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  5. Lake Country Dental, Ltd.

Lake Country Dental, Ltd.

Company Details

Name: Lake Country Dental, Ltd.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 27 Jun 1996 (29 years ago)
Company Number: 2452fd89-9ad4-e011-a886-001ec94ffe7f
File Number: 9F-944
Registered Office Address: 402 James Str, Brainerd, MN 56401, USA
Principal Executive Office Address: 402 JAMES ST, BRAINERD, MN 56401, US
ZIP code: 56401
County: Crow Wing County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2023 411844501 2024-05-06 LAKE COUNTRY DENTAL, LTD. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2024-05-06
Name of individual signing JEFFREY MATTSON
Valid signature Filed with authorized/valid electronic signature
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2022 411844501 2023-06-05 LAKE COUNTRY DENTAL, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET NORTHWEST, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2023-06-05
Name of individual signing ROLF MOEN
Valid signature Filed with authorized/valid electronic signature
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2021 411844501 2022-08-30 LAKE COUNTRY DENTAL, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET NORTHWEST, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2022-08-30
Name of individual signing ROLF MOEN
Valid signature Filed with authorized/valid electronic signature
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2020 411844501 2021-08-18 LAKE COUNTRY DENTAL, LTD. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET NORTHWEST, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2021-08-18
Name of individual signing ROLF MOEN
Valid signature Filed with authorized/valid electronic signature
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2019 411844501 2020-05-21 LAKE COUNTRY DENTAL, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET NORTHWEST, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2020-05-21
Name of individual signing ROLF MOEN
Valid signature Filed with authorized/valid electronic signature
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2018 411844501 2019-07-08 LAKE COUNTRY DENTAL, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET NORTHWEST, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2019-07-08
Name of individual signing ROLF MOEN
Valid signature Filed with authorized/valid electronic signature
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2017 411844501 2018-07-24 LAKE COUNTRY DENTAL, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET NORTHWEST, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2018-07-24
Name of individual signing ROLF MOEN
Valid signature Filed with authorized/valid electronic signature
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2016 411844501 2017-08-01 LAKE COUNTRY DENTAL, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET NORTHWEST, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2017-08-01
Name of individual signing ROLF MOEN
Valid signature Filed with authorized/valid electronic signature
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2015 411844501 2016-10-14 LAKE COUNTRY DENTAL, LTD. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET NORTHWEST, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2016-10-14
Name of individual signing ROLF MOEN
Valid signature Filed with authorized/valid electronic signature
LAKE COUNTRY DENTAL, LTD. 401(K) SAVINGS PLAN 2014 411844501 2015-10-15 LAKE COUNTRY DENTAL, LTD. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-12-31
Business code 621210
Sponsor’s telephone number 2188294243
Plan sponsor’s address 402 JAMES STREET NORTHWEST, BRAINERD, MN, 56401

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing ROLF MOEN
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Rolf P Moen Chief Executive Officer 402 James St, Brainerd, MN 56401, USA

Filing

Filing Name Filing date
Business Corporation (Domestic) Business Name (Business Name: Lake Country Dental, Ltd.) 2004-10-22
Original Filing - Business Corporation (Domestic) 1996-06-27
Business Corporation (Domestic) Business Name (Business Name: Lake Country Family Dental, Ltd.) 1996-06-27

Related by officers

No related officers

Related by address

402 James Str, Brainerd, MN 56401, USA

James Street Investments, LLC

Date of last update: 26 Sep 2024

Sources: Minnesota's Official State Website

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