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  5. BOULOS DENTAL CARE, P.C.

BOULOS DENTAL CARE, P.C.

Company Details

Name: BOULOS DENTAL CARE, P.C.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 17 Mar 2011 (14 years ago)
Company Number: 7b01d28a-97d4-e011-a886-001ec94ffe7f
File Number: 4224162-2
Registered Office Address: 470 W Hwy 96 #200, Shoreview, MN 55126, USA
Principal Executive Office Address: 470 HIGHWAY 96 W STE 200, SHOREVIEW, MN 55126–3214, USA
ZIP code: 55126
County: Ramsey County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BOULOS DENTAL CARE, P. C. RETIREMENT PLAN 2023 450683272 2024-07-01 BOULOS DENTAL CARE,P.C. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-04-15
Business code 111100
Sponsor’s telephone number 6513666880
Plan sponsor’s address P.O. BOX 270511, SAINT PAUL, MN, 55127

Signature of
Role Plan administrator
Date 2024-07-01
Name of individual signing SAMYBOULOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-01
Name of individual signing BOULOSDENTALCAREPC
Valid signature Filed with authorized/valid electronic signature
BOULOS DENTAL CARE, P. C. RETIREMENT PLAN 2022 450683272 2023-06-21 BOULOS DENTAL CARE,P.C. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-04-15
Business code 111100
Sponsor’s telephone number 6513666880
Plan sponsor’s address P.O. BOX 270511, SAINT PAUL, MN, 55127

Signature of
Role Plan administrator
Date 2023-06-21
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-06-21
Name of individual signing BOULOS DENTAL CARE
Valid signature Filed with authorized/valid electronic signature
BOULOS DENTAL CARE, P. C. RETIREMENT PLAN 2021 450683272 2022-06-16 BOULOS DENTAL CARE,P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-04-15
Business code 111100
Sponsor’s telephone number 6513666880
Plan sponsor’s address P.O. BOX 270511, SAINT PAUL, MN, 55127

Signature of
Role Plan administrator
Date 2022-06-16
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-16
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
BOULOS DENTAL CARE, P. C. RETIREMENT PLAN 2020 450683272 2021-06-01 BOULOS DENTAL CARE,P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-04-15
Business code 621210
Sponsor’s telephone number 6513666880
Plan sponsor’s address P.O. BOX 270511, SAINT PAUL, MN, 55127

Signature of
Role Plan administrator
Date 2021-06-01
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-01
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
BOULOS DENTAL CARE, P. C. RETIREMENT PLAN 2019 450683272 2020-06-10 BOULOS DENTAL CARE,P.C. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-04-15
Business code 621210
Sponsor’s telephone number 6513666880
Plan sponsor’s address P.O. BOX 270511, SAINT PAUL, MN, 55127

Signature of
Role Plan administrator
Date 2020-06-10
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-10
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
BOULOS DENTAL CARE, P. C. RETIREMENT PLAN 2018 450683272 2019-07-02 BOULOS DENTAL CARE,P.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-04-15
Business code 621210
Sponsor’s telephone number 6513666880
Plan sponsor’s address P.O. BOX 270511, SAINT PAUL, MN, 55127

Signature of
Role Plan administrator
Date 2019-07-02
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-02
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
BOULOS DENTAL CARE, P. C. RETIREMENT PLAN 2017 450683272 2018-05-25 BOULOS DENTAL CARE,P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-04-15
Business code 621210
Sponsor’s telephone number 6513666880
Plan sponsor’s address P.O. BOX 270511, SAINT PAUL, MN, 55127

Signature of
Role Plan administrator
Date 2018-05-25
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-25
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
BOULOS DENTAL CARE, P. C. RETIREMENT PLAN 2016 450683272 2017-07-19 BOULOS DENTAL CARE,P.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-04-15
Business code 621210
Sponsor’s telephone number 6513666880
Plan sponsor’s address P.O. BOX 270511, SAINT PAUL, MN, 55127

Signature of
Role Plan administrator
Date 2017-07-19
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-19
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature
BOULOS DENTAL CARE, P. C. RETIREMENT PLAN 2015 450683272 2016-07-15 BOULOS DENTAL CARE, P.C. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-04-15
Business code 621210
Sponsor’s telephone number 6513666880
Plan sponsor’s address P.O. BOX 270511, SAINT PAUL, MN, 55127

Signature of
Role Plan administrator
Date 2016-07-15
Name of individual signing SAMY BOULOS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
Samy Wasfy Yousef Agent

Chief Executive Officer

Name Role Address
Samy Boulos Chief Executive Officer 470 HIGHWAY 96 W STE 200, SHOREVIEW, MN 55126–3214, USA

Filing

Filing Name Filing date
Amendment - Business Corporation (Domestic) 2013-03-04
Original Filing - Business Corporation (Domestic) (Business Name: BOULOS DENTAL CARE, P.C.)Professional Service - Dentistry & Dental Hygiene 2011-03-17

Related by officers

No related officers

Related by address

470 W Hwy 96 #200, Shoreview, MN 55126, USA

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Date of last update: 10 Jan 2025

Sources: Minnesota's Official State Website

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