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  5. Lake Region Medical Group, P.A.

Lake Region Medical Group, P.A.

Company Details

Name: Lake Region Medical Group, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 26 Apr 2010 (15 years ago)
Company Number: 58a7a8b8-95d4-e011-a886-001ec94ffe7f
File Number: 3815622-2
Registered Office Address: 615 S Mill Str, Fergus Falls, MN 56537, USA
Principal Executive Office Address: 111 W Vernon Ave, Fergus Falls, MN 56537, USA
ZIP code: 56537
County: Otter Tail County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKE REGION MEDICAL GROUP, P. A. CASH BALANCE PLAN 2022 272451481 2024-07-10 LAKE REGION MEDICAL GROUP, P.A. 52
File View Page
Three-digit plan number (PN) 007
Effective date of plan 2019-10-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W VERNON, FERGUS FALLS, MN, 56537
LAKE REGION MEDICAL GROUP, P. A. 401(K) & PROFIT SHARING PLAN 2022 272451481 2024-03-20 LAKE REGION MEDICAL GROUP, P.A. 79
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1968-05-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W. VERNON, FERGUS FALLS, MN, 56537
LAKE REGION MEDICAL GROUP, P.A. CASH BALANCE PLAN 2021 272451481 2023-04-20 LAKE REGION MEDICAL GROUP, P.A. 51
File View Page
Three-digit plan number (PN) 007
Effective date of plan 2019-10-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W. VERNON, FERGUS FALLS, MN, 56537

Signature of
Role Plan administrator
Date 2023-04-18
Name of individual signing TREVOR GERVAIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-04-18
Name of individual signing TREVOR GERVAIS
Valid signature Filed with authorized/valid electronic signature
LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2021 272451481 2023-04-20 LAKE REGION MEDICAL GROUP, P.A. 112
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1968-05-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W. VERNON, FERGUS FALLS, MN, 56537

Signature of
Role Plan administrator
Date 2023-04-18
Name of individual signing TREVOR GERVAIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-04-18
Name of individual signing TREVOR GERVAIS
Valid signature Filed with authorized/valid electronic signature
LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2020 272451481 2022-04-26 LAKE REGION MEDICAL GROUP, P.A. 103
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1968-05-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W. VERNON, FERGUS FALLS, MN, 56537

Signature of
Role Plan administrator
Date 2022-04-26
Name of individual signing MATTHEW LEE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-04-26
Name of individual signing MATTHEW LEE
Valid signature Filed with authorized/valid electronic signature
LAKE REGION MEDICAL GROUP, P.A. CASH BALANCE PLAN 2020 272451481 2022-06-30 LAKE REGION MEDICAL GROUP, P.A. 50
File View Page
Three-digit plan number (PN) 007
Effective date of plan 2019-10-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W. VERNON, FERGUS FALLS, MN, 56537

Signature of
Role Plan administrator
Date 2022-06-29
Name of individual signing MATTHEW LEE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-29
Name of individual signing MATTHEW LEE
Valid signature Filed with authorized/valid electronic signature
LAKE REGION MEDICAL GROUP, P.A. PENSION PLAN 2019 272451481 2020-11-12 LAKE REGION MEDICAL GROUP, P.A. 61
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2010-05-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W. VERNON, FERGUS FALLS, MN, 56537

Signature of
Role Plan administrator
Date 2020-11-12
Name of individual signing LUCAS B. DRAXTEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-11-12
Name of individual signing LUCAS B. DRAXTEN
Valid signature Filed with authorized/valid electronic signature
LAKE REGION MEDICAL GROUP, P.A. CASH BALANCE PLAN 2019 272451481 2021-07-07 LAKE REGION MEDICAL GROUP, P.A. 47
File View Page
Three-digit plan number (PN) 007
Effective date of plan 2019-10-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W. VERNON, FERGUS FALLS, MN, 56537

Signature of
Role Plan administrator
Date 2021-06-25
Name of individual signing LUCAS DRAXTEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-25
Name of individual signing LUCAS DRAXTEN
Valid signature Filed with authorized/valid electronic signature
LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2019 272451481 2021-04-21 LAKE REGION MEDICAL GROUP, P.A. 98
File View Page
Three-digit plan number (PN) 005
Effective date of plan 1968-05-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W. VERNON, FERGUS FALLS, MN, 56537

Signature of
Role Plan administrator
Date 2021-04-20
Name of individual signing LUCAS DRAXTEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-20
Name of individual signing LUCAS DRAXTEN
Valid signature Filed with authorized/valid electronic signature
LAKE REGION MEDICAL GROUP, P.A. PENSION PLAN 2018 272451481 2020-07-07 LAKE REGION MEDICAL GROUP, P.A. 57
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2010-05-01
Business code 621112
Sponsor’s telephone number 2187392221
Plan sponsor’s address 111 W. VERNON, FERGUS FALLS, MN, 56537

Signature of
Role Plan administrator
Date 2020-07-06
Name of individual signing LUCAS B. DRAXTEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-07-06
Name of individual signing LUCAS B. DRAXTEN
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Luke Draxten Chief Executive Officer 111 W Vernon Ave, Fergus Falls, MN 56537, USA

Agent

Name Role
Greg Smith Agent

Filing

Filing Name Filing date
Annual Reinstatement - Business Corporation (Domestic) 2016-01-14
Administrative Dissolution - Business Corporation (Domestic) 2015-06-09
Original Filing - Business Corporation (Domestic) (Business Name: Lake Region Medical Group, P.A.)Professional Service - Medicine & Surgery 2010-04-26

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Related by address

615 S Mill Str, Fergus Falls, MN 56537, USA

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111 W Vernon Ave, Fergus Falls, MN 56537, USA

Fergus Falls Medical Holdings, LLC

Date of last update: 01 Oct 2024

Sources: Minnesota's Official State Website

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