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LAKE PLAINS MEDICAL PLLC

Company Details

Name: LAKE PLAINS MEDICAL PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 18 Dec 1996 (28 years ago)
Entity Number: 2094008
County: Orleans
Place of Formation: New York
Address: 100 OHIO STREET, MEDINA, NY, United States, 14103
Address ZIP Code: 14103

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKE PLAINS MEDICAL PLLC 401(K) PROFIT SHARING PLAN 2012 161531938 2013-07-12 LAKE PLAINS MEDICAL PLLC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 5857983345
Plan sponsor’s mailing address 100 OHIO STREET, MEDINA, NY, 14103
Plan sponsor’s address 100 OHIO STREET, MEDINA, NY, 14103

Plan administrator’s name and address
Administrator’s EIN 261371501
Plan administrator’s name MICHAEL ZELAZNY CPA
Plan administrator’s address 534 MAIN STREET SUITE 2, MEDINA, NY, 14103
Administrator’s telephone number 5857980944

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

Signature of
Role Plan administrator
Date 2013-07-12
Name of individual signing THOMAS J. MADEJSKI
Valid signature Filed with authorized/valid electronic signature
LAKE PLAINS MEDICAL PLLC 401(K) PROFIT SHARING PLAN 2011 161531938 2012-05-16 LAKE PLAINS MEDICAL PLLC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 5857983345
Plan sponsor’s mailing address 100 OHIO STREET, MEDINA, NY, 14103
Plan sponsor’s address 100 OHIO STREET, MEDINA, NY, 14103

Plan administrator’s name and address
Administrator’s EIN 261371501
Plan administrator’s name MICHAEL ZELAZNY CPA
Plan administrator’s address 534 MAIN ST, SUITE 2, MEDINA, NY, 14103
Administrator’s telephone number 5857980944

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 1
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 1
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-05-16
Name of individual signing THOMAS J. MADEJSKI
Valid signature Filed with authorized/valid electronic signature
LAKE PLAINS MEDICAL PLLC 401(K) PROFIT SHARING PLAN 2010 161531938 2011-09-22 LAKE PLAINS MEDICAL PLLC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 5857983345
Plan sponsor’s mailing address 100 OHIO ST, MEDINA, NY, 14103
Plan sponsor’s address 100 OHIO ST, MEDINA, NY, 14103

Plan administrator’s name and address
Administrator’s EIN 261371501
Plan administrator’s name MICHAEL ZELAZNY CPA
Plan administrator’s address 534 MAIN ST, SUITE 2, MEDINA, NY, 14103
Administrator’s telephone number 5857980944

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 1
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 1
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-09-22
Name of individual signing THOMAS J. MADEJSKI
Valid signature Filed with authorized/valid electronic signature
LAKE PLAINS MEDICAL PLLC 401(K) PROFIT SHARING PLAN 2009 161531938 2010-08-03 LAKE PLAINS MEDICAL PLLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621111
Sponsor’s telephone number 5857983345
Plan sponsor’s mailing address 100 OHIO ST, MEDINA, NY, 14103
Plan sponsor’s address 100 OHIO ST, MEDINA, NY, 14103

Plan administrator’s name and address
Administrator’s EIN 261371501
Plan administrator’s name MICHAEL ZELAZNY CPA
Plan administrator’s address 534 MAIN ST, SUITE 2, MEDINA, NY, 14103
Administrator’s telephone number 5857980944

Number of participants as of the end of the plan year
Active participants 23
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 1
Number of participants with account balances as of the end of the plan year 22
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-07-27
Name of individual signing MICHAEL ZELAZNY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-03
Name of individual signing THOMAS J. MADEJSKI
Valid signature Filed with authorized/valid electronic signature

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 100 OHIO STREET, MEDINA, NY, United States, 14103

History

Start date End date Type Value
1998-12-16 2000-11-30 Address 100 OHIO STREET, MEDINA, NY, 14103, USA (Type of address: Service of Process)
1996-12-18 1998-12-16 Address 100 OHIO STREET, MEDINA, NY, 14103, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
081121002071 2008-11-21 BIENNIAL STATEMENT 2008-12-01
061201002220 2006-12-01 BIENNIAL STATEMENT 2006-12-01
041227002146 2004-12-27 BIENNIAL STATEMENT 2004-12-01
021202002008 2002-12-02 BIENNIAL STATEMENT 2002-12-01
001130002262 2000-11-30 BIENNIAL STATEMENT 2000-12-01
981216002042 1998-12-16 BIENNIAL STATEMENT 1998-12-01
970327000637 1997-03-27 AFFIDAVIT OF PUBLICATION 1997-03-27
970327000633 1997-03-27 AFFIDAVIT OF PUBLICATION 1997-03-27
961218000397 1996-12-18 ARTICLES OF ORGANIZATION 1996-12-18

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Related by address

100 OHIO STREET, MEDINA, NY, United States, 14103

100 OHIO STREET LLC HARVEY J. BLANCHET, JR., M.D., P.C.

Date of last update: 12 Nov 2024

Sources: New York Secretary of State

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