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  5. Northern Lights Pediatric & Adolescent Medicine, P.A.

Northern Lights Pediatric & Adolescent Medicine, P.A.

Company Details

Name: Northern Lights Pediatric & Adolescent Medicine, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 17 Feb 2004 (21 years ago)
Company Number: 563f38d4-87d4-e011-a886-001ec94ffe7f
File Number: 797029-2
Registered Office Address: 3615 Grand Ave, White Bear Lake, MN 55110, USA
Principal Executive Office Address: 3555 Willow Lake Blvd. Suite 140, Vadnais Heights, MN 55110, USA
ZIP code: 55110
County: Ramsey County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2023 200740476 2024-03-25 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2024-03-25
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-03-25
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2022 200740476 2023-07-05 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2023-07-03
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-03
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2021 200740476 2022-06-14 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2022-06-14
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-14
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2020 200740476 2021-06-28 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2021-06-28
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-28
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2019 200740476 2020-06-16 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2020-06-16
Name of individual signing WENDY M N MCCABE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-16
Name of individual signing WENDY M N MCCABE
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2018 200740476 2019-06-28 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2019-06-28
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-28
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2016 200740476 2017-03-22 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2017-03-22
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-03-22
Name of individual signing WENDY MCCABE
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2015 200740476 2016-09-07 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2016-09-07
Name of individual signing SUCHITRA RONDLA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-07
Name of individual signing SUCHITRA RONDLA
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2014 200740476 2015-09-14 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2015-09-14
Name of individual signing THRESIAMMA A JOSEPH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-14
Name of individual signing THRESIAMMA A JOSEPH
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE P.A. 401(K) PLAN AND TRUST 2013 200740476 2014-09-08 NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE, P.A. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-10-01
Business code 621111
Sponsor’s telephone number 6517702124
Plan sponsor’s address 3555 WILLOW LAKE BLVD., SUITE 140, VADNAIS HEIGHTS, MN, 55110

Signature of
Role Plan administrator
Date 2014-09-08
Name of individual signing THRESIAMMA A JOSEPH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-09-08
Name of individual signing THRESIAMMA A JOSEPH
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Wendy McCabe Chief Executive Officer 3555 Willow Lake Blvd. Suite 140, Vadnais Heights, MN 55110, USA

Filing

Filing Name Filing date
Annual Reinstatement - Business Corporation (Domestic) 2019-08-01
Administrative Dissolution - Business Corporation (Domestic) 2019-03-15
Original Filing - Business Corporation (Domestic) (Business Name: Northern Lights Pediatric & Adolescent Medicine, P.A.)Professional Service - Medicine & Surgery 2004-02-17

Related by officers

No related officers

Related by address

3615 Grand Ave, White Bear Lake, MN 55110, USA

Northern Lights Holdings, LLC Northern Lights Realty Investors, LLC Margaret J. Hustad, M.D., P.A. White Bear Hills Properties, a Minnesota general partnership

Date of last update: 27 Sep 2024

Sources: Minnesota's Official State Website

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