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  5. Prairie Lakes Family Dentistry, LLC

Prairie Lakes Family Dentistry, LLC

Company Details

Name: Prairie Lakes Family Dentistry, LLC
Jurisdiction: Minnesota
Legal type: Limited Liability Company (Domestic)
Status: Active / In Good Standing
Date formed: 27 Apr 2012 (13 years ago)
Company Number: 158b813a-9093-e111-b001-001ec94ffe7f
File Number: 486676500025
Registered Office Address: 1442 191st Str, Slayton, MN 56172, USA
Principal Executive Office Address: 212 3rd St, Ste 5, Tracy, MN 56175, USA
ZIP code: 56172
County: Murray County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PRAIRIE LAKES FAMILY DENTISTRY LLC SAFE HARBOR 401(K) RETIREMENTPLAN 2023 455180131 2024-10-11 PRAIRIE LAKES FAMILY DENTISTRY LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 5072120002
Plan sponsor’s address 212 3RD STREET, SUITE 5, TRACY, MN, 56175

Signature of
Role Plan administrator
Date 2024-10-11
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-11
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
PRAIRIE LAKES FAMILY DENTISTRY LLC SAFE HARBOR 401(K) RETIREMENTPLAN 2022 455180131 2023-08-15 PRAIRIE LAKES FAMILY DENTISTRY LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 5072120002
Plan sponsor’s address 212 3RD STREET, SUITE 5, TRACY, MN, 56175

Signature of
Role Plan administrator
Date 2023-08-07
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-08-07
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
PRAIRIE LAKES FAMILY DENTISTRY LLC SAFE HARBOR 401(K) RETIREMENTPLAN 2021 455180131 2022-05-25 PRAIRIE LAKES FAMILY DENTISTRY LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 5072120002
Plan sponsor’s address 212 3RD STREET, SUITE 5, TRACY, MN, 56175

Signature of
Role Plan administrator
Date 2022-05-25
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-05-25
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
PRAIRIE LAKES FAMILY DENTISTRY LLC SAFE HARBOR 401(K) RETIREMENTPLAN 2020 455180131 2021-07-14 PRAIRIE LAKES FAMILY DENTISTRY LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 5072120002
Plan sponsor’s address 212 3RD STREET, SUITE 5, TRACY, MN, 56175

Signature of
Role Plan administrator
Date 2021-07-14
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-14
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
PRAIRIE LAKES FAMILY DENTISTRY LLC SAFE HARBOR 401(K) RETIREMENTPLAN 2019 455180131 2020-10-22 PRAIRIE LAKES FAMILY DENTISTRY LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 5072120002
Plan sponsor’s address 212 3RD STREET, SUITE 5, TRACY, MN, 56175

Signature of
Role Plan administrator
Date 2020-10-22
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-10-22
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
PRAIRIE LAKES FAMILY DENTISTRY LLC SAFE HARBOR 401(K) RETIREMENTPLAN 2019 455180131 2020-10-07 PRAIRIE LAKES FAMILY DENTISTRY LLC 4
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 5072120002
Plan sponsor’s address 212 3RD STREET, SUITE 5, TRACY, MN, 56175

Signature of
Role Plan administrator
Date 2020-07-23
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-23
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
PRAIRIE LAKES FAMILY DENTISTRY LLC SAFE HARBOR 401K RETIREMENT PLAN 2018 455180131 2019-10-15 PRAIRIE LAKES FAMILY DENTISTRY LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 5072120002
Plan sponsor’s address 212 3RD STREET, TRACY, MN, 56175

Signature of
Role Plan administrator
Date 2019-10-15
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
PRAIRIE LAKES FAMILY DENTISTRY LLC SAFE HARBOR 2017 455180131 2018-07-26 PRAIRIE LAKES FAMILY DENTISTRY LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 5072120002
Plan sponsor’s address 212 3RD ST SUITE 5, TRACY, MN, 56175

Signature of
Role Plan administrator
Date 2018-07-26
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature
PRAIRIE LAKES FAMILY DENTISTRY LLC SAFE HARBOR 2016 455180131 2017-07-31 PRAIRIE LAKES FAMILY DENTISTRY LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 5072120002
Plan sponsor’s address 212 3RD ST SUITE 5, TRACY, MN, 56175

Signature of
Role Plan administrator
Date 2017-07-31
Name of individual signing JON HEEZEN
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
Jon A. Heezen Manager 212 3rd St, Ste 5, Tracy, MN 56175, USA

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) 2016-05-12
Administrative Termination - Limited Liability Company (Domestic) 2016-03-15
Original Filing - Limited Liability Company (Domestic) (Business Name: Prairie Lakes Family Dentistry, LLC)Professional Service - Dentistry & Dental Hygiene 2012-04-27

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Date of last update: 24 Sep 2024

Sources: Minnesota's Official State Website

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