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  5. Pavilion Surgery Center, LLC

Pavilion Surgery Center, LLC

Company Details

Name: Pavilion Surgery Center, LLC
Jurisdiction: Minnesota
Legal type: Limited Liability Company (Domestic)
Status: Inactive
Date formed: 25 Jul 2000 (24 years ago)
Company Number: 60aa7f3a-a5d4-e011-a886-001ec94ffe7f
File Number: 17667-LLC
Registered Office Address: 915 E. 1st Street, Duluth, MN 55805, USA
Principal Executive Office Address: 915 E 1st St, Attn: Legal, DULUTH, MN 55805, USA
ZIP code: 55805
County: St. Louis County
Place of Formation: Minnesota

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
DBQZCQC8MLY3 2024-02-15 920 E 1ST ST, DULUTH, MN, 55805, 2201, USA 920 E 1ST ST, SUITE P-101, DULUTH, MN, 55805, 2201, USA

Business Information
Congressional District 08
State/Country of Incorporation MN, USA
Activation Date 2023-03-13
Initial Registration Date 2004-07-14
Entity Start Date 2000-07-25
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 621493
Product and Service Codes Q523

Points of Contacts
Electronic Business
Title PRIMARY POC
Name CHRIS JOHNSON
Role VICE PRESIDENT
Address 920 E. 1ST STREET, STE P-101, DULUTH, MN, 55805, 2301, USA
Title ALTERNATE POC
Name PATRICIA BREDOW
Address 920 EAST 1ST ST, SUITE P-101, DULUTH, MN, 55805, 2201, USA
Government Business
Title PRIMARY POC
Name JACQUE VOLK
Role ADMINSTRATIVE DIRECTOR
Address 920 E. 1ST STREET, STE P-101, DULUTH, MN, 55805, 2301, USA
Title ALTERNATE POC
Name PATRICIA BREDOW
Address 920 E 1ST ST, SUITE P-101, DULUTH, MN, 55805, 2201, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PAVILION SURGERY CENTER 401(K) PLAN 2019 411979428 2020-02-05 PAVILION SURGERY CENTER, LLC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Signature of
Role Plan administrator
Date 2020-01-30
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-01-30
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
PAVILION SURGERY CENTER 401(K) PLAN 2018 411979428 2019-05-31 PAVILION SURGERY CENTER, LLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Signature of
Role Plan administrator
Date 2019-05-30
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-30
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
PAVILION SURGERY CENTER 401(K) PLAN 2017 411979428 2018-06-08 PAVILION SURGERY CENTER, LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Signature of
Role Plan administrator
Date 2018-06-06
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-06
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
PAVILION SURGERY CENTER 401(K) PLAN 2016 411979428 2017-01-30 PAVILION SURGERY CENTER, LLC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Signature of
Role Plan administrator
Date 2017-01-30
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-01-30
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
PAVILION SURGERY CENTER 401(K) PLAN 2015 411979428 2016-06-22 PAVILION SURGERY CENTER, LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Signature of
Role Plan administrator
Date 2016-06-22
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-22
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
PAVILION SURGERY CENTER 401(K) PLAN 2014 411979428 2015-09-21 PAVILION SURGERY CENTER, LLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Signature of
Role Plan administrator
Date 2015-09-21
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-21
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
PAVILION SURGERY CENTER 401(K) PLAN 2013 411979428 2014-07-14 PAVILION SURGERY CENTER, LLC 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Signature of
Role Plan administrator
Date 2014-07-10
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-10
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
PAVILION SURGERY CENTER 401(K) PLAN 2012 411979428 2013-08-06 PAVILION SURGERY CENTER, LLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Signature of
Role Plan administrator
Date 2013-07-31
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-31
Name of individual signing ESTHER LINDEMAN
Valid signature Filed with authorized/valid electronic signature
PAVILION SURGERY CENTER 401(K) PLAN 2011 411979428 2012-07-30 PAVILION SURGERY CENTER, LLC 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Plan administrator’s name and address
Administrator’s EIN 411979428
Plan administrator’s name PAVILION SURGERY CENTER, LLC
Plan administrator’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805
Administrator’s telephone number 2182796200

Signature of
Role Plan administrator
Date 2012-07-30
Name of individual signing JAMES MUSTONEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-30
Name of individual signing JAMES MUSTONEN
Valid signature Filed with authorized/valid electronic signature
PAVILION SURGERY CENTER 401(K) PLAN 2010 411979428 2011-05-26 PAVILION SURGERY CENTER, LLC 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621493
Sponsor’s telephone number 2182796200
Plan sponsor’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805

Plan administrator’s name and address
Administrator’s EIN 411979428
Plan administrator’s name PAVILION SURGERY CENTER, LLC
Plan administrator’s address 920 EAST FIRST STREET, SUITE 101, DULUTH, MN, 55805
Administrator’s telephone number 2182796200

Signature of
Role Plan administrator
Date 2011-05-26
Name of individual signing JAMES MUSTONEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-26
Name of individual signing JAMES MUSTONEN
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
Tara Haugen Manager 920 E 1ST ST P-101, DULUTH, MN 55805, USA

Agent

Name Role
Katherine Becker Agent

Filing

Filing Name Filing date
Statement of Termination – Limited Liability Company (Domestic) 2024-03-01
Statement of Dissolution – Limited Liability Company (Domestic) 2024-03-01
Amendment - Limited Liability Company (Domestic)Restated Articles 2020-05-29
Conversion to 322C Due to Statute Mandate – Limited Liability Company (Domestic) 2018-01-01
Annual Reinstatement - Limited Liability Company (Domestic) 2012-08-17
Administrative Termination - Limited Liability Company (Domestic) 2012-08-03
Registered Office and/or Agent - Limited Liability Company (Domestic) 2000-10-03
Limited Liability Company (Domestic) Restated Articles 2000-10-03
Limited Liability Company (Domestic) Duration 2000-10-03
Limited Liability Company (Domestic) Business Name (Business Name: Pavilion Surgery Center, LLC) 2000-10-03

Related by officers

Katherine Becker

Northern Lakes Surgery Center LLC Lake View Memorial Hospital Foundation of Northeast Minnesota St. Francis Apartments, LLC

Related by address

No related companies by address

Date of last update: 03 Oct 2024

Sources: Minnesota's Official State Website

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