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  5. Lake Superior Community Health Center

Lake Superior Community Health Center

Company Details

Name: Lake Superior Community Health Center
Jurisdiction: Minnesota
Legal type: Nonprofit Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 28 Feb 1972 (53 years ago)
Company Number: 235f8468-a0d4-e011-a886-001ec94ffe7f
File Number: J-990
Registered Office Address: 4325 Grand Ave, Duluth, MN 55807, USA
ZIP code: 55807
County: St. Louis County
Place of Formation: Minnesota

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
ZCJMHEN9PH13 2024-12-07 4325 GRAND AVE, DULUTH, MN, 55807, 2730, USA 4325 GRAND AVENUE, DULUTH, MN, 55807, 2730, USA

Business Information
Congressional District 08
State/Country of Incorporation MN, USA
Activation Date 2023-12-11
Initial Registration Date 2004-12-07
Entity Start Date 1972-02-28
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name LEE HOMAN
Role INTERIM CEO
Address 4325 GRAND AVENUE, DULUTH, MN, 55807, 2730, USA
Government Business
Title PRIMARY POC
Name LEE HOMAN
Role INTERIM CEO
Address 4325 GRAND AVENUE, DULUTH, MN, 55807, 2730, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2023 237167576 2024-03-27 LAKE SUPERIOR COMMUNITY HEALTH CENTER 151
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Signature of
Role Plan administrator
Date 2024-03-27
Name of individual signing LEE HOMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-03-27
Name of individual signing LEE HOMAN
Valid signature Filed with authorized/valid electronic signature
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2018 237167576 2019-09-30 LAKE SUPERIOR COMMUNITY HEALTH CENTER 109
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Signature of
Role Plan administrator
Date 2019-09-30
Name of individual signing DAYLE PATTERSON
Valid signature Filed with authorized/valid electronic signature
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2017 237167576 2018-09-27 LAKE SUPERIOR COMMUNITY HEALTH CENTER 112
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Signature of
Role Plan administrator
Date 2018-09-27
Name of individual signing DAYLE PATTERSON
Valid signature Filed with authorized/valid electronic signature
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2016 237167576 2017-05-22 LAKE SUPERIOR COMMUNITY HEALTH CENTER 103
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Signature of
Role Plan administrator
Date 2017-05-22
Name of individual signing DAYLE PATTERSON
Valid signature Filed with authorized/valid electronic signature
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2015 237167576 2016-06-28 LAKE SUPERIOR COMMUNITY HEALTH CENTER 106
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Signature of
Role Plan administrator
Date 2016-06-28
Name of individual signing SARAH LEUCK
Valid signature Filed with authorized/valid electronic signature
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2014 237167576 2015-09-30 LAKE SUPERIOR COMMUNITY HEALTH CENTER 105
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Signature of
Role Plan administrator
Date 2015-09-30
Name of individual signing SARAH LEUCK
Valid signature Filed with authorized/valid electronic signature
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2013 237167576 2014-06-27 LAKE SUPERIOR COMMUNITY HEALTH CENTER 107
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Signature of
Role Plan administrator
Date 2014-06-27
Name of individual signing SARAH LEUCK
Valid signature Filed with authorized/valid electronic signature
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2012 237167576 2014-06-27 LAKE SUPERIOR COMMUNITY HEALTH CENTER 99
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Plan administrator’s name and address
Administrator’s EIN 237167576
Plan administrator’s name LAKE SUPERIOR COMMUNITY HEALTH CENTER
Plan administrator’s address 4325 GRAND AVENUE, DULUTH, MN, 55807
Administrator’s telephone number 2187221497

Signature of
Role Plan administrator
Date 2014-06-27
Name of individual signing SARAH LEUCK
Valid signature Filed with authorized/valid electronic signature
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2012 237167576 2013-04-26 LAKE SUPERIOR COMMUNITY HEALTH CENTER 99
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Plan administrator’s name and address
Administrator’s EIN 237167576
Plan administrator’s name LAKE SUPERIOR COMMUNITY HEALTH CENTER
Plan administrator’s address 4325 GRAND AVENUE, DULUTH, MN, 55807
Administrator’s telephone number 2187221497

Signature of
Role Plan administrator
Date 2013-04-26
Name of individual signing KATHY MILLER
Valid signature Filed with authorized/valid electronic signature
LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2011 237167576 2012-04-16 LAKE SUPERIOR COMMUNITY HEALTH CENTER 86
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621111
Sponsor’s telephone number 2187221497
Plan sponsor’s address 4325 GRAND AVENUE, DULUTH, MN, 55807

Plan administrator’s name and address
Administrator’s EIN 237167576
Plan administrator’s name LAKE SUPERIOR COMMUNITY HEALTH CENTER
Plan administrator’s address 4325 GRAND AVENUE, DULUTH, MN, 55807
Administrator’s telephone number 2187221497

Signature of
Role Plan administrator
Date 2012-04-16
Name of individual signing KATHY MILLER
Valid signature Filed with authorized/valid electronic signature

President

Name Role Address
Bob Lyman President 4325 GRAND AVE, DULUTH, MN 55807–2730, USA

Filing

Filing Name Filing date
Registered Office - Nonprofit Corporation (Domestic) 2020-09-11
Annual Reinstatement - Nonprofit Corporation (Domestic) 2012-09-10
Involuntary Dissolution - Nonprofit Corporation (Domestic) 2012-08-06
Nonprofit Corporation (Domestic) Business Name (Business Name: Lake Superior Community Health Center) 2000-04-12
Nonprofit Corporation (Domestic) Restated Articles 1991-05-20
Nonprofit Corporation (Domestic) Business Name (Business Name: Duluth Community Health Center) 1991-05-20
Registered Office and/or Agent - Nonprofit Corporation (Domestic) 1990-04-09
Amendment - Nonprofit Corporation (Domestic) 1973-05-01
Original Filing - Nonprofit Corporation (Domestic) 1972-02-28
Nonprofit Corporation (Domestic) Business Name (Business Name: The Duluth Community Health Center, Inc.) 1972-02-28

Related by officers

No related officers

Related by address

4325 Grand Ave, Duluth, MN 55807, USA

West Duluth Clinic

Date of last update: 01 Oct 2024

Sources: Minnesota's Official State Website

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