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  5. Ham Lake Dental Association, P.A.

Ham Lake Dental Association, P.A.

Company Details

Name: Ham Lake Dental Association, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Inactive
Date formed: 28 May 1998 (27 years ago)
Company Number: 54398e30-b6d4-e011-a886-001ec94ffe7f
File Number: 10E-118
Registered Office Address: 16220 Aberdeen Str NE, Ham Lake, MN 55304, USA
Principal Executive Office Address: 16220 Aberdeen Street NE, Ham Lake, MN 55304, USA
ZIP code: 55304
County: Anoka County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2021 411909575 2022-09-08 HAM LAKE DENTAL ASSOCIATION, P.A. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2021 411909575 2022-07-07 HAM LAKE DENTAL ASSOCIATION, P.A. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304

Signature of
Role Plan administrator
Date 2022-07-07
Name of individual signing SCOTT KIRKHOFF
Valid signature Filed with authorized/valid electronic signature
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2020 411909575 2021-09-16 HAM LAKE DENTAL ASSOCIATION, P.A. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304

Signature of
Role Plan administrator
Date 2021-09-16
Name of individual signing SCOTT KIRKHOFF
Valid signature Filed with authorized/valid electronic signature
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2019 411909575 2020-10-08 HAM LAKE DENTAL ASSOCIATION, P.A. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304

Signature of
Role Plan administrator
Date 2020-10-08
Name of individual signing SCOTT KIRKHOFF
Valid signature Filed with authorized/valid electronic signature
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2018 411909575 2019-10-02 HAM LAKE DENTAL ASSOCIATION, P.A. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2017 411909575 2019-01-18 HAM LAKE DENTAL ASSOCIATION, P.A. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2017 411909575 2018-09-29 HAM LAKE DENTAL ASSOCIATION, P.A. 24
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2016 411909575 2017-03-28 HAM LAKE DENTAL ASSOCIATION, P.A. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304

Signature of
Role Plan administrator
Date 2017-03-28
Name of individual signing SCOTT KIRKHOFF
Valid signature Filed with authorized/valid electronic signature
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2015 411909575 2016-09-20 HAM LAKE DENTAL ASSOCIATION, P.A. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304

Signature of
Role Plan administrator
Date 2016-09-20
Name of individual signing SCOTT KIRKHOFF
Valid signature Filed with authorized/valid electronic signature
HAM LAKE DENTAL ASSOCIATES 401(K) PLAN 2014 411909575 2015-06-11 HAM LAKE DENTAL ASSOCIATION, P.A. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621210
Sponsor’s telephone number 7634344188
Plan sponsor’s address 16220 ABERDEEN STREET NE SUITE A1, HAM LAKE, MN, 55304

Signature of
Role Plan administrator
Date 2015-06-11
Name of individual signing SCOTT KIRKHOFF
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Michele Revoir Chief Executive Officer 16220 Aberdeen Street NE, Ham Lake, MN 55304, USA

Filing

Filing Name Filing date
Intent to Dissolve - Business Corporation (Domestic) 2023-01-20
Dissolution - Business Corporation (Domestic) 2023-01-20
Registered Office and/or Agent - Business Corporation (Domestic) 2002-04-17
Original Filing - Business Corporation (Domestic) 1998-05-28
Business Corporation (Domestic) Business Name (Business Name: Ham Lake Dental Association, P.A.) 1998-05-28

Related by officers

Michele Revoir

Scandia Family Dental, P.A.

Related by address

No related companies by address

Date of last update: 03 Oct 2024

Sources: Minnesota's Official State Website

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