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  5. CANBY MEDICAL CENTER

CANBY MEDICAL CENTER

Company Details

Name: CANBY MEDICAL CENTER
Jurisdiction: Minnesota
Legal type: Nonprofit Corporation (Domestic)
Status: Inactive
Date formed: 16 Oct 1990 (34 years ago)
Company Number: dcdbb75a-aed4-e011-a886-001ec94ffe7f
File Number: 1F-339
Registered Office Address: 215 St Olaf Ave N, Canby, MN 56220, USA
ZIP code: 56220
County: Yellow Medicine County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CANBY MEDICAL CENTER EMPLOYEE 403B RETIREMENT PLAN 2016 411693839 2017-10-09 CANBY MEDICAL CENTER 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621498
Sponsor’s telephone number 5072237277
Plan sponsor’s address 112 SAINT OLAF AVE S, CANBY, MN, 562201433

Signature of
Role Plan administrator
Date 2017-10-09
Name of individual signing BILL GASSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-09
Name of individual signing BILL GASSEN
Valid signature Filed with authorized/valid electronic signature
CANBY MEDICAL CENTER EMPLOYEE 403B RETIREMENT PLAN 2015 411693839 2016-07-21 CANBY MEDICAL CENTER 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621498
Sponsor’s telephone number 5072237277
Plan sponsor’s address 112 SAINT OLAF AVE S, CANBY, MN, 562201433

Plan administrator’s name and address
Administrator’s EIN 411693839
Plan administrator’s name CANBY MEDICAL CENTER
Plan administrator’s address 112 SAINT OLAF AVE S, CANBY, MN, 562201433
Administrator’s telephone number 5072237277

Signature of
Role Plan administrator
Date 2016-07-21
Name of individual signing ALLISON NELSON
Valid signature Filed with authorized/valid electronic signature
CANBY MEDICAL CENTER EMPLOYEE 403B RETIREMENT PLAN 2014 411693839 2015-07-24 CANBY MEDICAL CENTER 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621498
Sponsor’s telephone number 5072237277
Plan sponsor’s address 112 ST OLAF AVE S, CANBY, MN, 56220

Plan administrator’s name and address
Administrator’s EIN 411693839
Plan administrator’s name CANBY MEDICAL CENTER
Plan administrator’s address 112 ST OLAF AVE S, CANBY, MN, 56220
Administrator’s telephone number 5072237277

Signature of
Role Plan administrator
Date 2015-07-24
Name of individual signing ALLISON NELSON
Valid signature Filed with authorized/valid electronic signature
CANBY MEDICAL CENTER EMPLOYEE 403B RETIREMENT PLAN 2013 411693839 2014-07-28 CANBY MEDICAL CENTER 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621498
Sponsor’s telephone number 5072237277
Plan sponsor’s address 112 ST OLAF AVE S, CANBY, MN, 56220

Plan administrator’s name and address
Administrator’s EIN 411693839
Plan administrator’s name CANBY MEDICAL CENTER
Plan administrator’s address 112 ST OLAF AVE S, CANBY, MN, 56220
Administrator’s telephone number 5072237277

Signature of
Role Plan administrator
Date 2014-07-28
Name of individual signing ALLISON NELSON
Valid signature Filed with authorized/valid electronic signature
CANBY MEDICAL CENTER EMPLOYEE 403B RETIREMENT PLAN 2012 411693839 2013-07-31 CANBY MEDICAL CENTER 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621498
Sponsor’s telephone number 5072237277
Plan sponsor’s address 112 ST OLAF AVE S, CANBY, MN, 56220

Plan administrator’s name and address
Administrator’s EIN 411693839
Plan administrator’s name CANBY MEDICAL CENTER
Plan administrator’s address 112 ST OLAF AVE S, CANBY, MN, 56220
Administrator’s telephone number 5072237277

Signature of
Role Plan administrator
Date 2013-07-31
Name of individual signing ALLISON NELSON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-31
Name of individual signing ALLISON NELSON
Valid signature Filed with authorized/valid electronic signature
CANBY MEDICAL CENTER EMPLOYEE 403B RETIREMENT PLAN 2011 411693839 2012-07-25 CANBY MEDICAL CENTER 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621498
Sponsor’s telephone number 5072237277
Plan sponsor’s address 112 ST OLAF AVE S, CANBY, MN, 56220

Plan administrator’s name and address
Administrator’s EIN 411693839
Plan administrator’s name CANBY MEDICAL CENTER
Plan administrator’s address 112 ST OLAF AVE S, CANBY, MN, 56220
Administrator’s telephone number 5072237277

Signature of
Role Plan administrator
Date 2012-07-25
Name of individual signing ALLISON NELSON
Valid signature Filed with authorized/valid electronic signature
CANBY MEDICAL CENTER EMPLOYEE 403B RETIREMENT PLAN 2010 411693839 2011-07-22 CANBY MEDICAL CENTER 13
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621498
Sponsor’s telephone number 5072237277
Plan sponsor’s address 112 ST OLAF AVE S, CANBY, MN, 56220

Plan administrator’s name and address
Administrator’s EIN 411693839
Plan administrator’s name CANBY MEDICAL CENTER
Plan administrator’s address 112 ST OLAF AVE S, CANBY, MN, 56220
Administrator’s telephone number 5072237277

Signature of
Role Employer/plan sponsor
Date 2011-07-22
Name of individual signing ALLISON NELSON
Valid signature Filed with authorized/valid electronic signature
CANBY MEDICAL CENTER EMPLOYEE 403B RETIREMENT PLAN 2010 411693839 2011-07-22 CANBY MEDICAL CENTER 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621498
Sponsor’s telephone number 5072237277
Plan sponsor’s address 112 ST OLAF AVE S, CANBY, MN, 56220

Plan administrator’s name and address
Administrator’s EIN 411693839
Plan administrator’s name CANBY MEDICAL CENTER
Plan administrator’s address 112 ST OLAF AVE S, CANBY, MN, 56220
Administrator’s telephone number 5072237277

Signature of
Role Plan administrator
Date 2011-07-22
Name of individual signing ALLISON NELSON
Valid signature Filed with authorized/valid electronic signature
CANBY MEDICAL CENTER EMPLOYEE 403B RETIREMENT PLAN 2009 411693839 2010-10-15 CANBY MEDICAL CENTER 13
Three-digit plan number (PN) 001
Effective date of plan 1988-01-01
Business code 621498
Sponsor’s telephone number 5072237277
Plan sponsor’s address 112 ST OLAF AVE S, CANBY, MN, 56220

Plan administrator’s name and address
Administrator’s EIN 411693839
Plan administrator’s name CANBY MEDICAL CENTER
Plan administrator’s address 112 ST OLAF AVE S, CANBY, MN, 56220
Administrator’s telephone number 5072237277

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing ALLISON NELSON
Valid signature Filed with authorized/valid electronic signature

Filing

Filing Name Filing date
Dissolution - Nonprofit Corporation (Domestic) 1998-05-05
Intent to Dissolve - Nonprofit Corporation (Domestic) 1997-12-22
Original Filing - Nonprofit Corporation (Domestic) 1990-10-16
Nonprofit Corporation (Domestic) Business Name (Business Name: CANBY MEDICAL CENTER) 1990-10-16

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Date of last update: 25 Sep 2024

Sources: Minnesota's Official State Website

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