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  5. TRI STATE SURGICAL ASSOCIATES PLLC

TRI STATE SURGICAL ASSOCIATES PLLC

Company Details

Name: TRI STATE SURGICAL ASSOCIATES PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 17 Feb 2006 (19 years ago)
Entity Number: 3322105
ZIP code: 10941
County: Orange
Place of Formation: New York
Address: 384 CRYSTAL RUN ROAD, STE 201, MIDDLETOWN, NY, United States, 10941

Contact Details

Phone +1 845-517-2870

Phone +1 845-896-0610

Phone +1 845-692-8780

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TRI-STATE SURGICAL ASSOCIATES, PLLC 401(K) PLAN 2022 204679131 2023-10-13 TRI-STATE SURGICAL ASSOCIATES, PLLC 53
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8455470804
Plan sponsor’s address 384 CRYSTAL RUN ROAD, SUITE 201, MIDDLETOWN, NY, 10941

Signature of
Role Plan administrator
Date 2023-10-13
Name of individual signing TARA RIVERA
TRI-STATE SURGICAL ASSOCIATES, PLLC 401(K) PLAN 2017 204679131 2018-05-17 TRI-STATE SURGICAL ASSOCIATES, PLLC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8456928780
Plan sponsor’s address 384 CRYSTAL RUN ROAD, SUITE 201, MIDDLETOWN, NY, 10941
TRI-STATE SURGICAL ASSOCIATES, PLLC 401(K) PLAN 2016 204679131 2017-08-30 TRI-STATE SURGICAL ASSOCIATES, PLLC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8456928780
Plan sponsor’s address 384 CRYSTAL RUN ROAD, SUITE 201, MIDDLETOWN, NY, 10941
TRI-STATE SURGICAL ASSOCIATES, PLLC 401(K) PLAN 2015 204679131 2016-06-30 TRI-STATE SURGICAL ASSOCIATES, PLLC 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8456928780
Plan sponsor’s address 384 CRYSTAL RUN ROAD, SUITE 201, MIDDLETOWN, NY, 10941
TRI-STATE SURGICAL ASSOCIATES, PLLC 401 (K) PLAN 2014 204679131 2015-01-20 TRI-STATE SURGICAL ASSOCIATES, PLLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8456928780
Plan sponsor’s address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941

Signature of
Role Plan administrator
Date 2015-01-20
Name of individual signing COURTNEY STEFFENS
TRI-STATE SURGICAL ASSOCIATES, PLLC 401 (K) PLAN 2013 204679131 2014-03-19 TRI-STATE SURGICAL ASSOCIATES, PLLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8456928780
Plan sponsor’s address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941

Signature of
Role Plan administrator
Date 2014-03-18
Name of individual signing COURTNEY STEFFENS
TRI-STATE SURGICAL ASSOCIATES, PLLC 401 (K) PLAN 2012 204679131 2013-08-08 TRI-STATE SURGICAL ASSOCIATES, PLLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8456928780
Plan sponsor’s address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941

Signature of
Role Plan administrator
Date 2013-08-08
Name of individual signing COURTNEY STEFFENS
TRI-STATE SURGICAL ASSOCIATES, PLLC 401 (K) PLAN 2011 204679131 2012-07-19 TRI-STATE SURGICAL ASSOCIATES, PLLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8456928780
Plan sponsor’s address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941

Plan administrator’s name and address
Administrator’s EIN 204679131
Plan administrator’s name TRI-STATE SURGICAL ASSOCIATES, PLLC
Plan administrator’s address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941
Administrator’s telephone number 8456928780

Signature of
Role Plan administrator
Date 2012-07-19
Name of individual signing COURTNEY STEFFENS
TRI-STATE SURGICAL ASSOCIATES, PLLC 401 (K) PLAN 2010 204679131 2011-04-07 TRI-STATE SURGICAL ASSOCIATES, PLLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8456928780
Plan sponsor’s address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941

Plan administrator’s name and address
Administrator’s EIN 204679131
Plan administrator’s name TRI-STATE SURGICAL ASSOCIATES, PLLC
Plan administrator’s address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941
Administrator’s telephone number 8456928780

Signature of
Role Plan administrator
Date 2011-04-07
Name of individual signing COURTNEY STEFFENS
TRI-STATE SURGICAL ASSOCIATES, PLLC 401 (K) PLAN 2009 204679131 2010-06-04 TRI-STATE SURGICAL ASSOCIATES, PLLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 8456928780
Plan sponsor’s address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941

Plan administrator’s name and address
Administrator’s EIN 204679131
Plan administrator’s name TRI-STATE SURGICAL ASSOCIATES, PLLC
Plan administrator’s address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941
Administrator’s telephone number 8456928780

Signature of
Role Plan administrator
Date 2010-06-04
Name of individual signing DANIELLE STEFFENS

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 384 CRYSTAL RUN ROAD, STE 201, MIDDLETOWN, NY, United States, 10941

History

Start date End date Type Value
2008-02-12 2010-03-12 Address 390 CRYSTAL RUN ROAD, SUITE 102, MIDDLETOWN, NY, 10941, USA (Type of address: Service of Process)
2006-02-17 2008-02-12 Address 15 JERSEY AVENUE, PORT JERVIS, NY, 12771, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
210414000116 2021-04-14 CERTIFICATE OF AMENDMENT 2021-04-14
200203060583 2020-02-03 BIENNIAL STATEMENT 2020-02-01
180206006110 2018-02-06 BIENNIAL STATEMENT 2018-02-01
160202006259 2016-02-02 BIENNIAL STATEMENT 2016-02-01
140212006302 2014-02-12 BIENNIAL STATEMENT 2014-02-01
120308002604 2012-03-08 BIENNIAL STATEMENT 2012-02-01
100312002892 2010-03-12 BIENNIAL STATEMENT 2010-02-01
080212002486 2008-02-12 BIENNIAL STATEMENT 2008-02-01
060427000799 2006-04-27 AFFIDAVIT OF PUBLICATION 2006-04-27
060427000795 2006-04-27 AFFIDAVIT OF PUBLICATION 2006-04-27

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Date of last update: 09 Nov 2024

Sources: New York Secretary of State

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