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  5. Northwest Eye Center PA

Northwest Eye Center PA

Company Details

Name: Northwest Eye Center PA
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Inactive
Date formed: 27 Jul 2000 (24 years ago)
Company Number: 9f554fad-b3d4-e011-a886-001ec94ffe7f
File Number: 11G-751
Registered Office Address: 1720 Hwy 59 SE #1, Thief River Falls, MN 56701, USA
Principal Executive Office Address: 901 Hanson Dr, Thief River Falls, MN 56701, USA
ZIP code: 56701
County: Pennington County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2020 411978255 2021-11-24 NORTHWEST EYE CENTER PA 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2021-11-24
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2020 411978255 2021-02-18 NORTHWEST EYE CENTER PA 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2021-02-18
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2019 411978255 2020-02-12 NORTHWEST EYE CENTER PA 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2020-02-12
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2018 411978255 2019-03-26 NORTHWEST EYE CENTER PA 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2019-03-26
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2017 411978255 2018-01-29 NORTHWEST EYE CENTER PA 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2018-01-29
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2016 411978255 2017-03-28 NORTHWEST EYE CENTER PA 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2017-03-28
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2015 411978255 2016-01-26 NORTHWEST EYE CENTER PA 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2016-01-26
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2014 411978255 2015-02-03 NORTHWEST EYE CENTER PA 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2015-02-03
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2013 411978255 2014-07-08 NORTHWEST EYE CENTER PA 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2014-07-08
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature
NORTHWEST EYE CENTER PA SAFE HARBOR 401K PLAN 2012 411978255 2013-05-01 NORTHWEST EYE CENTER PA 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 621320
Sponsor’s telephone number 2186812200
Plan sponsor’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332

Plan administrator’s name and address
Administrator’s EIN 411978255
Plan administrator’s name NORTHWEST EYE CENTER PA
Plan administrator’s address 1720 HIGHWAY 59 S STE 1, THIEF RIVER FALLS, MN, 567014332
Administrator’s telephone number 2186812200

Signature of
Role Plan administrator
Date 2013-05-01
Name of individual signing CHRIS BORGEN
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Chris Borgen Chief Executive Officer 901 Hanson Dr, Thief River Falls, MN 56701, USA

Filing

Filing Name Filing date
Converted to Limited Liability Company (Domestic) 2021-06-15
Business Corporation (Domestic) Business Name (Business Name: Northwest Eye Center PA) 2005-12-28
Registered Office and/or Agent - Business Corporation (Domestic) 2002-09-11
Original Filing - Business Corporation (Domestic) 2000-07-27
Business Corporation (Domestic) Business Name (Business Name: FREEMAN & ASSOCIATES O.D.s, P.A.) 2000-07-27

Related by officers

No related officers

Related by address

1720 Hwy 59 SE #1, Thief River Falls, MN 56701, USA

Freeman & Mickelson, P.A.

Date of last update: 05 Oct 2024

Sources: Minnesota's Official State Website

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