Entity Number 3579295
Status Active
NameCHURCHVILLE-CHILI FAMILY MEDICINE, LLC
CountyMonroe
Date of registration 12 Oct 2007 (17 years ago) 12 Oct 2007
Legal typeDOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Place of FormationNew York
Address 4201 BUFFALO RD, PO BOX 505, NORTH CHILI, NY, United States, 14514
Address ZIP code 14514
CHURCHVILLE-CHILI FAMILY MEDICINE 401(K) PLAN
2022
464927775
2023-10-16
CHURCHVILLE-CHILI FAMILY MEDICINE
27
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | 4201 BUFFALO ROAD, PO BOX 505, NORTH CHILI, NY, 145140505 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-16 |
| Name of individual signing | ADELE VAN DER VYVER |
CHURCHVILLE-CHILI FAMILY MEDICINE 401(K) PLAN
2021
464927775
2022-07-11
CHURCHVILLE-CHILI FAMILY MEDICINE
23
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | 4201 BUFFALO ROAD, P.O. BOX 505, NORTH CHILI, NY, 14514 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-11 |
| Name of individual signing | ADELE VAN DER VYVER |
CHURCHVILLE-CHILI FAMILY MEDICINE 401(K) PLAN
2020
464927775
2021-07-27
CHURCHVILLE-CHILI FAMILY MEDICINE
20
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | P.O. BOX 505, NORTH CHILI, NY, 14514 |
Signature of
| Role | Plan administrator |
| Date | 2021-07-27 |
| Name of individual signing | ADELE VAN DER VYVER |
CHURCHVILLE-CHILI FAMILY MEDICINE 401(K) PLAN
2019
464927775
2021-07-26
CHURCHVILLE-CHILI FAMILY MEDICINE
19
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | PO BOX 505, NORTH CHILI, NY, 14514 |
Signature of
| Role | Plan administrator |
| Date | 2021-07-26 |
| Name of individual signing | ADELE VAN DER VYVER |
CHURCHVILLE-CHILI FAMILY MEDICINE 401(K) PLAN
2019
161576149
2020-07-17
CHURCHVILLE-CHILI FAMILY MEDICINE
19
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | PO BOX 505, NORTH CHILI, NY, 14514 |
Signature of
| Role | Plan administrator |
| Date | 2020-07-17 |
| Name of individual signing | ADELE VAN DER VYVER |
| Role | Employer/plan sponsor |
| Date | 2020-07-17 |
| Name of individual signing | ADELE VAN DER VYVER |
CHURCHVILLE-CHILI FAMILY MEDICINE 401(K) PLAN
2018
161576149
2019-07-24
CHURCHVILLE-CHILI FAMILY MEDICINE LLC
20
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | 4201 BUFFALO ROAD, P.O. BOX 505, NORTH CHILI, NY, 14514 |
Signature of
| Role | Plan administrator |
| Date | 2019-07-24 |
| Name of individual signing | ADELE VAN DER VYVER |
CHURCHVILLE-CHILI FAMILY MEDICINE 401(K) PLAN
2018
464927775
2019-07-25
CHURCHVILLE-CHILI FAMILY MEDICINE LLC
20
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | 4201 BUFFALO ROAD, P.O. BOX 505, NORTH CHILI, NY, 14514 |
Signature of
| Role | Plan administrator |
| Date | 2019-07-25 |
| Name of individual signing | ADELE VAN DER VYVER |
CHURCHVILLE-CHILI FAMILY MEDICINE 401(K) PLAN
2017
464927775
2018-07-12
CHURCHVILLE-CHILI FAMILY MEDICINE LLC
13
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | 4201 BUFFALO ROAD, P.O. BOX 505, NORTH CHILI, NY, 14514 |
Signature of
| Role | Plan administrator |
| Date | 2018-07-12 |
| Name of individual signing | ADELE VAN DER VYVER |
CHURCHVILLE CHILI FAM. MED. PLAN
2016
464927775
2017-06-16
CHURCHVILLE CHILI FAMILY MEDICINE
6
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | PO BOX 505, NORTH CHILI, NY, 14514 |
Signature of
| Role | Plan administrator |
| Date | 2017-06-16 |
| Name of individual signing | ADELE VAN DER VYVER |
CHURCHVILLE CHILI FAM. MED. PLAN
2015
464927775
2016-06-08
CHURCHVILLE CHILI FAMILY MEDICINE
5
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-09-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 5855945995 |
| Plan sponsor’s address | PO BOX 505, NORTH CHILI, NY, 14514 |
Signature of
| Role | Plan administrator |
| Date | 2016-06-08 |
| Name of individual signing | ADELE VAN DER VYVER |
HENRY PASZKO, M.D.
Agent
4201 BUFFALO ROAD, NORTH CHILI, NY, 14514
(DELETE THE HYPHEN) CHURCHVILLE CHILI FAMILY MEDICINE, LLC
DOS Process Agent
4201 BUFFALO RD, PO BOX 505, NORTH CHILI, NY, United States, 14514
2013-10-17
2023-10-02
Address
4201 BUFFALO RD, PO BOX 505, NORTH CHILI, NY, 14514, USA (Type of address: Service of Process)
2009-10-21
2013-10-17
Address
4201 BUFFALO RD, PO BOX 505, NORTH CHILI, NY, 14514, USA (Type of address: Service of Process)
2007-10-12
2023-10-02
Address
4201 BUFFALO ROAD, NORTH CHILI, NY, 14514, USA (Type of address: Registered Agent)
2007-10-12
2009-10-21
Address
4201 BUFFALO ROAD, NORTH CHILI, NY, 14514, USA (Type of address: Service of Process)
231002000609
2023-10-02
BIENNIAL STATEMENT
2023-10-01
211020001082
2021-10-20
BIENNIAL STATEMENT
2021-10-20
191003060243
2019-10-03
BIENNIAL STATEMENT
2019-10-01
171010006047
2017-10-10
BIENNIAL STATEMENT
2017-10-01
151016006215
2015-10-16
BIENNIAL STATEMENT
2015-10-01
131017006685
2013-10-17
BIENNIAL STATEMENT
2013-10-01
111031002350
2011-10-31
BIENNIAL STATEMENT
2011-10-01
091021002662
2009-10-21
BIENNIAL STATEMENT
2009-10-01
080102000574
2008-01-02
CERTIFICATE OF PUBLICATION
2008-01-02
071012000273
2007-10-12
ARTICLES OF ORGANIZATION
2007-10-12
Date of last update: 30 Jul 2024
Sources: Companies info , Historical Data , Complaints , Contacts
