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  5. FORT COLLINS YOUTH CLINIC, P.C.

FORT COLLINS YOUTH CLINIC, P.C.

Company Details

Name: FORT COLLINS YOUTH CLINIC, P.C.
Jurisdiction: Colorado
Legal type: Domestic profit corporation
Status: Good Standing
Date of registration: 31 Oct 1974 (50 years ago)
Entity Number: 19871279696
ZIP code: 80525
County: Larimer County
Place of Formation: COLORADO
Principal Address: 1214 Oak Park Dr Fort Collins CO 80525 US

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FORT COLLINS YOUTH CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2021 840679626 2022-02-02 FORT COLLINS YOUTH CLINIC, P.C. 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 9702679510
Plan sponsor’s address 1214 OAK PARK DRIVE, FORT COLLINS, CO, 80525

Plan administrator’s name and address
Administrator’s EIN 463340706
Plan administrator’s name FUTUREPLAN FIDUCIARY SERVICES
Plan administrator’s address PO BOX 55757, BOSTON, MA, 02205

Signature of
Role Plan administrator
Date 2022-02-02
Name of individual signing ERIC QUELLA
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS YOUTH CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2020 840679626 2021-07-15 FORT COLLINS YOUTH CLINIC, P.C. 106
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 9702679510
Plan sponsor’s address 1214 OAK PARK DRIVE, FORT COLLINS, CO, 80525

Plan administrator’s name and address
Administrator’s EIN 463340706
Plan administrator’s name FUTUREPLAN FIDUCIARY SERVICES
Plan administrator’s address PO BOX 55757, BOSTON, MA, 02205

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing ERIC QUELLA
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS YOUTH CLINIC, P.C. 401(K) PROFIT SHARING PLAN 2019 840679626 2020-07-15 FORT COLLINS YOUTH CLINIC, P.C. 106
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 9702679510
Plan sponsor’s address 1214 OAK PARK DRIVE, FORT COLLINS, CO, 80525

Plan administrator’s name and address
Administrator’s EIN 463340706
Plan administrator’s name GOLDLEAF PARTNERS FIDUCIARY SERVICES
Plan administrator’s address 8009 34TH AVENUE SOUTH, SUITE 320, MINNEAPOLIS, MN, 56472
Administrator’s telephone number 8668828442

Signature of
Role Plan administrator
Date 2020-07-15
Name of individual signing JESSICA MARSON
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS YOUTH CLINIC P.C. 401K PROFIT SHARING PLAN 2018 840679626 2019-10-04 FORT COLLINS YOUTH CLINIC P.C. 98
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 9702679510
Plan sponsor’s address 1214 OAK PARK DR, FORT COLLINS, CO, 80525

Signature of
Role Plan administrator
Date 2019-10-04
Name of individual signing SUSAN FISCHER
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS YOUTH CLINIC P.C. 401K PROFIT SHARING PLAN 2017 840679626 2019-10-04 FORT COLLINS YOUTH CLINIC P.C. 106
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 9702679510
Plan sponsor’s address 1214 OAK PARK DR, FORT COLLINS, CO, 80525

Signature of
Role Plan administrator
Date 2019-10-04
Name of individual signing SUSAN FISCHER
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS YOUTH CLINIC P.C. 401K PROFIT SHARING PLAN 2017 840679626 2018-10-04 FORT COLLINS YOUTH CLINIC P.C. 106
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 9702679510
Plan sponsor’s address 1214 OAK PARK DR, FORT COLLINS, CO, 80525

Signature of
Role Plan administrator
Date 2018-10-04
Name of individual signing SUSAN FISCHER
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS YOUTH CLINIC P.C. 401K PROFIT SHARING PLAN 2016 840679626 2017-10-04 FORT COLLINS YOUTH CLINIC P.C. 105
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 9702679510
Plan sponsor’s address 1214 OAK PARK DR, FORT COLLINS, CO, 80525

Signature of
Role Plan administrator
Date 2017-10-04
Name of individual signing SUSAN FISCHER
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS YOUTH CLINIC P.C. 401K PROFIT SHARING PLAN 2015 840679626 2017-08-30 FORT COLLINS YOUTH CLINIC P.C. 80
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 9702679510
Plan sponsor’s address 1214 OAK PARK DR, FORT COLLINS, CO, 80525

Signature of
Role Plan administrator
Date 2017-08-30
Name of individual signing LARRY MORTENSEN
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS YOUTH CLINIC P.C. 401K PROFIT SHARING PLAN 2015 840679626 2016-10-12 FORT COLLINS YOUTH CLINIC P.C. 80
Three-digit plan number (PN) 001
Effective date of plan 1986-01-01
Business code 621111
Sponsor’s telephone number 9702679510
Plan sponsor’s address 1214 OAK PARK DR, FORT COLLINS, CO, 80525

Signature of
Role Plan administrator
Date 2016-10-12
Name of individual signing LARRY MORTENSEN
Valid signature Filed with authorized/valid electronic signature
FORT COLLINS YOUTH CLINIC, P.C. 401(K) PLAN 2014 840679626 2015-08-14 FORT COLLINS YOUTH CLINIC, P.C. 99
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 9704942583
Plan sponsor’s address 1214 OAK PARK DRIVE, FORT COLLINS, CO, 80525

Signature of
Role Plan administrator
Date 2015-08-14
Name of individual signing LARRY MORTENSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-08-14
Name of individual signing LARRY MORTENSEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Kirsten Sampera Agent 1214 Oak Park Dr Fort Collins CO 80525 US

Transaction History

Transaction ID Type Date Effective date Name Comment
20248013393 File Report 2024-09-23 2024-09-23 No data Principal address changed, Change in registered agent information
20238056716 File Report 2023-10-02 2023-10-02 No data Change in registered agent information
20228066908 File Report 2022-10-28 2022-10-28 No data Principal address changed, Change in registered agent information
20211947357 File Report 2021-10-15 2021-10-15 No data No data
20201899232 File Report 2020-10-20 2020-10-20 No data No data
20191869368 File Report 2019-10-30 2019-10-30 No data No data
20181771094 File Report 2018-09-28 2018-09-28 No data No data
20171719957 File Report 2017-09-25 2017-09-25 No data No data
20161653809 File Report 2016-09-27 2016-09-27 No data No data
20151631508 File Report 2015-09-29 2015-09-29 No data No data

Related by officers

Kirsten Sampera

LIZOAK, LLC

Related by address

1214 Oak Park Dr Fort Collins CO 80525 US

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Date of last update: 27 Jan 2025

Sources: Colorado's Secretary of State

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