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ADIRONDACK REHABILITATION MEDICINE, PLLC

Company Details

Name: ADIRONDACK REHABILITATION MEDICINE, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 15 Oct 1998 (26 years ago) (Companies founded in October 1998)
Entity Number: 2306881
ZIP code: 12804 (Companies in Warren, 12804)
County: Warren
Place of Formation: New York
Address: 17 MAIN ST, QUEENSBURY, NY, United States, 12804

Contact Details

Phone +1 518-798-0767

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT SHARING 401(K) PLAN 2023 141808809 2024-07-29 ADIRONDACK REHABILITATION MEDICINE, PLLC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804

Signature of
Role Plan administrator
Date 2024-07-29
Name of individual signing SHAWN JORGENSEN
Role Employer/plan sponsor
Date 2024-07-29
Name of individual signing SHAWN JORGENSEN
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT SHARING 401(K) PLAN 2022 141808809 2023-09-20 ADIRONDACK REHABILITATION MEDICINE, PLLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT SHARING 401(K) PLAN 2021 141808809 2022-05-25 ADIRONDACK REHABILITATION MEDICINE, PLLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT SHARING 401(K) PLAN 2020 141808809 2021-07-16 ADIRONDACK REHABILITATION MEDICINE, PLLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804

Signature of
Role Plan administrator
Date 2021-07-16
Name of individual signing SHAWN JORGENSEN
Role Employer/plan sponsor
Date 2021-07-16
Name of individual signing SHAWN JORGENSEN
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT SHARING 401(K) PLAN 2019 141808809 2020-02-12 ADIRONDACK REHABILITATION MEDICINE, PLLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804

Signature of
Role Plan administrator
Date 2020-02-12
Name of individual signing VAN T. JACKSON, JR.
Role Employer/plan sponsor
Date 2020-02-12
Name of individual signing VAN T. JACKSON, JR.
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT SHARING 401(K) PLAN 2018 141808809 2019-03-14 ADIRONDACK REHABILITATION MEDICINE, PLLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804

Signature of
Role Plan administrator
Date 2019-03-14
Name of individual signing VAN T. JACKSON, JR.
Role Employer/plan sponsor
Date 2019-03-14
Name of individual signing VAN T. JACKSON, JR.
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT A SHARING 401(K) PLAN 2017 141808809 2018-04-04 ADIRONDACK REHABILITATION MEDICINE, PLLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804

Signature of
Role Plan administrator
Date 2018-04-04
Name of individual signing VAN T. JACKSON, JR.
Role Employer/plan sponsor
Date 2018-04-04
Name of individual signing VAN T. JACKSON, JR.
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT A SHARING 401(K) PLAN 2016 141808809 2017-03-08 ADIRONDACK REHABILITATION MEDICINE, PLLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804

Signature of
Role Plan administrator
Date 2017-03-08
Name of individual signing VAN T. JACKSON, JR.
Role Employer/plan sponsor
Date 2017-03-08
Name of individual signing VAN T. JACKSON, JR.
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT SHARING 401(K) PLAN 2015 141808809 2016-03-01 ADIRONDACK REHABILITATION MEDICINE, PLLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804

Signature of
Role Plan administrator
Date 2016-03-01
Name of individual signing VAN T. JACKSON, JR.
Role Employer/plan sponsor
Date 2016-03-01
Name of individual signing VAN T. JACKSON, JR.
ADIRONDACK REHABILITATION MEDICINE, PLLC PROFIT SHARING 401(K) PLAN 2014 141808809 2015-05-05 ADIRONDACK REHABILITATION MEDICINE, PLLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-01-01
Business code 621111
Sponsor’s telephone number 5187980767
Plan sponsor’s address 17 MAIN STREET, QUEENSBURY, NY, 12804

Signature of
Role Plan administrator
Date 2015-05-05
Name of individual signing TODD JORGENSEN, MD
Role Employer/plan sponsor
Date 2015-05-05
Name of individual signing TODD JORGENSEN, MD

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 17 MAIN ST, QUEENSBURY, NY, United States, 12804

History

Start date End date Type Value
2000-10-18 2006-10-13 Address PO BOX 2053, GLENS FALLS, NY, 12801, USA (Type of address: Service of Process)
1998-10-15 2000-10-18 Address 17 MAIN STREET, P.O. BOX 2053, GLENS FALLS, NY, 12801, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
121016006213 2012-10-16 BIENNIAL STATEMENT 2012-10-01
101006002075 2010-10-06 BIENNIAL STATEMENT 2010-10-01
080926002032 2008-09-26 BIENNIAL STATEMENT 2008-10-01
061013002259 2006-10-13 BIENNIAL STATEMENT 2006-10-01
041001002300 2004-10-01 BIENNIAL STATEMENT 2004-10-01
020925002242 2002-09-25 BIENNIAL STATEMENT 2002-10-01
001018002189 2000-10-18 BIENNIAL STATEMENT 2000-10-01
990201000090 1999-02-01 AFFIDAVIT OF PUBLICATION 1999-02-01
990201000086 1999-02-01 AFFIDAVIT OF PUBLICATION 1999-02-01
981015000478 1998-10-15 ARTICLES OF ORGANIZATION 1998-10-15

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Date of last update: 12 Nov 2024

Sources: New York Secretary of State

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