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  5. ELIZABETHTOWN COMMUNITY HOSPITAL

ELIZABETHTOWN COMMUNITY HOSPITAL

Company Details

Name: ELIZABETHTOWN COMMUNITY HOSPITAL
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 08 May 1926 (99 years ago)
Entity Number: 20564
ZIP code: 12932
County: Essex
Place of Formation: New York
Address: 75 PARK STREET, ELIZABETHTOWN, NY, United States, 12932

Contact Details

Phone +1 518-873-3130

Phone +1 518-585-2831

Phone +1 518-647-8164

Phone +1 518-946-1111

Phone +1 518-873-6377

Phone +1 518-216-4076

Phone +1 518-963-4275

Phone +1 518-962-2313

Phone +1 518-873-6896

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
HJNUASYCKTZ6 2024-12-03 75 PARK ST, ELIZABETHTOWN, NY, 12932, 2300, USA P.O. BOX 277, ELIZABETHTOWN, NY, 12932, 0277, USA

Business Information
Doing Business As UNIVERSITY OF VERMONT HEALTH NETWORK-ELIZABETHTOWN
URL http://www.ech.org
Congressional District 21
State/Country of Incorporation NY, USA
Activation Date 2023-12-06
Initial Registration Date 2004-08-13
Entity Start Date 1926-04-26
Fiscal Year End Close Date Sep 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name MORGAN MORRIS
Address 75 PARK STREET, ELIZABETHTOWN, NY, 12932, USA
Title ALTERNATE POC
Name ALAN CHARDAVOYNE
Address 75 PARK STREET, ELIZABETHTOWN, NY, 12932, 0277, USA
Government Business
Title PRIMARY POC
Name ROBERT ORTMYER
Address 75 PARK STREET, ELIZABETHTOWN, NY, 12932, USA
Title ALTERNATE POC
Name ALAN CHARDAVOYNE
Address 75 PARK STREET, P.O. BOX 277, ELIZABETHTOWN, NY, 12932, 0277, USA
Past Performance
Title PRIMARY POC
Name MORGAN MORRIS
Address 75 PARK STREET, ELIZABETHTOWN, NY, 12932, USA
Title ALTERNATE POC
Name KRISTA BIGELOW
Address 75 PARK STREET, PO BOX 277, ELIZABETHTOWN, NY, 12932, USA

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
3ZKY2 Obsolete Non-Manufacturer 2004-08-13 2024-03-10 No data 2024-12-03

Contact Information
POC ROBERT ORTMYER
Phone +1 518-873-3002
Fax +1 518-873-2005
Address 75 PARK ST, ELIZABETHTOWN, NY, 12932 2300, UNITED STATES

Ownership of Offeror Information
Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
549300GGWG3JX6MQG453 20564 US-NY GENERAL ACTIVE No data

Addresses
Legal 75 PARK STREET, ELIZABETHTOWN, US-NY, US, 12932
Headquarters 75 Park Street, Elizabethtown, US-NY, US, 12932

Registration details
Registration Date 2017-10-14
Last Update 2023-08-04
Status LAPSED
Next Renewal 2018-09-27
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 20564

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ELIZABETHTOWN COMMUNITY HOSPITAL EMPLOYEES CAFETERIA PLAN 2021 141364513 2023-08-23 ELIZABETHTOWN COMMUNITY HOSPITAL 223
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1997-01-01
Business code 622000
Sponsor’s telephone number 5188733006
Plan sponsor’s mailing address 75 PARK STREET, PO BOX 277, ELIZABETHTOWN, NY, 129322300
Plan sponsor’s address 75 PARK STREET, PO BOX 277, ELIZABETHTOWN, NY, 129322300

Number of participants as of the end of the plan year
Active participants 0
ELIZABETHTOWN COMMUNITY HOSPITAL EMPLOYEES CAFETERIA PLAN 2021 141364513 2022-10-13 ELIZABETHTOWN COMMUNITY HOSPITAL 223
Three-digit plan number (PN) 502
Effective date of plan 1997-01-01
Business code 622000
Sponsor’s telephone number 5188733006
Plan sponsor’s mailing address 75 PARK STREET, PO BOX 277, ELIZABETHTOWN, NY, 129322300
Plan sponsor’s address 75 PARK STREET, PO BOX 277, ELIZABETHTOWN, NY, 129322300

Number of participants as of the end of the plan year
Active participants 222
ELIZABETHTOWN COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2012 141364513 2013-10-15 ELIZABETHTOWN COMMUNITY HOSPITAL 213
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 622000
Sponsor’s telephone number 5188736377
Plan sponsor’s mailing address 75 PARK STREET, ELIZABETHTOWN, NY, 12932
Plan sponsor’s address 75 PARK STREET, ELIZABETHTOWN, NY, 12932

Number of participants as of the end of the plan year
Active participants 212
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 11
Number of participants with account balances as of the end of the plan year 181
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 9

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing RODNEY BOULA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-10-15
Name of individual signing RODNEY BOULA
Valid signature Filed with authorized/valid electronic signature
ELIZABETHTOWN COMMUNITY HOSPITAL RETIREMENT SAVINGS PLAN 2011 141364513 2012-10-08 ELIZABETHTOWN COMMUNITY HOSPITAL 201
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2009-01-01
Business code 622000
Sponsor’s telephone number 5188736377
Plan sponsor’s mailing address 75 PARK STREET, ELIZABETHTOWN, NY, 12932
Plan sponsor’s address 75 PARK STREET, ELIZABETHTOWN, NY, 12932

Plan administrator’s name and address
Administrator’s EIN 141364513
Plan administrator’s name ELIZABETHTOWN COMMUNITY HOSPITAL
Plan administrator’s address 75 PARK STREET, ELIZABETHTOWN, NY, 12932
Administrator’s telephone number 5188736377

Number of participants as of the end of the plan year
Active participants 167
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 16
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 167
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 11

Signature of
Role Plan administrator
Date 2012-10-08
Name of individual signing RODNEY BOULA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-08
Name of individual signing RODNEY BOULA
Valid signature Filed with authorized/valid electronic signature

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 75 PARK STREET, ELIZABETHTOWN, NY, United States, 12932

Agent

Name Role Address
ELIZABETHTOWN COMMUNITY HOSPITAL Agent ELIZABETHTOWN COMMUNITY, HOSPITAL, ELIZABETHTOWN, NY, 12932

History

Start date End date Type Value
2012-12-21 2018-01-05 Address 75 PARK STREET, ELIZABETHTOWN, NY, 12932, USA (Type of address: Service of Process)
1993-01-21 2012-12-21 Address NO STREET ADDRESS, ELIZABETHTOWN, NY, 00000, USA (Type of address: Service of Process)
1989-11-01 1993-01-21 Address HOSPITAL, ELIZABETHTOWN, NY, 12932, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
180105000327 2018-01-05 CERTIFICATE OF AMENDMENT 2018-01-05
121221001082 2012-12-21 CERTIFICATE OF AMENDMENT 2012-12-21
C197379-2 1993-03-05 ASSUMED NAME CORP INITIAL FILING 1993-03-05
930121000534 1993-01-21 CERTIFICATE OF AMENDMENT 1993-01-21
C071387-9 1989-11-01 CERTIFICATE OF AMENDMENT 1989-11-01
A715025-4 1980-11-17 CERTIFICATE OF AMENDMENT 1980-11-17
967128-4 1972-02-15 CERTIFICATE OF AMENDMENT 1972-02-15
10EX-174 1951-02-19 CERTIFICATE OF AMENDMENT 1951-02-19
252Q-28 1926-05-08 CERTIFICATE OF INCORPORATION 1926-05-08

Awards

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
DCA AWARD VA528P0104 2007-10-01 2008-09-30 2012-09-30
Unique Award Key CONT_AWD_VA528P0104_3600_-NONE-_-NONE-
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title ELIZABETHTOWN CBOC
NAICS Code 622110: GENERAL MEDICAL AND SURGICAL HOSPITALS
Product and Service Codes Q201: GENERAL HEALTH CARE SERVICES

Recipient Details
Recipient ELIZABETHTOWN COMMUNITY HOSPITAL
UEI HJNUASYCKTZ6
Legacy DUNS 080481674
Recipient Address UNITED STATES, 75 PARK ST, ELIZABETHTOWN, 129320277
PO AWARD VA528C13109 2010-10-01 2010-12-31 2010-12-31
Unique Award Key CONT_AWD_VA528C13109_3600_-NONE-_-NONE-
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title PRIMARY CARE SERVICES AT ELIZABETHTOWN CBOC
NAICS Code 622110: GENERAL MEDICAL AND SURGICAL HOSPITALS
Product and Service Codes Q509: INTERNAL MEDICINE SERVICES

Recipient Details
Recipient ELIZABETHTOWN COMMUNITY HOSPITAL
UEI HJNUASYCKTZ6
Legacy DUNS 080481674
Recipient Address UNITED STATES, 75 PARK ST, ELIZABETHTOWN, 129322300

Related by officers

THE CORPORATION

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Related by address

No related companies by address

Date of last update: 17 Nov 2024

Sources: New York Secretary of State

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