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  5. AMBER LEAF FAMILY DENTAL

AMBER LEAF FAMILY DENTAL

Company Details

Name: AMBER LEAF FAMILY DENTAL
Jurisdiction: Minnesota
Legal type: Assumed Name
Status: Inactive
Date formed: 02 Nov 2001 (23 years ago)
Company Number: 11e80902-afd4-e011-a886-001ec94ffe7f
File Number: 258812
Principal Place of Business Address: 8910 Penn Ave S, Blmgtn, MN 55431, USA
ZIP code: 55431
County: Hennepin County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AMBER LEAF FAMILY DENTAL DEFINED BENEFIT PLAN AND TRUST 2023 411991249 2024-10-15 AMBER LEAF FAMILY DENTAL 22
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing FRANK RUSSOMANNO JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-15
Name of individual signing FRANK RUSSOMANNO JR.
Valid signature Filed with authorized/valid electronic signature
AMBER LEAF FAMILY DENTAL 401(K) PLAN AND TRUST 2023 411991249 2024-10-15 AMBER LEAF FAMILY DENTAL 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431

Signature of
Role Plan administrator
Date 2024-10-15
Name of individual signing FRANK RUSSOMANNO JR.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-15
Name of individual signing FRANK RUSSOMANNO JR.
Valid signature Filed with authorized/valid electronic signature
AMBER LEAF FAMILY DENTAL 401(K) PROFIT SHARING PLAN 2022 411991249 2024-04-25 AMBER LEAF FAMILY DENTAL 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431

Signature of
Role Plan administrator
Date 2024-04-25
Name of individual signing FRANK RUSSOMANNO, JR.
Valid signature Filed with authorized/valid electronic signature
AMBER LEAF FAMILY DENTAL RETIREMENT PLAN 2022 411991249 2023-10-16 AMBER LEAF FAMILY DENTAL 25
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431
AMBER LEAF FAMILY DENTAL 401(K) PROFIT SHARING PLAN 2022 411991249 2023-09-29 AMBER LEAF FAMILY DENTAL 25
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431

Signature of
Role Plan administrator
Date 2023-09-29
Name of individual signing FRANK RUSSOMANNO, JR.
Valid signature Filed with authorized/valid electronic signature
AMBER LEAF FAMILY DENTAL 401(K) PROFIT SHARING PLAN 2021 411991249 2023-03-07 AMBER LEAF FAMILY DENTAL 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431

Signature of
Role Plan administrator
Date 2023-03-07
Name of individual signing FRANK RUSSOMANNO, JR.
Valid signature Filed with authorized/valid electronic signature
AMBER LEAF FAMILY DENTAL 401(K) PROFIT SHARING PLAN 2021 411991249 2022-10-11 AMBER LEAF FAMILY DENTAL 25
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431

Signature of
Role Plan administrator
Date 2022-10-11
Name of individual signing FRANK RUSSOMANNO, JR.
Valid signature Filed with authorized/valid electronic signature
AMBER LEAF FAMILY DENTAL RETIREMENT PLAN 2021 411991249 2023-02-24 AMBER LEAF FAMILY DENTAL 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431

Signature of
Role Plan administrator
Date 2023-02-24
Name of individual signing FRANK RUSSOMANNO, JR.
Valid signature Filed with authorized/valid electronic signature
AMBER LEAF FAMILY DENTAL RETIREMENT PLAN 2020 411991249 2021-10-14 AMBER LEAF FAMILY DENTAL 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing FRANK RUSSOMANNO, JR.
Valid signature Filed with authorized/valid electronic signature
AMBER LEAF FAMILY DENTAL 401(K) PROFIT SHARING PLAN 2020 411991249 2021-10-14 AMBER LEAF FAMILY DENTAL 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621210
Sponsor’s telephone number 9528810504
Plan sponsor’s address 8910 PENN AVENUE SOUTH, BLOOMINGTON, MN, 55431

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing FRANK RUSSOMANNO, JR.
Valid signature Filed with authorized/valid electronic signature

Aplicant

Name Role Address
Frank Russomanno Jr DDS PA Aplicant 8910 Penn Ave S, Blmgtn, MN 55431

Filing

Filing Name Filing date
Expired - Assumed Name 2021-11-03
Assumed Name Renewal 2011-05-25
Assumed Name Nameholder 2011-05-25
Original Filing - Assumed Name 2001-11-02
Assumed Name Business Name (Business Name: AMBER LEAF FAMILY DENTAL) 2001-11-02

Related by officers

No related officers

Related by address

8910 Penn Ave S, Blmgtn, MN 55431, USA

CSI CONSULTING, LLC Radiant Dental Ceramics, LLC Kitzenberg Family Company, LLC Russomanno Enterprises LLC Frank Russomanno, Jr., D.D.S., P.A. Kitzenberg Family Dental Group, P.A. MATHEW DENTAL CERAMICS Cross DentalCare

Date of last update: 23 Dec 2024

Sources: Minnesota's Official State Website

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