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  5. Otolaryngology & Head and Neck Surgery, P.A.

Otolaryngology & Head and Neck Surgery, P.A.

Company Details

Name: Otolaryngology & Head and Neck Surgery, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 14 May 1962 (63 years ago)
Company Number: e042b9a8-9bd4-e011-a886-001ec94ffe7f
File Number: 1B-854
Registered Office Address: STE 202, 215 RADIO DR, WOODBURY, MN 55125–5822, USA
ZIP code: 55125
County: Washington County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2018 410854211 2019-07-16 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 114
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Signature of
Role Plan administrator
Date 2019-07-16
Name of individual signing ANTHONY BENUSA
Valid signature Filed with authorized/valid electronic signature
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2017 410854211 2018-07-24 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 109
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Signature of
Role Plan administrator
Date 2018-07-24
Name of individual signing ANTHONY BENUSA
Valid signature Filed with authorized/valid electronic signature
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2016 410854211 2017-07-21 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 107
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Signature of
Role Plan administrator
Date 2017-07-21
Name of individual signing MOLLY JOHNSON
Valid signature Filed with authorized/valid electronic signature
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2015 410854211 2016-07-19 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 101
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Signature of
Role Plan administrator
Date 2016-07-19
Name of individual signing MOLLY JOHNSON
Valid signature Filed with authorized/valid electronic signature
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2014 410854211 2015-06-04 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 103
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Signature of
Role Plan administrator
Date 2015-06-04
Name of individual signing MOLLY JOHNSON
Valid signature Filed with authorized/valid electronic signature
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2013 410854211 2014-07-30 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 91
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Signature of
Role Plan administrator
Date 2014-07-30
Name of individual signing ANTHONY BENUSA
Valid signature Filed with authorized/valid electronic signature
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2012 410854211 2013-08-06 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 92
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Signature of
Role Plan administrator
Date 2013-08-06
Name of individual signing ANTHONY BENUSA
Valid signature Filed with authorized/valid electronic signature
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2011 410854211 2012-10-08 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 92
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Plan administrator’s name and address
Administrator’s EIN 410854211
Plan administrator’s name OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A.
Plan administrator’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125
Administrator’s telephone number 6517020750

Signature of
Role Plan administrator
Date 2012-10-08
Name of individual signing ANTHONY BENUSA
Valid signature Filed with authorized/valid electronic signature
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2010 410854211 2011-09-23 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 93
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Plan administrator’s name and address
Administrator’s EIN 410854211
Plan administrator’s name OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A.
Plan administrator’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125
Administrator’s telephone number 6517020750

Signature of
Role Plan administrator
Date 2011-09-23
Name of individual signing RANDY GRUBER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-23
Name of individual signing RANDY GRUBER
Valid signature Filed with authorized/valid electronic signature
OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 401(K) PROFIT SHARING PLAN 2009 410854211 2010-10-08 OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A. 94
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 6517020750
Plan sponsor’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125

Plan administrator’s name and address
Administrator’s EIN 410854211
Plan administrator’s name OTOLARYNGOLOGY & HEAD AND NECK SURGERY, P.A.
Plan administrator’s address 2080 WOODWINDS DRIVE SUITE 120, WOODBURY, MN, 55125
Administrator’s telephone number 6517020750

Signature of
Role Plan administrator
Date 2010-10-08
Name of individual signing RANDY GRUBER
Valid signature Filed with incorrect/unrecognized electronic signature

Chief Executive Officer

Name Role Address
Richard Karlen Chief Executive Officer STE 202, 215 RADIO DR, WOODBURY, MN 55125–5822, USA

Filing

Filing Name Filing date
Annual Reinstatement - Business Corporation (Domestic) 2013-04-03
Administrative Dissolution - Business Corporation (Domestic) 2013-02-25
Merger - Business Corporation (Domestic) 1993-12-23
Business Corporation (Domestic) Restated Articles 1993-12-17
Registered Office and/or Agent - Business Corporation (Domestic) 1981-02-24
Business Corporation (Domestic) Business Name (Business Name: Otolaryngology & Head and Neck Surgery, P.A.) 1978-11-13
Original Filing - Business Corporation (Domestic) 1962-05-14
Business Corporation (Domestic) Business Name (Business Name: Otolaryngology P.A.) 1962-05-14

Related by officers

Richard Karlen

Highlands Associates, LLC Midwest Ancillary Services, Inc. Oto Surgical Associates, Inc.

Related by address

STE 202, 215 RADIO DR, WOODBURY, MN 55125–5822, USA

OtoDavis Investors, LLC Fail Safe LLC Highlands Associates, LLC Midwest Ancillary Services, Inc. Oto Surgical Associates, Inc.

Date of last update: 18 Jan 2025

Sources: Minnesota's Official State Website

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