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  5. Lee Carlson Center for Mental Health and Well-Being

Lee Carlson Center for Mental Health and Well-Being

Company Details

Name: Lee Carlson Center for Mental Health and Well-Being
Jurisdiction: Minnesota
Legal type: Nonprofit Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 29 May 1979 (46 years ago)
Company Number: ad59c74e-aed4-e011-a886-001ec94ffe7f
File Number: R-518
Registered Office Address: 7954 University Ave NE, Fridley, MN 55432, USA
ZIP code: 55432
County: Anoka County
Place of Formation: Minnesota

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
UESLBPUFM996 2024-06-19 7954 UNIVERSITY AVE NE, MINNEAPOLIS, MN, 55432, 1860, USA 7954 UNIVERSITY AVE.NE, FRIDLEY, MN, 55432, 1860, USA

Business Information
URL www.leecarlsoncenter.org
Congressional District 05
State/Country of Incorporation MN, USA
Activation Date 2023-06-22
Initial Registration Date 2009-09-02
Entity Start Date 1979-05-29
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name SUSAN FULLERTON
Address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 55432, USA
Title ALTERNATE POC
Name SUSAN FULLERTON
Address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 55432, 1806, USA
Government Business
Title PRIMARY POC
Name SUSAN FULLERTON
Address 7954 UNIVERSITY AVE. NE, FRIDLEY, MN, 55432, USA
Title ALTERNATE POC
Name SUSAN FULLERTON
Address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 55432, 1806, USA
Past Performance
Title PRIMARY POC
Name SUSAN FULLERTON
Address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 55432, USA
Title ALTERNATE POC
Name SUSAN FULLERTON
Address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 55432, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
403(B) THRIFT PLAN OF LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 2023 411354967 2024-09-09 LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 119
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 624200
Sponsor’s telephone number 7637803036
Plan sponsor’s address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 554321860

Signature of
Role Plan administrator
Date 2024-09-09
Name of individual signing SUE VANG
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 2022 411354967 2023-10-16 LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624200
Sponsor’s telephone number 7637803036
Plan sponsor’s address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 554321860

Signature of
Role Plan administrator
Date 2023-10-16
Name of individual signing SUE VANG
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 2021 411354967 2022-03-29 LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624200
Sponsor’s telephone number 7637803036
Plan sponsor’s address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 554321860

Signature of
Role Plan administrator
Date 2022-03-29
Name of individual signing RANCE RAND
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 2020 411354967 2021-03-24 LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 91
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624200
Sponsor’s telephone number 7637803036
Plan sponsor’s address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 554321860

Signature of
Role Plan administrator
Date 2021-03-24
Name of individual signing RANCE RAND
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 2019 411354967 2020-03-11 LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624200
Sponsor’s telephone number 7637803036
Plan sponsor’s address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 554321860

Signature of
Role Plan administrator
Date 2020-03-11
Name of individual signing RANCE RAND
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 2018 411354967 2019-03-20 LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 624100
Sponsor’s telephone number 7637803036
Plan sponsor’s address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 554321860

Signature of
Role Plan administrator
Date 2019-03-20
Name of individual signing REBECCA OSTERMAN
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 2011 411354967 2012-07-09 LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 624100
Plan sponsor’s address 7954 UNIVERISITY AVE NE, FRIDLEY, MN, 55432

Plan administrator’s name and address
Administrator’s EIN 411354967
Plan administrator’s name LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING
Plan administrator’s address 7954 UNIVERISITY AVE NE, FRIDLEY, MN, 55432

Signature of
Role Plan administrator
Date 2012-07-09
Name of individual signing JOHN PEPPER
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 2009 411354967 2010-07-22 LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 624100
Sponsor’s telephone number 7637803036
Plan sponsor’s address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 55432

Plan administrator’s name and address
Administrator’s EIN 411354967
Plan administrator’s name LEE CARLSON CENTER FOR MENTAL HEALTH AND WELL-BEING
Plan administrator’s address 7954 UNIVERSITY AVE NE, FRIDLEY, MN, 55432
Administrator’s telephone number 7637803036

Signature of
Role Plan administrator
Date 2010-07-22
Name of individual signing KATHY SAMILO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-22
Name of individual signing KATHY SAMILO
Valid signature Filed with authorized/valid electronic signature

President

Name Role Address
Robert Edwards President 7954 UNIVERSITY AVE NE, FRIDLEY, MN 55432–1860, USA

Filing

Filing Name Filing date
Annual Reinstatement - Nonprofit Corporation (Domestic) 2015-02-26
Involuntary Dissolution - Nonprofit Corporation (Domestic) 2014-04-22
Nonprofit Corporation (Domestic) Business Name (Business Name: Lee Carlson Center for Mental Health and Well-Being) 2009-08-14
Registered Office and/or Agent - Nonprofit Corporation (Domestic) 1990-02-14
Amendment - Nonprofit Corporation (Domestic) 1979-07-27
Original Filing - Nonprofit Corporation (Domestic) 1979-05-29
Nonprofit Corporation (Domestic) Business Name (Business Name: Central Center for Family Resources) 1979-05-29

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Related by address

7954 University Ave NE, Fridley, MN 55432, USA

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Date of last update: 01 Oct 2024

Sources: Minnesota's Official State Website

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