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Prism Eye Care

Prism Eye Care

Company Details

Name:	Prism Eye Care
Jurisdiction:	Minnesota
Legal type:	Assumed Name
Status:	Active / In Good Standing
Date formed:	30 Oct 2019 (5 years ago)
Company Number:	7b6d3623-5efb-e911-9188-00155d01b4fc
File Number:	1114831700026
Principal Place of Business Address:	272 Snelling Ave. S., Suite 300, Saint Paul, MN 55105, USA
Mailing Address:	1969 Jefferson Avenue, Saint Paul, MN 55105, USA
ZIP code:	55105
County:	Ramsey County
Place of Formation:	Minnesota

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

PRISM EYE CARE 401(K) PLAN

2023

843108893

2024-05-17

PRISM EYE CARE

5

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2021-08-30
Business code	621320
Sponsor’s telephone number	6513697833
Plan sponsor’s address	272 SNELLING AVENUE S., SUITE 300, SAINT PAUL, MN, 55105

Plan administrator’s name and address

Administrator’s EIN	474474775
Plan administrator’s name	GUIDELINE, INC.
Plan administrator’s address	1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number	8882283491

Signature of

Role	Plan administrator
Date	2024-05-17
Name of individual signing	QIAN LIU
Valid signature	Filed with authorized/valid electronic signature

PRISM EYE CARE 401(K) PLAN

2022

843108893

2023-05-27

PRISM EYE CARE

3

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2021-08-30
Business code	621320
Sponsor’s telephone number	6513697833
Plan sponsor’s address	272 SNELLING AVENUE S., SUITE 300, SAINT PAUL, MN, 55105

Plan administrator’s name and address

Administrator’s EIN	474474775
Plan administrator’s name	GUIDELINE, INC.
Plan administrator’s address	1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number	8882283491

Signature of

Role	Plan administrator
Date	2023-05-27
Name of individual signing	CHRISTINE RIMER
Valid signature	Filed with authorized/valid electronic signature

PRISM EYE CARE 401(K) PLAN

2021

843108893

2022-05-20

PRISM EYE CARE

2

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2021-08-30
Business code	621320
Sponsor’s telephone number	6513697833
Plan sponsor’s address	272 SNELLING AVENUE S., SUITE 300, SAINT PAUL, MN, 55105

Plan administrator’s name and address

Administrator’s EIN	474474775
Plan administrator’s name	GUIDELINE, INC.
Plan administrator’s address	1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number	8882283491

Signature of

Role	Plan administrator
Date	2022-05-20
Name of individual signing	CHRISTINE RIMER
Valid signature	Filed with authorized/valid electronic signature

Aplicant

Name	Role	Address
Lauren K Haverly LLC	Aplicant	1969 Jefferson Avenue, Saint Paul, MN 55105 – 5510

Filing

Filing Name	Filing date
Original Filing - Assumed Name (Business Name: Prism Eye Care)	2019-10-30

Date of last update: 11 Jan 2025

Sources: Minnesota's Official State Website