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  5. Allergy & Asthma Specialty Clinic

Allergy & Asthma Specialty Clinic

Company Details

Name: Allergy & Asthma Specialty Clinic
Jurisdiction: Minnesota
Legal type: Assumed Name
Status: Inactive
Date formed: 17 Jun 1999 (26 years ago)
Company Number: a705b7c5-9ad4-e011-a886-001ec94ffe7f
File Number: 223405
Principal Place of Business Address: 1037 19th Ave SW, Willmar, MN 56201, USA
ZIP code: 56201
County: Kandiyohi County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2023 411989263 2024-05-10 ALLERGY & ASTHMA SPECIALTY CLINIC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2024-05-10
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2022 411989263 2023-03-24 ALLERGY & ASTHMA SPECIALTY CLINIC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2023-03-24
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2021 411989263 2022-06-13 ALLERGY & ASTHMA SPECIALTY CLINIC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2022-06-13
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2020 411989263 2021-09-17 ALLERGY & ASTHMA SPECIALTY CLINIC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2021-09-17
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2019 411989263 2020-09-17 ALLERGY & ASTHMA SPECIALTY CLINIC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2020-09-17
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2018 411989263 2019-10-08 ALLERGY & ASTHMA SPECIALTY CLINIC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2019-10-08
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2017 411989263 2018-09-07 ALLERGY & ASTHMA SPECIALTY CLINIC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2018-09-07
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2016 411989263 2017-06-01 ALLERGY & ASTHMA SPECIALTY CLINIC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2017-06-01
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2015 411989263 2016-09-23 ALLERGY & ASTHMA SPECIALTY CLINIC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2016-09-23
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature
ALLERGY & ASTHMA SPECIALTY CLINIC SAFE HARBOR 401K 2014 411989263 2015-06-10 ALLERGY & ASTHMA SPECIALTY CLINIC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 3202141100
Plan sponsor’s DBA name ALLERGY & ASTHMA SPECIALTY CLINIC
Plan sponsor’s address PO BOX 1015, 1037 19TH AVE SW, WILLMAR, MN, 562011015

Plan administrator’s name and address
Administrator’s EIN 411989263
Plan administrator’s name AMY R. ELLINGSON, MD PA
Plan administrator’s address PO BOX 1015, WILLMAR, MN, 562011015
Administrator’s telephone number 3202141100

Signature of
Role Plan administrator
Date 2015-06-10
Name of individual signing JIM ELLINGSON
Valid signature Filed with authorized/valid electronic signature

Aplicant

Name Role Address
Amy R Ellingson MD PA Aplicant 1605 Country Club Drv NE, Willmar, MN 56201

Filing

Filing Name Filing date
Expired - Assumed Name 2019-06-18
Assumed Name Renewal 2008-12-15
Assumed Name Principal Place of Business 2001-01-12
Assumed Name Nameholder 2001-01-12
Original Filing - Assumed Name 1999-06-17
Assumed Name Business Name (Business Name: Allergy & Asthma Specialty Clinic) 1999-06-17

Related by officers

No related officers

Related by address

1037 19th Ave SW, Willmar, MN 56201, USA

AMY R. ELLINGSON, M.D., P.A.

Date of last update: 02 Oct 2024

Sources: Minnesota's Official State Website

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