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  5. Forestview Family Dentistry, PA

Forestview Family Dentistry, PA

Company Details

Name: Forestview Family Dentistry, PA
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Inactive
Date formed: 30 Jun 1986 (39 years ago)
Company Number: 56dad47e-a8d4-e011-a886-001ec94ffe7f
File Number: 5H-19
Registered Office Address: 7270 Forestview Ln #250, Maple Grove, MN 55369, USA
ZIP code: 55369
County: Hennepin County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FORESTVIEW FAMILY DENTISTRY, PA PROFIT SHARING PLAN 2015 411559790 2016-05-17 FORESTVIEW FAMILY DENTISTRY, PA 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 7634249202
Plan sponsor’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369
FORESTVIEW FAMILY DENTISTRY, PA PROFIT SHARING PLAN 2014 411559790 2015-05-07 FORESTVIEW FAMILY DENTISTRY, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 7634249202
Plan sponsor’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2015-05-07
Name of individual signing DONNA SHAMP
Valid signature Filed with authorized/valid electronic signature
FORESTVIEW FAMILY DENTISTRY, PA PROFIT SHARING PLAN 2013 411559790 2014-06-16 FORESTVIEW FAMILY DENTISTRY, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 7634249202
Plan sponsor’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2014-06-16
Name of individual signing DONNA SHAMP
Valid signature Filed with authorized/valid electronic signature
FORESTVIEW FAMILY DENTISTRY, PA PROFIT SHARING PLAN 2012 411559790 2013-06-07 FORESTVIEW FAMILY DENTISTRY, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 7634249202
Plan sponsor’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369

Signature of
Role Plan administrator
Date 2013-06-07
Name of individual signing DOUGLAS SHAMP
Valid signature Filed with authorized/valid electronic signature
FORESTVIEW FAMILY DENTISTRY, PA PROFIT SHARING PLAN 2011 411559790 2012-05-29 FORESTVIEW FAMILY DENTISTRY, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621210
Plan sponsor’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369

Plan administrator’s name and address
Administrator’s EIN 411559790
Plan administrator’s name FORESTVIEW FAMILY DENTISTRY, PA
Plan administrator’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369
Administrator’s telephone number 7634249202

Signature of
Role Plan administrator
Date 2012-05-29
Name of individual signing DOUGLAS SHAMP
Valid signature Filed with authorized/valid electronic signature
FORESTVIEW FAMILY DENTISTRY, PA PROFIT SHARING PLAN 2010 411559790 2011-05-26 FORESTVIEW FAMILY DENTISTRY, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 7634249202
Plan sponsor’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369

Plan administrator’s name and address
Administrator’s EIN 411559790
Plan administrator’s name FORESTVIEW FAMILY DENTISTRY, PA
Plan administrator’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369
Administrator’s telephone number 7634249202

Signature of
Role Plan administrator
Date 2011-05-26
Name of individual signing DOUGLAS SHAMP
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-26
Name of individual signing DOUGLAS SHAMP
Valid signature Filed with authorized/valid electronic signature
FORESTVIEW FAMILY DENTISTRY, PA PROFIT SHARING PLAN 2009 411559790 2010-07-16 FORESTVIEW FAMILY DENTISTRY, PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 621210
Sponsor’s telephone number 7634249202
Plan sponsor’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369

Plan administrator’s name and address
Administrator’s EIN 411559790
Plan administrator’s name FORESTVIEW FAMILY DENTISTRY, PA
Plan administrator’s address 7270 FORESTVIEW LANE, MAPLE GROVE, MN, 55369
Administrator’s telephone number 7634249202

Signature of
Role Plan administrator
Date 2010-07-16
Name of individual signing DOUGLAS SHAMP
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-16
Name of individual signing DOUGLAS SHAMP
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Douglas G. Shamp Chief Executive Officer 7270 Forestview Ln #250, Maple Grove, MN 55369, USA

Filing

Filing Name Filing date
Dissolution - Business Corporation (Domestic) 2018-07-31
Business Corporation (Domestic) Business Name (Business Name: Forestview Family Dentistry, PA) 2004-10-13
Registered Office and/or Agent - Business Corporation (Domestic) 1991-06-21
Original Filing - Business Corporation (Domestic) 1986-06-30
Business Corporation (Domestic) Business Name (Business Name: Douglas G. Shamp, D.D.S., P.A.) 1986-06-30

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Date of last update: 26 Sep 2024

Sources: Minnesota's Official State Website

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