| Name: | Borealis Dental Studio, P.A. |
| Jurisdiction: | Minnesota |
| Legal type: | Business Corporation (Domestic) |
| Status: | Active / In Good Standing |
| Date formed: | 14 Apr 2015 (10 years ago) |
| Company Number: | 54990fdd-c1e2-e411-b14d-001ec94ffe7f |
| File Number: | 821762800034 |
| Registered Office Address: | 6892 256th Str, Wyoming, MN 55092, USA |
| Principal Executive Office Address: | 5239 190TH LN NE, WYOMING, MN 55092–9704, USA |
| ZIP code: | 55092 |
| County: | Anoka County |
| Place of Formation: | Minnesota |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BOREALIS DENTAL STUDIO 401(K) PLAN | 2023 | 473851914 | 2024-01-19 | BOREALIS DENTAL STUDIO, P.A. | 15 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-01-18 |
| Name of individual signing | BECKY GOOLSBY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-01-18 |
| Name of individual signing | BECKY GOOLSBY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 6512572720 |
| Plan sponsor’s address | 12745 FIRST AVENUE NORTH, LINDSTROM, MN, 55045 |
Signature of
| Role | Plan administrator |
| Date | 2023-04-25 |
| Name of individual signing | BECKY GOOLSBY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2023-04-25 |
| Name of individual signing | BECKY GOOLSBY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 6512572720 |
| Plan sponsor’s address | 12745 FIRST AVENUE NORTH, LINDSTROM, MN, 55045 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-20 |
| Name of individual signing | BECKY GOOLSBY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2022-07-20 |
| Name of individual signing | BECKY GOOLSBY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Sean Goolsby | Chief Executive Officer | 5239 190TH LN NE, WYOMING, MN 55092–9704, USA |
| Filing Name | Filing date |
|---|---|
| Original Filing - Business Corporation (Domestic) (Business Name: Borealis Dental Studio, P.A.)Professional Service - Dentistry & Dental Hygiene | 2015-04-14 |
Date of last update: 24 Sep 2024
Sources: Minnesota's Official State Website
