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  5. Peterson Dental Associates, P.A.

Peterson Dental Associates, P.A.

Company Details

Name: Peterson Dental Associates, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 07 May 1980 (45 years ago)
Company Number: eb07fd15-b1d4-e011-a886-001ec94ffe7f
File Number: 3Q-972
Registered Office Address: 816 W St Germain #101, St Cloud, MN 56301, USA
Principal Executive Office Address: 816 W St Germain Street, Ste 101, St Cloud, MN 56301, USA
ZIP code: 56301
County: Stearns County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2023 411375495 2024-04-24 PETERSON DENTAL ASSOCIATES, P.A. 20
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST ST. GERMAIN STREET, ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2024-04-24
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2022 411375495 2023-07-10 PETERSON DENTAL ASSOCIATES, P.A. 19
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST GERMAIN ST., ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2023-07-10
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2021 411375495 2022-09-12 PETERSON DENTAL ASSOCIATES, P.A. 21
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST GERMAIN ST., SUITE 101, ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2022-09-12
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2020 411375495 2021-06-15 PETERSON DENTAL ASSOCIATES, P.A. 21
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST GERMAIN ST., SUITE 101, ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2021-06-15
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2019 411375495 2020-06-04 PETERSON DENTAL ASSOCIATES, P.A. 21
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST GERMAIN ST., SUITE 101, ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2020-06-04
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2018 411375495 2019-07-16 PETERSON DENTAL ASSOCIATES, P.A. 19
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST GERMAIN ST., SUITE 101, ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2019-07-16
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2017 411375495 2018-06-14 PETERSON DENTAL ASSOCIATES, P.A. 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST GERMAIN ST., SUITE 101, ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2018-06-14
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2016 411375495 2017-07-10 PETERSON DENTAL ASSOCIATES, P.A. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST GERMAIN ST., SUITE 101, ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2017-07-10
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2015 411375495 2016-07-05 PETERSON DENTAL ASSOCIATES, P.A. 15
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST GERMAIN ST., SUITE 101, ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2016-07-05
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature
PETERSON DENTAL ASSOCIATES, P.A. 401(K) 2014 411375495 2015-06-24 PETERSON DENTAL ASSOCIATES, P.A. 15
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-04-01
Business code 621210
Sponsor’s telephone number 3202522454
Plan sponsor’s address 816 WEST GERMAIN ST., SUITE 101, ST. CLOUD, MN, 56301

Signature of
Role Plan administrator
Date 2015-06-24
Name of individual signing RUSSELL PETERSON
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
Russell T Peterson Chief Executive Officer 816 W St Germain Street, Ste 101, St Cloud, MN 56301, USA

Filing

Filing Name Filing date
Amendment - Business Corporation (Domestic) (Business Name: Peterson Dental Associates, P.A.) 2012-11-26
Amendment - Business Corporation (Domestic)Change of Shares Restated Articles 2012-09-05
Business Corporation (Domestic) Business Name (Business Name: Peterson and Barrymore, D.D.S., P.A.) 1991-12-16
Business Corporation (Domestic) Business Name (Business Name: Simi, Peterson and Barrymore, D.D.S., P.A.) 1990-05-03
Original Filing - Business Corporation (Domestic) 1980-05-07
Business Corporation (Domestic) Business Name (Business Name: Drs. Simi & Peterson, D.D.S., P.A.) 1980-05-07

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Date of last update: 27 Sep 2024

Sources: Minnesota's Official State Website

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