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  5. JOHN A. SALLUSTO M.D., P.C.

JOHN A. SALLUSTO M.D., P.C.

Company Details

Name: JOHN A. SALLUSTO M.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 20 Jun 1996 (28 years ago)
Entity Number: 2041129
ZIP code: 11730
County: Suffolk
Place of Formation: New York
Address: 4 PERCY WILLIAMS DR., EAST ISLIP, NY, United States, 11730
Principal Address: 4 PERRY WILLIAMS DR., EAST ISLIP, NY, United States, 11730

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
THE JOHN A. SALLUSTO, M.D., P.C. DEFINED BENEFIT PENSION PLAN 2020 113021669 2021-10-13 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2021-10-13
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2021-10-13
Name of individual signing JOHN SALLUSTO
THE JOHN A. SALLUSTO, M.D., P.C. 401(K) PROFIT SHARING PLAN & TRUST 2020 113021669 2021-10-13 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-05-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2021-10-13
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2021-10-13
Name of individual signing JOHN SALLUSTO
THE JOHN A. SALLUSTO, M.D., P.C. DEFINED BENEFIT PENSION PLAN 2019 113021669 2020-10-02 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2020-10-02
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2020-10-02
Name of individual signing JOHN SALLUSTO
THE JOHN A. SALLUSTO, M.D., P.C. 401(K) PROFIT SHARING PLAN & TRUST 2019 113021669 2020-10-02 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-05-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2020-10-02
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2020-10-02
Name of individual signing JOHN SALLUSTO
THE JOHN A. SALLUSTO, M.D., P.C. DEFINED BENEFIT PENSION PLAN 2018 113021669 2019-10-11 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2019-10-11
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2019-10-11
Name of individual signing JOHN SALLUSTO
THE JOHN A. SALLUSTO, M.D., P.C. 401(K) PROFIT SHARING PLAN & TRUST 2018 113021669 2019-10-11 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-05-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2019-10-11
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2019-10-11
Name of individual signing JOHN SALLUSTO
THE JOHN A. SALLUSTO, M.D., P.C. 401(K) PROFIT SHARING PLAN & TRUST 2017 113021669 2018-10-03 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-05-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2018-10-02
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2018-10-02
Name of individual signing JOHN SALLUSTO
THE JOHN A. SALLUSTO, M.D., P.C. DEFINED BENEFIT PENSION PLAN 2017 113021669 2018-10-03 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2018-10-02
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2018-10-02
Name of individual signing JOHN SALLUSTO
THE JOHN A. SALLUSTO, M.D., P.C. 401(K) PROFIT SHARING PLAN & TRUST 2016 113021669 2017-10-04 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1990-05-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2017-10-04
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2017-10-04
Name of individual signing JOHN SALLUSTO
THE JOHN A. SALLUSTO, M.D., P.C. DEFINED BENEFIT PENSION PLAN 2016 113021669 2017-10-04 JOHN A. SALLUSTO, M.D., P.C. 2
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 6312244379
Plan sponsor’s address 4 PERCY WILLIAMS DRIVE, EAST ISLIP, NY, 11730

Signature of
Role Plan administrator
Date 2017-10-04
Name of individual signing JOHN SALLUSTO
Role Employer/plan sponsor
Date 2017-10-04
Name of individual signing JOHN SALLUSTO

DOS Process Agent

Name Role Address
JOHN A SALLUSTO DOS Process Agent 4 PERCY WILLIAMS DR., EAST ISLIP, NY, United States, 11730

Chief Executive Officer

Name Role Address
JOHN A SALLUSTO Chief Executive Officer 4 PERCY WILLIAMS DR., EAST ISLIP, NY, United States, 11730

History

Start date End date Type Value
2006-05-30 2010-06-18 Address 244-HELM LANE, WEST BAY SHORE, NY, 11706, 8110, USA (Type of address: Principal Executive Office)
2006-05-30 2010-06-18 Address 244-HELM LANE, WEST BAY SHORE, NY, 11706, 8110, USA (Type of address: Chief Executive Officer)
2006-05-30 2010-06-18 Address 244-HELM LANE, WEST BAY SHORE, NY, 11706, 8110, USA (Type of address: Service of Process)
1998-07-07 2006-05-30 Address 21 THE HELM, EAST ISLIP, NY, 11730, USA (Type of address: Chief Executive Officer)
1998-07-07 2006-05-30 Address 21 THE HELM, EAST ISLIP, NY, 11730, USA (Type of address: Service of Process)
1998-07-07 2006-05-30 Address 21 THE HELM, EAST ISLIP, NY, 11730, USA (Type of address: Principal Executive Office)
1996-06-20 1998-07-07 Address 21 THE HELM, EAST ISLIP, NY, 11730, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
200602060091 2020-06-02 BIENNIAL STATEMENT 2020-06-01
160601006471 2016-06-01 BIENNIAL STATEMENT 2016-06-01
120605007221 2012-06-05 BIENNIAL STATEMENT 2012-06-01
100618002553 2010-06-18 BIENNIAL STATEMENT 2010-06-01
080626002864 2008-06-26 BIENNIAL STATEMENT 2008-06-01
060530002985 2006-05-30 BIENNIAL STATEMENT 2006-06-01
040628002824 2004-06-28 BIENNIAL STATEMENT 2004-06-01
020517002329 2002-05-17 BIENNIAL STATEMENT 2002-06-01
000605002118 2000-06-05 BIENNIAL STATEMENT 2000-06-01
980707002201 1998-07-07 BIENNIAL STATEMENT 1998-06-01

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Dec 2024

Sources: New York Secretary of State

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