Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. Nicollet County
    4. ›
  4. 56054
    5. ›
  5. Community Insurance Agency of Lafayette, Inc.

Community Insurance Agency of Lafayette, Inc.

Company Details

Name: Community Insurance Agency of Lafayette, Inc.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 22 Jan 1998 (27 years ago)
Company Number: 46f36680-a3d4-e011-a886-001ec94ffe7f
File Number: 9Z-428
Registered Office Address: 761 Main Ave, Lafayette, MN 56054, USA
Principal Executive Office Address: 761 MAIN AVE, PO BOX 306, LAFAYETTE, MN 56054–0306, USA
ZIP code: 56054
County: Nicollet County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2023 411898087 2024-05-10 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2024-05-10
Name of individual signing MELISSA SCHULTZ
Valid signature Filed with authorized/valid electronic signature
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2022 411898087 2023-06-06 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2023-06-06
Name of individual signing TIFFANY PEDERSEN
Valid signature Filed with authorized/valid electronic signature
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2021 411898087 2022-05-02 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2022-05-02
Name of individual signing TIFFANY PEDERSEN
Valid signature Filed with authorized/valid electronic signature
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2020 411898087 2021-05-20 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2021-05-20
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2019 411898087 2020-07-09 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2020-07-09
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-09
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2018 411898087 2019-06-18 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2019-06-18
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-18
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2017 411898087 2018-07-10 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2018-07-10
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-10
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2016 411898087 2017-07-11 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2017-07-11
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-11
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2015 411898087 2016-04-18 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2016-04-18
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-04-18
Name of individual signing GENEVIEVE DEBOER
Valid signature Filed with authorized/valid electronic signature
COMMUNITY INS AGENCY OF LAFAYETTE 401K 2014 411898087 2015-10-13 COMMUNITY INSURANCE AGENCY OF LAFAYETTE, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-07-01
Business code 524210
Sponsor’s telephone number 5072288201
Plan sponsor’s address PO BOX 306, LAFAYETTE, MN, 560540306

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing CHRISTINE KLOEMPKEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-13
Name of individual signing CHRISTINE KLOEMPKEN
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Dwight Deboer Chief Executive Officer 761 MAIN AVE, LAFAYETTE, MN 56054–4401, USA

Agent

Name Role
Dwight DeBoer Agent

Filing

Filing Name Filing date
Annual Reinstatement - Business Corporation (Domestic) 2020-01-07
Administrative Dissolution - Business Corporation (Domestic) 2018-03-13
Registered Office and/or Agent - Business Corporation (Domestic) 2001-08-08
Original Filing - Business Corporation (Domestic) 1998-01-22
Business Corporation (Domestic) Business Name (Business Name: Community Insurance Agency of Lafayette, Inc.) 1998-01-22

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Nov 2024

Sources: Minnesota's Official State Website

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 mnprof.com, Part of Big Data Integrated