| Name: | Pine Park Family Dentistry, PLLC |
| Jurisdiction: | Minnesota |
| Legal type: | Limited Liability Company (Domestic) |
| Status: | Active / In Good Standing |
| Date formed: | 23 Jun 2011 (14 years ago) |
| Company Number: | 61f2a2b4-97d4-e011-a886-001ec94ffe7f |
| File Number: | 4353685-2 |
| Registered Office Address: | 314 Pleasant Ave, Park Rapids, MN 56470, USA |
| Principal Executive Office Address: | 314 PLEASANT AVENUE, PARK RAPIDS, MN 56470, USA |
| ZIP code: | 56470 |
| County: | Hubbard County |
| Place of Formation: | Minnesota |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PINE PARK FAMILY DENTISTRY SAFE HARBOR 401K PLAN | 2023 | 452653348 | 2024-10-25 | PINE PARK FAMILY DENTISTRY | 6 | |||||||||||||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2024-10-25 |
| Name of individual signing | SANDRA LARA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-10-25 |
| Name of individual signing | SANDRA LARA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2022-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 2187324466 |
| Plan sponsor’s address | 314 PLEASANT AVENUE S, PARK RAPIDS, MN, 56470 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-13 |
| Name of individual signing | SANDRA LARA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-05-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 2187324466 |
| Plan sponsor’s address | 314 PLEASANT AVENUE, PARK RAPIDS, MN, 56470 |
Signature of
| Role | Plan administrator |
| Date | 2014-03-28 |
| Name of individual signing | SANDRA LARA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-05-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 2187324466 |
| Plan sponsor’s address | 314 PLEASANT AVENUE, PARK RAPIDS, MN, 56470 |
Signature of
| Role | Plan administrator |
| Date | 2013-07-29 |
| Name of individual signing | SANDRA LARA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-07-29 |
| Name of individual signing | SANDRA LARA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-05-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 2187324466 |
| Plan sponsor’s address | 314 PLEASANT AVENUE, PARK RAPIDS, MN, 56470 |
Plan administrator’s name and address
| Administrator’s EIN | 452653348 |
| Plan administrator’s name | PINE PARK FAMILY DENTISTRY |
| Plan administrator’s address | 314 PLEASANT AVENUE, PARK RAPIDS, MN, 56470 |
| Administrator’s telephone number | 2187324466 |
Signature of
| Role | Plan administrator |
| Date | 2012-09-30 |
| Name of individual signing | SANDRA LARA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SANDRA LARA | Manager | 314 PLEASANT AVENUE, PARK RAPIDS, MN 56470, USA |
| Name | Role |
|---|---|
| Dr Sandra Lara | Agent |
| Filing Name | Filing date |
|---|---|
| Conversion to 322C Due to Statute Mandate – Limited Liability Company (Domestic) | 2018-01-01 |
| Original Filing - Limited Liability Company (Domestic) (Business Name: Pine Park Family Dentistry, PLLC)Professional Service - Dentistry & Dental Hygiene | 2011-06-23 |
Date of last update: 24 Sep 2024
Sources: Minnesota's Official State Website
