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  5. PORT JEFFERSON MEDICAL ASSOCIATES, P.C.

PORT JEFFERSON MEDICAL ASSOCIATES, P.C.

Company Details

Name: PORT JEFFERSON MEDICAL ASSOCIATES, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Inactive
Date of registration: 08 Jan 2004 (21 years ago)
Date of dissolution: 13 Aug 2020
Entity Number: 2997548
ZIP code: 11777
County: Suffolk
Place of Formation: New York
Address: 70 NORTH COUNTRY RD, PT JEFFERSON, NY, United States, 11777
Principal Address: 70 NORTH COUNTRY RD SUITE 105, PT JEFFERSON, NY, United States, 11777

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 PORT JEFFERSON MEDICAL ASSOCIATES, P.C. 401(K) PROFIT SHARING PLAN AND TRUST 2013 593776277 2014-10-13 PORT JEFFERSON MEDICAL ASSOCIATES, P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6316420609
Plan sponsor’s address 70 NORTH COUNTRY ROAD, SUITE 105, PORT JEFFERSON, NY, 11777

Signature of
Role Plan administrator
Date 2014-10-13
Name of individual signing JOANNE JOHANSSON SCARCELLA
THE PORT JEFFERSON MEDICAL ASSOCIATES, P.C. 401(K) PROFIT SHARING PLAN AND TRUST 2012 593776272 2013-10-03 PORT JEFFERSON MEDICAL ASSOCIATES, P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6316420609
Plan sponsor’s address 70 NORTH COUNTRY ROAD, SUITE 105, PORT JEFFERSON, NY, 11777

Signature of
Role Plan administrator
Date 2013-10-03
Name of individual signing RHONDA BURMEISTER
Role Employer/plan sponsor
Date 2013-10-03
Name of individual signing RHONDA BURMEISTER
THE PORT JEFFERSON MEDICAL ASSOCIATES, P.C. 401(K) PROFIT SHARING PLAN AND TRUST 2011 593776272 2012-09-29 PORT JEFFERSON MEDICAL ASSOCIATES, P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6316420609
Plan sponsor’s address 70 NORTH COUNTRY ROAD, SUITE 105, PORT JEFFERSON, NY, 11777

Plan administrator’s name and address
Administrator’s EIN 593776272
Plan administrator’s name PORT JEFFERSON MEDICAL ASSOCIATES, P.C.
Plan administrator’s address 70 NORTH COUNTRY ROAD, SUITE 105, PORT JEFFERSON, NY, 11777
Administrator’s telephone number 6316420609

Signature of
Role Plan administrator
Date 2012-09-28
Name of individual signing RHONDA BURMEISTER
Role Employer/plan sponsor
Date 2012-09-28
Name of individual signing RHONDA BURMEISTER
THE PORT JEFFERSON MEDICAL ASSOCIATES, P.C. 401(K) PROFIT SHARING PLAN AND TRUST 2010 593776272 2011-09-01 PORT JEFFERSON MEDICAL ASSOCIATES, P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 6316420609
Plan sponsor’s address 70 NORTH COUNTRY ROAD, SUITE 105, PORT JEFFERSON, NY, 11777

Plan administrator’s name and address
Administrator’s EIN 593776272
Plan administrator’s name PORT JEFFERSON MEDICAL ASSOCIATES, P.C.
Plan administrator’s address 70 NORTH COUNTRY ROAD, SUITE 105, PORT JEFFERSON, NY, 11777
Administrator’s telephone number 6316420609

Signature of
Role Plan administrator
Date 2011-08-31
Name of individual signing RHONDA BURMEISTER
Role Employer/plan sponsor
Date 2011-08-31
Name of individual signing RHONDA BURMEISTER

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 70 NORTH COUNTRY RD, PT JEFFERSON, NY, United States, 11777

Chief Executive Officer

Name Role Address
JAMES KELLY Chief Executive Officer 70 NORTH COUNTRY RD SUITE 105, PT JEFFERSON, NY, United States, 11777

History

Start date End date Type Value
2008-01-23 2010-02-24 Address 625 BELLE TERRE ROAD, SUITE 119, PT JEFFERSON, NY, 11777, USA (Type of address: Chief Executive Officer)
2008-01-23 2010-02-24 Address 625 BELLE TERRE ROAD, SUITE 119, PT JEFFERSON, NY, 11777, USA (Type of address: Principal Executive Office)
2008-01-23 2014-08-07 Address 625 BELLE TERRE ROAD, SUITE 119, PT JEFFERSON, NY, 11777, USA (Type of address: Service of Process)
2006-03-22 2008-01-23 Address 625 BELLE TERRE RD, STE 119, PORT JEFFERSON, NY, 11777, USA (Type of address: Chief Executive Officer)
2006-03-22 2008-01-23 Address 625 BELLE TERRE RD, STE 119, PORT JEFFERSON, NY, 11777, USA (Type of address: Principal Executive Office)
2004-01-08 2008-01-23 Address 625 BELLE TERRE ROAD, STE 119, PORT JEFFERSON, NY, 11777, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
200813000153 2020-08-13 CERTIFICATE OF DISSOLUTION 2020-08-13
140807002228 2014-08-07 BIENNIAL STATEMENT 2014-01-01
100224002505 2010-02-24 BIENNIAL STATEMENT 2010-01-01
080123002964 2008-01-23 BIENNIAL STATEMENT 2008-01-01
060322002561 2006-03-22 BIENNIAL STATEMENT 2006-01-01
040108000803 2004-01-08 CERTIFICATE OF INCORPORATION 2004-01-08

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THE CORPORATION

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JAMES KELLY

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Related by address

No related companies by address

Date of last update: 28 Nov 2024

Sources: New York Secretary of State

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