| Entity Name: | COASTAL PERIODONTICS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Nov 2004 (20 years ago) |
| Document Number: | P04000155871 |
| FEI/EIN Number | 04-3800470 |
| Address: | 82 BEAL PARKWAY SW, FORT WALTON BEACH, FL 32548 |
| Mail Address: | 82 BEAL PARKWAY SW, FORT WALTON BEACH, FL 32548 |
| ZIP code: | 32548 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COASTAL PERIODONTICS, P.A. 401(K) PLAN | 2020 | 043800470 | 2021-05-12 | COASTAL PERIODONTICS, P.A. | 10 | |||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2021-05-12 |
| Name of individual signing | JEFFREY B. BARTRUFF |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2005-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 8508626666 |
| Plan sponsor’s address | 82 BEAL PARKWAY SW, FORT WALTON BEACH, FL, 32548 |
Signature of
| Role | Plan administrator |
| Date | 2020-07-27 |
| Name of individual signing | JEFFREY B. BARTRUFF |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2005-01-01 |
| Business code | 621210 |
| Sponsor’s telephone number | 8508626666 |
| Plan sponsor’s address | 82 BEAL PARKWAY SW, FORT WALTON BEACH, FL, 32548 |
Signature of
| Role | Plan administrator |
| Date | 2019-10-10 |
| Name of individual signing | JEFFREY B. BARTRUFF |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| DOWD, JOHN RJR. | Agent | 285 HWY. 98 EAST, SUITE A, DESTIN, FL 32541 |
| Name | Role | Address |
|---|---|---|
| BARTRUFF, JEFFREY BD.M.D | DR. | 3961 INDIAN TRAIL, DESTIN, FL 32541 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-03-23 | 82 BEAL PARKWAY SW, FORT WALTON BEACH, FL 32548 | No data |
| CHANGE OF MAILING ADDRESS | 2009-03-23 | 82 BEAL PARKWAY SW, FORT WALTON BEACH, FL 32548 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-13 |
| ANNUAL REPORT | 2023-04-11 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-04-05 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-05-12 |
| ANNUAL REPORT | 2015-06-11 |
Date of last update: 04 Jan 2025
Sources: Florida Department of State
