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  5. Southdale Internal Medicine, P.A.

Southdale Internal Medicine, P.A.

Company Details

Name: Southdale Internal Medicine, P.A.
Jurisdiction: Minnesota
Legal type: Business Corporation (Domestic)
Status: Inactive
Date formed: 02 Oct 1972 (52 years ago)
Company Number: f2d88b81-b1d4-e011-a886-001ec94ffe7f
File Number: 2E-245
Registered Office Address: 6545 France Ave South, Suite 510, Edina, MN 55435, USA
Principal Executive Office Address: 13521 Knoxe Drive, Burnsville, MN 55337, USA
ZIP code: 55435
County: Hennepin County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTHDALE INTERNAL MEDICINE, P.A. PROFIT SHARING PLAN 401(K) 2015 410988226 2016-12-29 SOUTHDALE INTERNAL MEDICINE, P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1973-09-30
Business code 621111
Sponsor’s telephone number 9529277079
Plan sponsor’s address 6545 FRANCE AVENUE SOUTH, SUITE 510, EDINA, MN, 55435

Signature of
Role Plan administrator
Date 2016-12-28
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-12-28
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
SOUTHDALE INTERNAL MEDICINE, P.A. PROFIT SHARING PLAN 401(K) 2015 410988226 2016-07-25 SOUTHDALE INTERNAL MEDICINE, P.A. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1973-09-30
Business code 621111
Sponsor’s telephone number 9529277079
Plan sponsor’s address 6545 FRANCE AVENUE SOUTH, SUITE 510, EDINA, MN, 55435

Signature of
Role Plan administrator
Date 2016-07-22
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-22
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
SOUTHDALE INTERNAL MEDICINE, P.A. PROFIT SHARING PLAN 401(K) 2014 410988226 2015-09-11 SOUTHDALE INTERNAL MEDICINE, P.A. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1973-09-30
Business code 621111
Sponsor’s telephone number 9529277079
Plan sponsor’s address 6545 FRANCE AVENUE SOUTH, SUITE 510, EDINA, MN, 55435

Signature of
Role Plan administrator
Date 2015-09-11
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-11
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
SOUTHDALE INTERNAL MEDICINE, P.A. PROFIT SHARING PLAN 401(K) 2013 410988226 2014-06-26 SOUTHDALE INTERNAL MEDICINE, P.A. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1973-09-30
Business code 621111
Sponsor’s telephone number 9529277079
Plan sponsor’s address 6545 FRANCE AVENUE SOUTH, SUITE 510, EDINA, MN, 55435

Signature of
Role Plan administrator
Date 2014-06-26
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-26
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
SOUTHDALE INTERNAL MEDICINE, P.A. PROFIT SHARING PLAN 401(K) 2012 410988226 2013-06-12 SOUTHDALE INTERNAL MEDICINE, P.A. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1973-09-30
Business code 621111
Sponsor’s telephone number 9529277079
Plan sponsor’s address 6545 FRANCE AVE S, SUITE 510, EDINA, MN, 55435

Signature of
Role Plan administrator
Date 2013-04-12
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-12
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
SOUTHDALE INTERNAL MEDICINE, P.A. PROFIT SHARING PLAN 401(K) 2011 410988226 2012-03-21 SOUTHDALE INTERNAL MEDICINE, P.A. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1973-09-30
Business code 621111
Sponsor’s telephone number 9529277079
Plan sponsor’s address 6545 FRANCE AVE S, SUITE 510, EDINA, MN, 55435

Plan administrator’s name and address
Administrator’s EIN 410988226
Plan administrator’s name SOUTHDALE INTERNAL MEDICINE, P.A.
Plan administrator’s address 6545 FRANCE AVE S, SUITE 510, EDINA, MN, 55435
Administrator’s telephone number 9529277079

Signature of
Role Plan administrator
Date 2012-03-20
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-03-20
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
SOUTHDALE INTERNAL MEDICINE, P.A. PROFIT SHARING PLAN 401(K) 2010 410988226 2011-05-10 SOUTHDALE INTERNAL MEDICINE, P.A. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1973-09-30
Business code 621111
Sponsor’s telephone number 9529277079
Plan sponsor’s address 6545 FRANCE AVE S, SUITE 510, EDINA, MN, 55435

Plan administrator’s name and address
Administrator’s EIN 410988226
Plan administrator’s name SOUTHDALE INTERNAL MEDICINE, P.A.
Plan administrator’s address 6545 FRANCE AVE S, SUITE 510, EDINA, MN, 55435
Administrator’s telephone number 9529277079

Signature of
Role Plan administrator
Date 2011-05-10
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-10
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
SOUTHDALE INTERNAL MEDICINE, P.A. PROFIT SHARING PLAN 401(K) 2009 410988226 2010-07-23 SOUTHDALE INTERNAL MEDICINE, P.A. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1973-09-30
Business code 621111
Sponsor’s telephone number 9529277079
Plan sponsor’s address 6545 FRANCE AVE S, SUITE 510, EDINA, MN, 55435

Plan administrator’s name and address
Administrator’s EIN 410988226
Plan administrator’s name SOUTHDALE INTERNAL MEDICINE, P.A.
Plan administrator’s address 6545 FRANCE AVE S, SUITE 510, EDINA, MN, 55435
Administrator’s telephone number 9529277079

Signature of
Role Plan administrator
Date 2010-07-23
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-23
Name of individual signing GARY BRUNKOW
Valid signature Filed with authorized/valid electronic signature

Chief Executive Officer

Name Role Address
David Walcher Chief Executive Officer 4671 Wildwood Street, Eagan, MN 55122, USA

Filing

Filing Name Filing date
Dissolution - Business Corporation (Domestic) 2022-06-08
Annual Reinstatement - Business Corporation (Domestic) 2022-06-08
Administrative Dissolution - Business Corporation (Domestic) 2022-01-25
Amendment - Business Corporation (Domestic) 1989-01-25
Business Corporation (Domestic) Active Status Report 1981-11-30
Registered Office and/or Agent - Business Corporation (Domestic) 1981-11-12
Original Filing - Business Corporation (Domestic) 1972-10-02
Business Corporation (Domestic) Business Name (Business Name: Southdale Internal Medicine, P.A.) 1972-10-02

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Date of last update: 04 Dec 2024

Sources: Minnesota's Official State Website

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