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  5. Southern Minnesota Periodontics, P.A.

Southern Minnesota Periodontics, P.A.

Company Details

Name: Southern Minnesota Periodontics, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 09 Jun 2016 (9 years ago)
Company Number: c7191b9a-922e-e611-816a-00155d01c56d
File Number: 891582900029
Registered Office Address: 1560 Adams St, Mankato, MN 56001, USA
Principal Executive Office Address: 1560 ADAMS ST, MANKATO, MN 56001–5192, USA
ZIP code: 56001
County: Blue Earth County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHERN MINNESOTA PERIODONTICS, P.A. 401(K) PROFIT SHARING PLAN 2023 812895838 2024-11-28 SOUTHERN MINNESOTA PERIODONTICS, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-08-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 1560 ADAMS ST, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2024-11-28
Name of individual signing DR. SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
SOUTHERN MINNESOTA PERIODONTICS, P.A. 401(K) PROFIT SHARING PLAN 2022 812895838 2023-10-12 SOUTHERN MINNESOTA PERIODONTICS, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-08-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 1560 ADAMS ST, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2023-10-12
Name of individual signing DR. SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
SOUTHERN MINNESOTA PERIODONTICS, P.A. 401(K) PROFIT SHARING PLAN 2021 812895838 2022-10-10 SOUTHERN MINNESOTA PERIODONTICS, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-08-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 1560 ADAMS ST, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing DR. SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
SOUTHERN MINNESOTA PERIODONTICS, P.A. 401(K) PROFIT SHARING PLAN 2020 812895838 2021-12-13 SOUTHERN MINNESOTA PERIODONTICS, P.A. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-08-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 99 NAVAHO AVE. SUITE 102, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2021-12-13
Name of individual signing DR. SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
SOUTHERN MINNESOTA PERIODONTICS, P.A. 401(K) PROFIT SHARING PLAN 2019 812895838 2020-08-14 SOUTHERN MINNESOTA PERIODONTICS, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-08-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 99 NAVAHO AVE. SUITE 102, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2020-08-14
Name of individual signing DR. SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
SOUTHERN MINNESOTA PERIODONTICS, P. A. 401(K) PROFIT SHARING PLAN 2018 812895838 2019-06-26 SOUTHERN MINNESOTA PERIODONTICS, P.A. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-08-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 99 NAVAHO AVENUE, SUITE 102, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2019-06-26
Name of individual signing SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-26
Name of individual signing SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
SOUTHERN MINNESOTA PERIODONTICS, P. A. 401(K) PROFIT SHARING PLAN 2017 812895838 2018-10-09 SOUTHERN MINNESOTA PERIODONTICS, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-08-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 99 NAVAHO AVENUE, SUITE 102, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2018-10-09
Name of individual signing SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-09
Name of individual signing SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
SOUTHERN MINNESOTA PERIODONTICS, P. A. 2016 263807609 2017-04-10 SOUTHERN MINNESOTA PERIODONTICS, P.A. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 99 NAVAHO AVENUE, SUITE 102, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2017-04-10
Name of individual signing GARY R. JERNBERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-10
Name of individual signing GARY R. JERNBERG
Valid signature Filed with authorized/valid electronic signature
SOUTHERN MINNESOTA PERIODONTICS, P.A. 401(K) PROFIT SHARING PLAN 2016 263807609 2017-04-10 SOUTHERN MINNESOTA PERIODONTICS, P.A. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 99 NAVAHO AVENUE, SUITE 102, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2017-04-10
Name of individual signing GARY R. JERNBERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-10
Name of individual signing GARY R. JERNBERG
Valid signature Filed with authorized/valid electronic signature
SOUTHERN MINNESOTA PERIODONTICS, P. A. 401(K) PROFIT SHARING PLAN 2016 812895838 2017-06-07 SOUTHERN MINNESOTA PERIODONTICS, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-08-01
Business code 621210
Sponsor’s telephone number 5073457537
Plan sponsor’s address 99 NAVAHO AVENUE, SUITE 102, MANKATO, MN, 56001

Signature of
Role Plan administrator
Date 2017-06-07
Name of individual signing SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-07
Name of individual signing SERGEY DOLGOV
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Sergey Dolgov Chief Executive Officer 210 WOODHAVEN LN, MANKATO, MN 56001–5706, USA

Filing

Filing Name Filing date
Annual Reinstatement - Business Corporation (Domestic) 2022-03-23
Administrative Dissolution - Business Corporation (Domestic) 2022-01-26
Amendment - Business Corporation (Domestic) 2021-03-22
Amendment - Business Corporation (Domestic) (Business Name: Southern Minnesota Periodontics, P.A.) 2016-08-16
Original Filing - Business Corporation (Domestic) (Business Name: Sergey Dolgov Acquisition P. A.)Professional Service - Dentistry & Dental Hygiene 2016-06-09

Related by officers

Sergey Dolgov

CREE-ADAMS PROFESSIONAL OFFICES ASSOCIATION Southern Minnesota Periodontics, LLC

Related by address

1560 ADAMS ST, MANKATO, MN 56001–5192, USA

Southern Minnesota Periodontics, LLC

Date of last update: 03 Oct 2024

Sources: Minnesota's Official State Website

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