 2014 (10 years ago)
Company Number: 103b260c-2d85-e411-ae63-001ec94ffe7f
File Number: 799046200050
Registered Office Address: 13998 Maple Knoll Way #100, Maple Grove, MN 55369, USA
Principal Executive Office Address: STE 100, 13998 MAPLE KNOLL WAY, MAPLE GROVE, MN 55369–7004, 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
RICE LAKE DENTAL, P.A. 401(K) PLAN 2023 472536364 2024-07-08 RICE LAKE DENTAL, P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 7634205599
Plan sponsor’s address 13998 MAPLE KNOLL WAY, #100, MAPLE GROVE, MN, 55369
RICE LAKE DENTAL, P.A. 401(K) PLAN 2022 472536364 2023-07-26 RICE LAKE DENTAL, P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 7634205599
Plan sponsor’s address 13998 MAPLE KNOLL WAY, #100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing DARREL H. JOHNSRUD
Valid signature Filed with authorized/valid electronic signature
RICE LAKE DENTAL, P.A. 401(K) PLAN 2021 472536364 2022-08-22 RICE LAKE DENTAL, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 7634205599
Plan sponsor’s address 13998 MAPLE KNOLL WAY #100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2022-08-22
Name of individual signing DARREL H. JOHNSRUD
Valid signature Filed with authorized/valid electronic signature
RICE LAKE DENTAL, P.A. 401(K) PLAN 2020 472536364 2021-08-08 RICE LAKE DENTAL, P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 7634205599
Plan sponsor’s address 13998 MAPLE KNOLL WAY #100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2021-08-08
Name of individual signing DARREL H. JOHNSRUD
Valid signature Filed with authorized/valid electronic signature
RICE LAKE DENTAL, P.A. 401(K) PLAN 2019 472536364 2020-05-23 RICE LAKE DENTAL, P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 7634205599
Plan sponsor’s address 13998 MAPLE KNOLL WAY #100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2020-05-23
Name of individual signing DARREL H. JOHNSRUD
Valid signature Filed with authorized/valid electronic signature
RICE LAKE DENTAL, P.A. 401(K) PLAN 2018 472536364 2019-08-23 RICE LAKE DENTAL, P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 7634205599
Plan sponsor’s address 13998 MAPLE KNOLL WAY #100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2019-08-23
Name of individual signing DARREL H. JOHNSRUD
Valid signature Filed with authorized/valid electronic signature
RICE LAKE DENTAL, P.A. 401(K) PLAN 2017 472536364 2018-09-02 RICE LAKE DENTAL, P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 7634205599
Plan sponsor’s address 13998 MAPLE KNOLL WAY, #100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2018-09-02
Name of individual signing DARREL H. JOHNSRUD
Valid signature Filed with authorized/valid electronic signature
RICE LAKE DENTAL, P.A. 401(K) PLAN 2016 472536364 2017-06-15 RICE LAKE DENTAL, P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 7634205599
Plan sponsor’s address 13998 MAPLE KNOLL WAY, #100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2017-06-15
Name of individual signing DARREL H. JOHNSRUD
Valid signature Filed with authorized/valid electronic signature
RICE LAKE DENTAL, P.A. 401(K) PLAN 2015 472536364 2016-07-17 RICE LAKE DENTAL, P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621210
Sponsor’s telephone number 7634205599
Plan sponsor’s address 13998 MAPLE KNOLL WAY, #100, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2016-07-17
Name of individual signing DARREL H. JOHNSRUD
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Darrel H Johnsrud Chief Executive Officer 9100 SCHUTTE LN, CORCORAN, MN 55340–2111, USA

Filing

Filing Name Filing date
Original Filing - Business Corporation (Domestic) (Business Name: Rice Lake Dental, P.A.)Professional Service - Dentistry & Dental Hygiene 2014-12-16

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 30 Dec 2024

Sources: Minnesota's Official State Website

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