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  5. EVANSVILLE CARE CAMPUS LLC

EVANSVILLE CARE CAMPUS LLC

Company Details

Name: EVANSVILLE CARE CAMPUS LLC
Jurisdiction: Minnesota
Legal type: Limited Liability Company (Domestic)
Status: Active / In Good Standing
Date formed: 08 Jun 2009 (16 years ago)
Company Number: 6b899627-94d4-e011-a886-001ec94ffe7f
File Number: 3368990-2
Registered Office Address: 649 STATE ST NW, Evansville, MN 56326, USA
Principal Executive Office Address: 649 STATE ST NW, EVANSVILLE, MN 56326, USA
ZIP code: 56326
County: Douglas County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EVANSVILLE CARE CAMPUS 401(K) PLAN 2023 270553932 2024-02-23 EVANSVILLE CARE CAMPUS, LLC 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2024-02-23
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-02-23
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
EVANSVILLE CARE CAMPUS 401(K) PLAN 2022 270553932 2023-02-01 EVANSVILLE CARE CAMPUS, LLC 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2023-02-01
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-02-01
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
EVANSVILLE CARE CAMPUS 401(K) PLAN 2021 270553932 2022-01-18 EVANSVILLE CARE CAMPUS, LLC 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2022-01-17
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-01-17
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
EVANSVILLE CARE CAMPUS 401(K) PLAN 2020 270553932 2021-02-08 EVANSVILLE CARE CAMPUS, LLC 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2021-02-08
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-02-08
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
EVANSVILLE CARE CAMPUS 401(K) PLAN 2019 270553932 2020-04-17 EVANSVILLE CARE CAMPUS, LLC 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2020-04-17
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-04-17
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
EVANSVILLE CARE CAMPUS 401(K) PLAN 2018 270553932 2019-05-20 EVANSVILLE CARE CAMPUS, LLC 52
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2019-05-20
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
EVANSVILLE CARE CAMPUS 401(K) PLAN 2017 270553932 2018-04-19 EVANSVILLE CARE CAMPUS, LLC 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2018-04-19
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
EVANSVILLE CARE CAMPUS 401(K) PLAN 2016 270553932 2017-05-08 EVANSVILLE CARE CAMPUS, LLC 53
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2017-05-08
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
EVANSVILLE CARE CAMPUS 401(K) PLAN 2015 270553932 2016-05-18 EVANSVILLE CARE CAMPUS, LLC 43
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2016-05-18
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
EVANSVILLE CARE CAMPUS 401(K) PLAN 2014 270553932 2015-05-14 EVANSVILLE CARE CAMPUS, LLC 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 623000
Sponsor’s telephone number 2189482219
Plan sponsor’s address 649 STATE STREET NW, EVANSVILLE, MN, 56326

Signature of
Role Plan administrator
Date 2015-05-14
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-05-14
Name of individual signing ARLYNN JOHNSON
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
ARLYNN JOHNSON Manager 633 STATE ST NW, EVANSVILLE, MN 56326, USA

Filing

Filing Name Filing date
Conversion to 322C Due to Statute Mandate – Limited Liability Company (Domestic) 2018-01-01
Registered Office and/or Agent - Limited Liability Company (Domestic) 2010-11-03
Original Filing - Limited Liability Company (Domestic) 2009-06-08
Limited Liability Company (Domestic) Business Name (Business Name: EVANSVILLE CARE CAMPUS LLC) 2009-06-08

Related by officers

ARLYNN JOHNSON

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Related by address

No related companies by address

Date of last update: 27 Sep 2024

Sources: Minnesota's Official State Website

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