Menu
Search icon
  1. Home Page
    2. ›
  2. Counties
    3. ›
  3. Pine County
    4. ›
  4. 55063
    5. ›
  5. Pine Eye Associates, P.A.

Pine Eye Associates, P.A.

Company Details

Name: Pine Eye Associates, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Inactive
Date formed: 28 Jun 2001 (24 years ago)
Company Number: 8b623b22-abd4-e011-a886-001ec94ffe7f
File Number: 11S-426
Registered Office Address: 110 Evergreen Sq Evergreen Square, Pine City, MN 55063, USA
Principal Executive Office Address: 110 Evergreen Square, Pine City, MN 55063, USA
ZIP code: 55063
County: Pine County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PINE EYE ASSOCIATES 401(K) PLAN 2021 412010195 2022-01-27 PINE EYE ASSOCIATES, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3202697262
Plan sponsor’s address 110 EVERGREEN SQUARE SW, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2022-01-27
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-01-27
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
PINE EYE ASSOCIATES 401(K) PLAN 2021 412010195 2022-07-28 PINE EYE ASSOCIATES, P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3202697262
Plan sponsor’s address 110 EVERGREEN SQUARE SW, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2022-07-28
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-28
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
PINE EYE ASSOCIATES 401(K) PLAN 2020 412010195 2021-07-19 PINE EYE ASSOCIATES, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3202697262
Plan sponsor’s address 110 EVERGREEN SQUARE SW, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2021-07-18
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-18
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
PINE EYE ASSOCIATES 401(K) PLAN 2019 412010195 2020-07-29 PINE EYE ASSOCIATES, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3202697262
Plan sponsor’s address 110 EVERGREEN SQUARE SW, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2020-07-29
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-29
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
PINE EYE ASSOCIATES 401(K) PLAN 2018 412010195 2019-07-17 PINE EYE ASSOCIATES, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3206297262
Plan sponsor’s address 110 EVERGREEN SQUARE SW, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-17
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
PINE EYE ASSOCIATES 401(K) PLAN 2017 412010195 2018-07-31 PINE EYE ASSOCIATES, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3206297262
Plan sponsor’s address 110 EVERGREEN SQUARE SW, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2018-07-31
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-31
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
PINE EYE ASSOCIATES 401(K) PLAN 2016 412010195 2017-06-07 PINE EYE ASSOCIATES P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3206297262
Plan sponsor’s address 110 EVERGREEN SQUARE SOUTHWEST, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
PINE EYE ASSOCIATES 401(K) PLAN 2015 412010195 2016-06-29 PINE EYE ASSOCIATES P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3206297262
Plan sponsor’s address 110 EVERGREEN SQUARE SOUTHWEST, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2016-06-29
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
PINE EYE ASSOCIATES 401(K) PLAN 2014 412010195 2015-07-13 PINE EYE ASSOCIATES P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3206297262
Plan sponsor’s address 110 EVERGREEN SQUARE SOUTHWEST, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2015-07-13
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature
PINE EYE ASSOCIATES 401(K) PLAN 2013 412010195 2014-10-11 PINE EYE ASSOCIATES P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 3206297262
Plan sponsor’s address 110 EVERGREEN SQUARE SOUTHWEST, PINE CITY, MN, 55063

Signature of
Role Plan administrator
Date 2014-10-11
Name of individual signing KRISTI IVERSON
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Rafe Garofalo Chief Executive Officer 110 Evergreen Square, Pine City, MN 55063, USA

Filing

Filing Name Filing date
Annual Reinstatement - Business Corporation (Domestic) 2018-07-16
Administrative Dissolution - Business Corporation (Domestic) 2018-03-13
Original Filing - Business Corporation (Domestic) (Business Name: Pine Eye Associates, P.A.)Professional Service - Optometry 2001-06-28

Related by officers

Rafe Garofalo

Northeast Eye Care of Hugo, P.A.

Related by address

No related companies by address

Date of last update: 03 Oct 2024

Sources: Minnesota's Official State Website

Privacy policy Policy
About us About us
Contacts Contact us

© 2025 mnprof.com, Part of Big Data Integrated