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  5. SLOCUM DICKSON MEDICAL GROUP, PLLC

SLOCUM DICKSON MEDICAL GROUP, PLLC

Company Details

Name: SLOCUM DICKSON MEDICAL GROUP, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 02 Jul 2002 (22 years ago)
Entity Number: 2785389
ZIP code: 13413
County: Oneida
Place of Formation: New York
Address: 1729 BURRSTONE ROAD, NEW HARTFORD, NY, United States, 13413

Contact Details

Phone +1 315-798-4500

Phone +1 315-798-1500

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
549300CIB78CO3F9LL42 2785389 US-NY GENERAL ACTIVE No data

Addresses
Legal C/O SLOCUM DICKSON MEDICAL GROUP, PLLC, 1729 BURRSTONE ROAD, NEW HARTFORD, US-NY, US, 13413
Headquarters 1729 Burrstone Road, New Hartford, US-NY, US, 13413

Registration details
Registration Date 2018-03-01
Last Update 2023-08-04
Status LAPSED
Next Renewal 2020-02-29
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 2785389

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2023 200362623 2024-06-07 SLOCUM DICKSON MEDICAL GROUP PLLC 387
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 286
Retired or separated participants receiving benefits 2
Other retired or separated participants entitled to future benefits 2

Signature of
Role Plan administrator
Date 2024-06-07
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-06-07
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2022 200362623 2023-05-01 SLOCUM DICKSON MEDICAL GROUP PLLC 314
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 387
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 1

Signature of
Role Plan administrator
Date 2023-05-01
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-05-01
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2021 200362623 2023-03-02 SLOCUM DICKSON MEDICAL GROUP PLLC 329
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 314
Retired or separated participants receiving benefits 5
Other retired or separated participants entitled to future benefits 5

Signature of
Role Plan administrator
Date 2023-03-02
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-03-02
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2020 200362623 2021-07-15 SLOCUM DICKSON MEDICAL GROUP PLLC 326
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 329
Retired or separated participants receiving benefits 4
Other retired or separated participants entitled to future benefits 4

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-15
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2019 200362623 2020-06-01 SLOCUM DICKSON MEDICAL GROUP PLLC 316
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 326
Retired or separated participants receiving benefits 3
Other retired or separated participants entitled to future benefits 3

Signature of
Role Plan administrator
Date 2020-06-01
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-01
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2018 200362623 2019-06-10 SLOCUM DICKSON MEDICAL GROUP PLLC 411
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 316
Retired or separated participants receiving benefits 2
Other retired or separated participants entitled to future benefits 1

Signature of
Role Plan administrator
Date 2019-06-10
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-10
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2017 200362623 2018-07-30 SLOCUM DICKSON MEDICAL GROUP PLLC 498
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 411
Retired or separated participants receiving benefits 2
Other retired or separated participants entitled to future benefits 2

Signature of
Role Plan administrator
Date 2018-07-30
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2016 200362623 2017-06-20 SLOCUM DICKSON MEDICAL GROUP PLLC 387
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 498
Retired or separated participants receiving benefits 3
Other retired or separated participants entitled to future benefits 3

Signature of
Role Plan administrator
Date 2017-06-20
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-20
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2015 200362623 2016-06-13 SLOCUM DICKSON MEDICAL GROUP PLLC 388
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 387
Retired or separated participants receiving benefits 2
Other retired or separated participants entitled to future benefits 1

Signature of
Role Plan administrator
Date 2016-06-13
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-13
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
SLOCUM DICKSON MEDICAL GROUP BENEFIT BANK PLAN 2014 200362623 2015-06-08 SLOCUM DICKSON MEDICAL GROUP PLLC 381
File View Page
Three-digit plan number (PN) 520
Effective date of plan 1990-04-01
Business code 621498
Sponsor’s telephone number 3157981693
Plan sponsor’s mailing address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Plan sponsor’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413

Plan administrator’s name and address
Administrator’s EIN 200362623
Plan administrator’s name SLOCUM DICKSON MEDICAL GROUP PLLC
Plan administrator’s address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413
Administrator’s telephone number 3157981693

Number of participants as of the end of the plan year
Active participants 388
Retired or separated participants receiving benefits 5
Other retired or separated participants entitled to future benefits 5

Signature of
Role Plan administrator
Date 2015-06-08
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-08
Name of individual signing DONALD SLEEZER
Valid signature Filed with authorized/valid electronic signature

DOS Process Agent

Name Role Address
SLOCUM DICKSON MEDICAL GROUP, PLLC DOS Process Agent 1729 BURRSTONE ROAD, NEW HARTFORD, NY, United States, 13413

History

Start date End date Type Value
2002-07-02 2024-04-04 Address 1729 BURRSTONE ROAD, NEW HARTFORD, NY, 13413, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
240404003769 2024-04-04 BIENNIAL STATEMENT 2024-04-04
200716060489 2020-07-16 BIENNIAL STATEMENT 2020-07-01
180711006049 2018-07-11 BIENNIAL STATEMENT 2018-07-01
160727006029 2016-07-27 BIENNIAL STATEMENT 2016-07-01
120705006145 2012-07-05 BIENNIAL STATEMENT 2012-07-01
100805002022 2010-08-05 BIENNIAL STATEMENT 2010-07-01
080723002302 2008-07-23 BIENNIAL STATEMENT 2008-07-01
060705002242 2006-07-05 BIENNIAL STATEMENT 2006-07-01
050706002436 2005-07-06 BIENNIAL STATEMENT 2004-07-01
030812000195 2003-08-12 CERTIFICATE OF AMENDMENT 2003-08-12

Related by officers

No related officers

Related by address

1729 BURRSTONE ROAD, NEW HARTFORD, NY, United States, 13413

BURRSTONE ROAD ASSOCIATES, L.L.C. LASER SPA CENTERS, LLC MOHAWK VALLEY INVASIVE CARDIOLOGY ASSOCIATES, PLLC SLOCUM DICKSON EDUCATIONAL INSTITUTE, INC. SLOCUM-DICKSON MEDICAL GROUP, P.C. OBSTETRIC HOSPITALIST STAFFING GROUP, LLC

Date of last update: 11 Nov 2024

Sources: New York Secretary of State

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