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  5. Southside Community Health Services, Inc.

Southside Community Health Services, Inc.

Company Details

Name: Southside Community Health Services, Inc.
Jurisdiction: Minnesota
Legal type: Nonprofit Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 18 Jun 1971 (54 years ago)
Company Number: 4a98f4a5-b8d4-e011-a886-001ec94ffe7f
File Number: J-315
Registered Office Address: 4243 4th Ave S, Mpls, MN 55409, USA
ZIP code: 55409
County: Hennepin County
Place of Formation: Minnesota

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
CQSZHY4JPCM3 2024-08-27 4243 4TH AVE S, MINNEAPOLIS, MN, 55409, 2113, USA 4243 4TH AVENUE S, MINNEAPOLIS, MN, 55409, 2113, USA

Business Information
URL www.southsidechs.org
Congressional District 05
State/Country of Incorporation MN, USA
Activation Date 2023-08-30
Initial Registration Date 2006-01-19
Entity Start Date 1971-06-18
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name ANN CAZABAN
Role EXECUTIVE DIRECTOR
Address 4243 4TH AVENUE S, MINNEAPOLIS, MN, 55409, 2113, USA
Government Business
Title PRIMARY POC
Name ANN CAZABAN
Role EXECUTIVE DIRECTOR
Address 4243 4TH AVENUE SOUTH, MINNEAPOLIS, MN, 55409, 2113, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
403(B) THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 2023 237113799 2024-08-21 SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 121
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 813000
Sponsor’s telephone number 6128229030
Plan sponsor’s address 4243 4TH AVENUE SOUTH, MINNEAPOLIS, MN, 554092113

Signature of
Role Plan administrator
Date 2024-08-21
Name of individual signing JOHN PATRIKUS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-08-21
Name of individual signing JOHN PATRIKUS
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 2022 237113799 2023-10-03 SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 119
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 813000
Sponsor’s telephone number 6128229030
Plan sponsor’s address 4243 4TH AVENUE SOUTH, MINNEAPOLIS, MN, 554092113

Signature of
Role Plan administrator
Date 2023-10-03
Name of individual signing ANN CAZABAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-10-03
Name of individual signing ANN CAZABAN
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 2021 237113799 2022-07-28 SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 115
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 813000
Sponsor’s telephone number 6128229030
Plan sponsor’s address 4243 4TH AVENUE SOUTH, MINNEAPOLIS, MN, 554092113

Signature of
Role Plan administrator
Date 2022-07-28
Name of individual signing JENNIFER BACON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-28
Name of individual signing JENNIFER BACON
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 2020 237113799 2021-09-17 SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 116
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 813000
Sponsor’s telephone number 6128229030
Plan sponsor’s address 4243 4TH AVENUE SOUTH, MINNEAPOLIS, MN, 554092113

Signature of
Role Plan administrator
Date 2021-09-17
Name of individual signing JENNIFER BACON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-09-17
Name of individual signing JENNIFER BACON
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 2019 237113799 2020-04-10 SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 116
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 813000
Sponsor’s telephone number 6128229030
Plan sponsor’s address 4243 4TH AVENUE SOUTH, MINNEAPOLIS, MN, 554092113

Signature of
Role Plan administrator
Date 2020-04-10
Name of individual signing ANN CAZABAN
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 2018 237113799 2019-04-30 SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 119
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 813000
Sponsor’s telephone number 6128229030
Plan sponsor’s address 4243 4TH AVE S, MINNEAPOLIS, MN, 554092113

Signature of
Role Plan administrator
Date 2019-04-30
Name of individual signing DEB STACHOWSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-04-30
Name of individual signing DEB STACHOWSKI
Valid signature Filed with authorized/valid electronic signature
403 B THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES INC 2017 237113799 2018-04-11 SOUTHSIDE COMMUNITY HEALTH SERVICES INC 79
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 6128229030
Plan sponsor’s address 4243 4TH AVE S, MINNEAPOLIS, MN, 554092113

Signature of
Role Plan administrator
Date 2018-04-11
Name of individual signing ANN CAZABAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-04-11
Name of individual signing ANN CAZABAN
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. 2016 237113799 2017-04-12 SOUTHSIDE COMMUNITY HEALTH SERVICES , INC 83
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 6128223282
Plan sponsor’s address 4243 4TH AVE S, MINNEAPOLIS, MN, 55409

Signature of
Role Plan administrator
Date 2017-04-12
Name of individual signing ANN CAZABAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-12
Name of individual signing ANN CAZABAN
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES, INC 2015 237113799 2016-05-19 SOUTHSIDE COMMUNITY HEALTH SERVICES , INC 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 6128223282
Plan sponsor’s address 4243 4TH AVE S, MINNEAPOLIS, MN, 55409

Signature of
Role Plan administrator
Date 2016-05-19
Name of individual signing ANN CAZABAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-19
Name of individual signing ANN CAZABAN
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF SOUTHSIDE COMMUNITY HEALTH SERVICES, INC 2014 237113799 2015-06-10 SOUTHSIDE COMMUNITY HEALTH SERVICES , INC 86
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 6128223282
Plan sponsor’s address 4243 4TH AVE S, MINNEAPOLIS, MN, 55409

Signature of
Role Plan administrator
Date 2015-06-10
Name of individual signing JOSEPH BUSKE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-10
Name of individual signing JOSEPH BUSKE
Valid signature Filed with authorized/valid electronic signature

President

Name Role Address
Ann Cazaban President 4243 4th Ave S, Mpls, MN 55409, USA

Filing

Filing Name Filing date
Annual Reinstatement - Nonprofit Corporation (Domestic) 2013-09-23
Involuntary Dissolution - Nonprofit Corporation (Domestic) 2013-02-27
Nonprofit Corporation (Domestic) Business Name (Business Name: Southside Community Health Services, Inc.) 1995-05-31
Registered Office and/or Agent - Nonprofit Corporation (Domestic) 1990-08-03
Nonprofit Corporation (Domestic) Business Name (Business Name: Southside Community Clinic, Incorporated) 1973-06-20
Amendment - Nonprofit Corporation (Domestic) 1972-03-03
Original Filing - Nonprofit Corporation (Domestic) 1971-06-18
Nonprofit Corporation (Domestic) Business Name (Business Name: Southside Medical Clinic, Incorporated) 1971-06-18

Related by officers

Ann Cazaban

AMPM Advisors Inc. SCHS, Inc. Neighborhood Health Care Network, Inc.

Related by address

4243 4th Ave S, Mpls, MN 55409, USA

Q FOUNDATION, INC. Q Health Clinics Q Health Clinical Intelligence Q Health Connections Q Health Foundation Q Health Management Services Q Health Services LLC Q Clinic Q Health Services

Date of last update: 04 Jan 2025

Sources: Minnesota's Official State Website

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