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  5. Jaclyn M. Jensen, D.D.S., P.C.

Jaclyn M. Jensen, D.D.S., P.C.

Company Details

Name: Jaclyn M. Jensen, D.D.S., P.C.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Inactive
Date formed: 27 Aug 2008 (16 years ago)
Company Number: 2e58ac6c-92d4-e011-a886-001ec94ffe7f
File Number: 2985124-2
Registered Office Address: 2211 Sahlstrom Drive Ste A, Crookston, MN 56716, USA
ZIP code: 56716
County: Polk County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2021 263281962 2022-08-15 JACLYN M. JENSEN D.D.S., P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 2211 SAHLSTROM DRIVE, SUITE A, CROOKSTON, MN, 56716

Signature of
Role Plan administrator
Date 2022-08-15
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2021 263281962 2022-08-15 JACLYN M. JENSEN D.D.S., P.C. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 2211 SAHLSTROM DRIVE, CROOKSTON, MN, 56716

Signature of
Role Plan administrator
Date 2022-08-15
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2020 263281962 2021-07-15 JACLYN M. JENSEN D.D.S., P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 2211 SAHLSTROM DRIVE, CROOKSTON, MN, 56716

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2019 263281962 2020-06-28 JACLYN M. JENSEN D.D.S., P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 2211 SAHLSTROM DRIVE CROOKSTON, CROOKSTON, MN, 56716

Signature of
Role Plan administrator
Date 2020-06-28
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2018 263281962 2019-07-08 JACLYN M. JENSEN D.D.S., P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 2211 SAHLSTROM DRIVE CROOKSTON, CROOKSTON, MN, 56716

Signature of
Role Plan administrator
Date 2019-07-08
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2017 263281962 2018-07-22 JACLYN M. JENSEN D.D.S., P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 2211 SAHLSTROM DRIVE CROOKSTON, CROOKSTON, MN, 56716

Signature of
Role Plan administrator
Date 2018-07-22
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2016 263281962 2017-07-12 JACLYN M. JENSEN D.D.S., P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 310 S BROADWAY, CROOKSTON, MN, 56716

Signature of
Role Plan administrator
Date 2017-07-12
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2015 263281962 2016-07-06 JACLYN M. JENSEN D.D.S., P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 310 BROADWAY, CROOKSTON, MN, 56716

Signature of
Role Plan administrator
Date 2016-07-06
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2014 263281962 2015-06-15 JACLYN M. JENSEN D.D.S., P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 310 BROADWAY, CROOKSTON, MN, 56716

Signature of
Role Plan administrator
Date 2015-06-15
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature
JACLYN M. JENSEN D.D.S., P.C. 401(K) PLAN 2013 263281962 2014-06-20 JACLYN M. JENSEN D.D.S., P.C. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621210
Sponsor’s telephone number 2182811301
Plan sponsor’s address 310 BROADWAY, CROOKSTON, MN, 36652

Signature of
Role Plan administrator
Date 2014-06-20
Name of individual signing JACLYN NUVEEN
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Jaclyn M Jensen, D.D.S., P.C. Chief Executive Officer 2211 Sahlstrom Drive Ste A, Crookston, MN 56716, USA

Agent

Name Role
Sandy Lindtwed Agent

Filing

Filing Name Filing date
Administrative Dissolution - Business Corporation (Domestic) 2023-01-26
Registered Office and/or Agent - Business Corporation (Domestic) 2018-12-19
Original Filing - Business Corporation (Domestic) (Business Name: Jaclyn M. Jensen, D.D.S., P.C.)Professional Service - Dentistry & Dental Hygiene 2008-08-27

Related by officers

Sandy Lindtwed

TLA DDS, PLLC

Related by address

2211 Sahlstrom Drive Ste A, Crookston, MN 56716, USA

TLA DDS, PLLC

Date of last update: 24 Sep 2024

Sources: Minnesota's Official State Website

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