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  5. Maple Lawn Nursing Home, Inc.

Maple Lawn Nursing Home, Inc.

Company Details

Name: Maple Lawn Nursing Home, Inc.
Jurisdiction: Minnesota
Legal type: Nonprofit Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 24 Sep 1962 (62 years ago)
Company Number: 5f549aff-a5d4-e011-a886-001ec94ffe7f
File Number: E-354
Registered Office Address: 400 7Th ST NE, Fulda, MN 56131, USA
ZIP code: 56131
County: Murray County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2023 410870856 2024-01-26 MAPLE LAWN NURSING HOME, INC 56
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Plan sponsor’s DBA name MAPLE LAWN SENIOR CARE
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 561311122

Signature of
Role Plan administrator
Date 2024-01-26
Name of individual signing SHELBY JASS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-01-26
Name of individual signing SHELBY JASS
Valid signature Filed with authorized/valid electronic signature
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2022 410870856 2024-01-25 MAPLE LAWN NURSING HOME, INC 57
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Plan sponsor’s DBA name MAPLE LAWN SENIOR CARE
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 561311122

Signature of
Role Plan administrator
Date 2023-06-30
Name of individual signing SHELBY JASS
Valid signature Filed with authorized/valid electronic signature
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2021 410870856 2022-05-18 MAPLE LAWN NURSING HOME, INC. 55
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Sponsor’s telephone number 5074252571
Plan sponsor’s DBA name MAPLE LAWN SENIOR CARE
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 561311122

Signature of
Role Plan administrator
Date 2022-05-18
Name of individual signing SHELBY JASS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-05-18
Name of individual signing SHELBY JASS
Valid signature Filed with authorized/valid electronic signature
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2020 410870856 2021-08-19 MAPLE LAWN NURSING HOME, INC. 57
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Sponsor’s telephone number 5074252571
Plan sponsor’s DBA name MAPLE LAWN SENIOR CARE
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 561311122

Signature of
Role Plan administrator
Date 2021-08-19
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-08-19
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2019 410870856 2021-07-31 MAPLE LAWN NURSING HOME, INC. 58
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Sponsor’s telephone number 5074252571
Plan sponsor’s DBA name MAPLE LAWN SENIOR CARE
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 561311122

Signature of
Role Plan administrator
Date 2021-07-31
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-31
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2018 410870856 2019-06-17 MAPLE LAWN NURSING HOME, INC. 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Sponsor’s telephone number 5074252571
Plan sponsor’s DBA name MAPLE LAWN SENIOR CARE
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 561311122

Signature of
Role Plan administrator
Date 2019-06-17
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-17
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2017 410870856 2018-07-30 MAPLE LAWN NURSING HOME, INC. 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Sponsor’s telephone number 5074252571
Plan sponsor’s DBA name MAPLE LAWN SENIOR CARE
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 561311122

Signature of
Role Plan administrator
Date 2018-07-30
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-30
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2016 410870856 2017-02-07 MAPLE LAWN NURSING HOME, INC 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Sponsor’s telephone number 5074252571
Plan sponsor’s DBA name MAPLE LAWN SENIOR CARE
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 561311122

Signature of
Role Plan administrator
Date 2017-02-07
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-02-07
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2015 410870856 2017-02-07 MAPLE LAWN NURSING HOME, INC. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Sponsor’s telephone number 5074252571
Plan sponsor’s DBA name MAPLE LAWN SENIOR CARE
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 561311122

Signature of
Role Plan administrator
Date 2017-02-07
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-02-07
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
MAPLE LAWN NURSING HOME EMPLOYEE RETIREMENT PLAN 2014 410870856 2015-08-31 MAPLE LAWN NURSING HOME, INC. 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 623000
Sponsor’s telephone number 5074252571
Plan sponsor’s address 400 7TH ST NE, FULDA, MN, 56131

Signature of
Role Plan administrator
Date 2015-08-31
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-08-31
Name of individual signing ARLAN SWANSON
Valid signature Filed with authorized/valid electronic signature

President

Name Role Address
Olsem Don President 400 7TH ST NE, FULDA, MN 56131–1122, USA

Filing

Filing Name Filing date
Registered Office - Nonprofit Corporation (Domestic) 2023-08-14
Amendment - Nonprofit Corporation (Domestic)Restated Articles 2022-05-23
Annual Reinstatement - Nonprofit Corporation (Domestic) 2009-04-06
Involuntary Dissolution - Nonprofit Corporation (Domestic) 2008-01-23
Registered Office and/or Agent - Nonprofit Corporation (Domestic) 1990-02-27
Original Filing - Nonprofit Corporation (Domestic) 1962-09-24
Nonprofit Corporation (Domestic) Business Name (Business Name: Maple Lawn Nursing Home, Inc.) 1962-09-24

Related by officers

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Related by address

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Date of last update: 01 Nov 2024

Sources: Minnesota's Official State Website

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