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  5. Luverne Family Dental, PLLC

Luverne Family Dental, PLLC

Company Details

Name: Luverne Family Dental, PLLC
Jurisdiction: Minnesota
Legal type: Limited Liability Company (Domestic)
Status: Active / In Good Standing
Date formed: 14 Jan 2021 (4 years ago)
Company Number: dceb12ee-7d56-eb11-917c-00155d01c43b
File Number: 1210330200023
Registered Office Address: 6609 Cherokee Lane North, Brooklyn Park, MN 55428, USA
Mailing Address: 115 E Main Street, Luverne, MN 56156, USA
Principal Executive Office Address: 115 E MAIN ST, LUVERNE, MN 56156–1830, United States
ZIP code: 55428
County: Hennepin County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LUVERNE FAMILY DENTAL 401(K) PROFIT SHARING PLAN AND TRUST 2023 861455543 2024-04-23 LUVERNE FAMILY DENTAL, PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5072839129
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156

Signature of
Role Plan administrator
Date 2024-04-23
Name of individual signing TANNER BROLSMA
Valid signature Filed with authorized/valid electronic signature
LUVERNE FAMILY DENTAL 401(K) PROFIT SHARING PLAN AND TRUST 2022 861455543 2023-05-08 LUVERNE FAMILY DENTAL, PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5072839129
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156
LUVERNE FAMILY DENTAL 401(K) PROFIT SHARING PLAN AND TRUST 2021 861455543 2022-12-15 LUVERNE FAMILY DENTAL, PLLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5072839129
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156
LUVERNE FAMILY DENTAL 401(K) PROFIT SHARING PLAN AND TRUST 2021 861455543 2022-06-21 LUVERNE FAMILY DENTAL, PLLC 7
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5072839129
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156
LUVERNE FAMILY DENTAL 401(K) PROFIT SHARING PLAN 2012 262467569 2013-08-13 LUVERNE FAMILY DENTAL 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5073014185
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156

Plan administrator’s name and address
Administrator’s EIN 262467569
Plan administrator’s name LUVERNE FAMILY DENTAL
Plan administrator’s address 115 E. MAIN STREET, LUVERNE, MN, 56156
Administrator’s telephone number 5073014185

Signature of
Role Plan administrator
Date 2013-08-13
Name of individual signing KALE LEUTHOLD
Valid signature Filed with authorized/valid electronic signature
LUVERNE FAMILY DENTAL 401(K) P/S PLAN 2011 262467569 2012-06-28 LUVERNE FAMILY DENTAL 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5072839129
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156

Plan administrator’s name and address
Administrator’s EIN 262467569
Plan administrator’s name LUVERNE FAMILY DENTAL
Plan administrator’s address 115 E. MAIN STREET, LUVERNE, MN, 56156
Administrator’s telephone number 5072839129

Signature of
Role Plan administrator
Date 2012-06-28
Name of individual signing ADAM KLEIN
Valid signature Filed with authorized/valid electronic signature
LUVERNE FAMILY DENTAL 401(K) P/S PLAN 2010 262467569 2011-06-06 LUVERNE FAMILY DENTAL 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5072839129
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156

Plan administrator’s name and address
Administrator’s EIN 262467569
Plan administrator’s name LUVERNE FAMILY DENTAL
Plan administrator’s address 115 E. MAIN STREET, LUVERNE, MN, 56156
Administrator’s telephone number 5072839129

Signature of
Role Plan administrator
Date 2011-06-06
Name of individual signing ADAM KLEIN
Valid signature Filed with authorized/valid electronic signature
LUVERNE FAMILY DENTAL 401(K) P/S PLAN 2009 262467569 2010-06-24 LUVERNE FAMILY DENTAL 7
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5072839129
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156

Plan administrator’s name and address
Administrator’s EIN 262467569
Plan administrator’s name LUVERNE FAMILY DENTAL
Plan administrator’s address 115 E. MAIN STREET, LUVERNE, MN, 56156
Administrator’s telephone number 5072839129

Signature of
Role Plan administrator
Date 2010-06-24
Name of individual signing ADAM KLEIN
Valid signature Filed with incorrect/unrecognized electronic signature
LUVERNE FAMILY DENTAL 401(K) P/S PLAN 2009 262467569 2010-09-28 LUVERNE FAMILY DENTAL 7
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5072839129
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156

Plan administrator’s name and address
Administrator’s EIN 262467569
Plan administrator’s name LUVERNE FAMILY DENTAL
Plan administrator’s address 115 E. MAIN STREET, LUVERNE, MN, 56156
Administrator’s telephone number 5072839129

Signature of
Role Plan administrator
Date 2010-09-28
Name of individual signing ADAM KLEIN
Valid signature Filed with incorrect/unrecognized electronic signature
LUVERNE FAMILY DENTAL 401(K) P/S PLAN 2009 262467569 2010-09-28 LUVERNE FAMILY DENTAL 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-07-01
Business code 621210
Sponsor’s telephone number 5072839129
Plan sponsor’s address 115 E. MAIN STREET, LUVERNE, MN, 56156

Plan administrator’s name and address
Administrator’s EIN 262467569
Plan administrator’s name LUVERNE FAMILY DENTAL
Plan administrator’s address 115 E. MAIN STREET, LUVERNE, MN, 56156
Administrator’s telephone number 5072839129

Signature of
Role Plan administrator
Date 2010-09-28
Name of individual signing ADAM KLEIN
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
SARA ROBISON Manager 115 E MAIN ST, LUVERNE, MN 56156–1830, United States

Agent

Name Role
Tanner Brolsma Agent

Filing

Filing Name Filing date
Amendment - Limited Liability Company (Domestic) 2024-02-28
Original Filing - Limited Liability Company (Domestic) (Business Name: Luverne Family Dental, PLLC)Professional Service - Dentistry & Dental Hygiene 2021-01-14

Related by officers

No related officers

Related by address

6609 Cherokee Lane North, Brooklyn Park, MN 55428, USA

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Date of last update: 24 Dec 2024

Sources: Minnesota's Official State Website

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