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  5. Chisago Lakes Dental

Chisago Lakes Dental

Company Details

Name: Chisago Lakes Dental
Jurisdiction: Minnesota
Legal type: Assumed Name
Status: Inactive
Date formed: 07 Aug 1998 (26 years ago)
Company Number: fd792693-a4d4-e011-a886-001ec94ffe7f
File Number: 210658
Principal Place of Business Address: 11721 Stinson Ave, Chisago City, MN 55013, USA
ZIP code: 55013
County: Chisago County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CHISAGO LAKES DENTAL 401K PLAN 2011 410947768 2012-07-27 CHISAGO LAKES DENTAL 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6512572922
Plan sponsor’s address PO BOX 757, LINDSTROM, MN, 550450757

Plan administrator’s name and address
Administrator’s EIN 410947768
Plan administrator’s name CHISAGO LAKES DENTAL
Plan administrator’s address PO BOX 757, LINDSTROM, MN, 550450757
Administrator’s telephone number 6512572922

Signature of
Role Plan administrator
Date 2012-07-27
Name of individual signing DAVID B ALBRECHT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-27
Name of individual signing DAVID B ALBRECHT
Valid signature Filed with authorized/valid electronic signature
CHISAGO LAKES DENTAL 401K PLAN 2010 410947768 2011-07-01 CHISAGO LAKES DENTAL 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6512572922
Plan sponsor’s address 11721 STINSON AVE, CHISAGO CITY, MN, 550139542

Plan administrator’s name and address
Administrator’s EIN 410947768
Plan administrator’s name CHISAGO LAKES DENTAL
Plan administrator’s address 11721 STINSON AVE, CHISAGO CITY, MN, 550139542
Administrator’s telephone number 6512572922

Signature of
Role Plan administrator
Date 2011-07-01
Name of individual signing DAVID B ALBRECHT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-01
Name of individual signing DAVID B ALBRECHT
Valid signature Filed with authorized/valid electronic signature
CHISAGO LAKES DENTAL 401K PLAN 2009 410947768 2010-07-21 CHISAGO LAKES DENTAL 5
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6512572922
Plan sponsor’s address 11721 STINSON AVE, CHISAGO CITY, MN, 550139542

Plan administrator’s name and address
Administrator’s EIN 410947768
Plan administrator’s name CHISAGO LAKES DENTAL
Plan administrator’s address 11721 STINSON AVE, CHISAGO CITY, MN, 550139542
Administrator’s telephone number 6512572922

Signature of
Role Plan administrator
Date 2010-07-21
Name of individual signing DAVID B ALBRECHT
Valid signature Filed with incorrect/unrecognized electronic signature
CHISAGO LAKES DENTAL 401K PLAN 2009 410947768 2010-07-22 CHISAGO LAKES DENTAL 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6512572922
Plan sponsor’s address 11721 STINSON AVE, CHISAGO CITY, MN, 550139542

Plan administrator’s name and address
Administrator’s EIN 410947768
Plan administrator’s name CHISAGO LAKES DENTAL
Plan administrator’s address 11721 STINSON AVE, CHISAGO CITY, MN, 550139542
Administrator’s telephone number 6512572922

Signature of
Role Plan administrator
Date 2010-07-22
Name of individual signing DAVID ALBRECHT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-22
Name of individual signing DAVID ALBRECHT
Valid signature Filed with authorized/valid electronic signature
CHISAGO LAKES DENTAL 401K PLAN 2009 410947768 2010-07-21 CHISAGO LAKES DENTAL 5
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 6512572922
Plan sponsor’s address 11721 STINSON AVE, CHISAGO CITY, MN, 550139542

Plan administrator’s name and address
Administrator’s EIN 410947768
Plan administrator’s name CHISAGO LAKES DENTAL
Plan administrator’s address 11721 STINSON AVE, CHISAGO CITY, MN, 550139542
Administrator’s telephone number 6512572922

Signature of
Role Plan administrator
Date 2010-07-21
Name of individual signing DAVID B ALBRECHT
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-07-21
Name of individual signing DAVID B ALBRECHT
Valid signature Filed with incorrect/unrecognized electronic signature

Aplicant

Name Role Address
Shipp Dental Care, Ltd. Aplicant 11721 Stinson Ave, Chisago City, MN 55013

Filing

Filing Name Filing date
Expired - Assumed Name 2018-08-08
Amendment - Assumed Name 2014-10-10
Assumed Name Principal Place of Business 2008-08-04
Assumed Name Nameholder 2008-08-04
Assumed Name Renewal 2008-08-04
Original Filing - Assumed Name 1998-08-07
Assumed Name Business Name (Business Name: Chisago Lakes Dental) 1998-08-07

Related by officers

Shipp Dental Care, Ltd.

CHISAGO LAKES DENTAL CARE

Related by address

11721 Stinson Ave, Chisago City, MN 55013, USA

Shipp Dental Care, Ltd. CHISAGO LAKES DENTAL CARE

Date of last update: 24 Sep 2024

Sources: Minnesota's Official State Website

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