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  5. THE ELBOW LAKE DENTAL CENTER, INC.

THE ELBOW LAKE DENTAL CENTER, INC.

Company Details

Name: THE ELBOW LAKE DENTAL CENTER, INC.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Inactive
Date formed: 04 Dec 1992 (32 years ago)
Company Number: c4a39abf-a7d4-e011-a886-001ec94ffe7f
File Number: 7P-876
Registered Office Address: 18 Division W, Elbow Lake, MN 56531, USA
Principal Executive Office Address: 18 W Division Str, Elbow Lake, MN 56531, USA
ZIP code: 56531
County: Grant County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2019 411738015 2020-03-30 ELBOW LAKE DENTAL CENTER, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2020-03-30
Name of individual signing ORVIN LEIS
Valid signature Filed with authorized/valid electronic signature
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2018 411738015 2019-04-17 ELBOW LAKE DENTAL CENTER, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION STREET, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION STREET, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2019-04-17
Name of individual signing ORVIN LEIS
Valid signature Filed with authorized/valid electronic signature
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2017 411738015 2018-05-20 ELBOW LAKE DENTAL CENTER, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2018-05-20
Name of individual signing DONNA LEIS
Valid signature Filed with authorized/valid electronic signature
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2016 411738015 2017-05-18 ELBOW LAKE DENTAL CENTER, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2017-05-18
Name of individual signing DONNA LEIS
Valid signature Filed with authorized/valid electronic signature
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2015 411738015 2016-04-20 ELBOW LAKE DENTAL CENTER, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2016-04-20
Name of individual signing DONNA LEIS
Valid signature Filed with authorized/valid electronic signature
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2014 411738015 2015-06-11 ELBOW LAKE DENTAL CENTER, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2015-06-11
Name of individual signing DONNA LEIS
Valid signature Filed with authorized/valid electronic signature
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2013 411738015 2014-04-29 ELBOW LAKE DENTAL CENTER, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2014-04-29
Name of individual signing DONNA LEIS
Valid signature Filed with authorized/valid electronic signature
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2012 411738015 2013-05-15 ELBOW LAKE DENTAL CENTER, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2013-05-15
Name of individual signing ORVIN LEIS
Valid signature Filed with authorized/valid electronic signature
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2011 411738015 2012-04-20 ELBOW LAKE DENTAL CENTER, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2012-04-20
Name of individual signing ORVIN LEIS
Valid signature Filed with authorized/valid electronic signature
ELBOW LAKE DENTAL CENTER 401(K) P/S PLAN 2010 411738015 2011-05-13 ELBOW LAKE DENTAL CENTER, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621210
Sponsor’s telephone number 2186854710
Plan sponsor’s address 18 W DIVISION, PO BOX 1032, ELBOW LAKE, MN, 56531

Plan administrator’s name and address
Administrator’s EIN 411738015
Plan administrator’s name ELBOW LAKE DENTAL CENTER, INC.
Plan administrator’s address 18 W DIVISION, PO BOX 1032, ELBOW LAKE, MN, 56531
Administrator’s telephone number 2186854710

Signature of
Role Plan administrator
Date 2011-05-13
Name of individual signing ORVIN LEIS
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Orvin J J Leis Chief Executive Officer 18 W Division Str, Elbow Lake, MN 56531, USA

Filing

Filing Name Filing date
Annual Reinstatement - Business Corporation (Domestic) 2007-05-08
Administrative Dissolution - Business Corporation (Domestic) 2007-01-08
Registered Office and/or Agent - Business Corporation (Domestic) 1994-12-12
Original Filing - Business Corporation (Domestic) 1992-12-04
Business Corporation (Domestic) Business Name (Business Name: THE ELBOW LAKE DENTAL CENTER, INC.) 1992-12-04

Related by officers

No related officers

Related by address

18 W Division Str, Elbow Lake, MN 56531, USA

Superior Prosthodontics

Date of last update: 06 Oct 2024

Sources: Minnesota's Official State Website

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