OPTIMUM CARE FAMILY MEDICINE 401(K) PROFIT SHARING PLAN & TRUST
|
2023
|
262870614
|
2024-04-04
|
OPTIMUM CARE FAMILY MEDICINE
|
10
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2017-01-02
|
Business code |
621111
|
Sponsor’s telephone number |
6318486798
|
Plan sponsor’s
address |
321 MIDDLE COUNTRY RD, SMITHTOWN, NY, 11787
|
Plan administrator’s name and address
Administrator’s EIN |
471637791 |
Plan administrator’s name |
ERISA FIDUCIARY SERVICES, INC. |
Plan administrator’s
address |
1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788 |
Administrator’s telephone number |
6312490500 |
Signature of
Role |
Plan administrator |
Date |
2024-04-04 |
Name of individual signing |
ANNA KAPSALIS-RAMBALAKOS MD |
|
|
OPTIMUM CARE FAMILY MEDICINE 401(K) PROFIT SHARING PLAN & TRUST
|
2022
|
262870614
|
2023-03-30
|
OPTIMUM CARE FAMILY MEDICINE
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2017-01-02
|
Business code |
621111
|
Sponsor’s telephone number |
6318486798
|
Plan sponsor’s
address |
321 MIDDLE COUNTRY RD, SMITHTOWN, NY, 11787
|
Plan administrator’s name and address
Administrator’s EIN |
471637791 |
Plan administrator’s name |
ERISA FIDUCIARY SERVICES, INC. |
Plan administrator’s
address |
1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788 |
Administrator’s telephone number |
6312490500 |
Signature of
Role |
Plan administrator |
Date |
2023-03-30 |
Name of individual signing |
ANNA KAPSALIS-RAMBALAKOS MD |
|
|
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN
|
2020
|
262870614
|
2021-03-29
|
OPTIMUM CARE FAMILY MEDICINE LLC
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2017-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
6312654606
|
Plan sponsor’s
address |
321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820
|
Signature of
Role |
Plan administrator |
Date |
2021-03-29 |
Name of individual signing |
ANTHONY WARD AS ATTORNEY |
|
|
OPTIMUM CARE FAMILY MEDICINE LLC PROFIT SHARING PLAN
|
2020
|
800433881
|
2021-08-03
|
OPTIMUM CARE FAMILY MEDICINE LLC
|
5
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2017-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
6312654606
|
Plan sponsor’s
address |
321 E MAIN ST STE 1, SMITHTOWN, NY, 117872820
|
Plan administrator’s name and address
Administrator’s EIN |
471637791 |
Plan administrator’s name |
ERISA FIDUCIARY SERVICES |
Plan administrator’s
address |
1373 VETERAN'S MEMORIAL HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788 |
Administrator’s telephone number |
6312490500 |
Signature of
Role |
Plan administrator |
Date |
2021-08-03 |
Name of individual signing |
ANTHONY WARD AS ATTORNEY |
|
|
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN
|
2020
|
262870614
|
2021-03-29
|
OPTIMUM CARE FAMILY MEDICINE LLC
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2017-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
6312654606
|
Plan sponsor’s
address |
321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820
|
Signature of
Role |
Plan administrator |
Date |
2021-03-29 |
Name of individual signing |
ANTHONY WARD AS ATTORNEY |
|
|
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN
|
2020
|
262870614
|
2021-03-29
|
OPTIMUM CARE FAMILY MEDICINE LLC
|
3
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2017-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
6312654606
|
Plan sponsor’s
address |
321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820
|
Signature of
Role |
Plan administrator |
Date |
2021-03-29 |
Name of individual signing |
ANTHONY WARD AS ATTORNEY |
|
|
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN
|
2020
|
262870614
|
2021-03-29
|
OPTIMUM CARE FAMILY MEDICINE LLC
|
3
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2017-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
6312654606
|
Plan sponsor’s
address |
321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820
|
Signature of
Role |
Plan administrator |
Date |
2021-03-29 |
Name of individual signing |
ANTHONY WARD AS ATTORNEY |
|
|
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN
|
2019
|
262870614
|
2021-03-29
|
OPTIMUM CARE FAMILY MEDICINE LLC
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2017-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
6312654606
|
Plan sponsor’s
address |
321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820
|
Signature of
Role |
Plan administrator |
Date |
2021-03-29 |
Name of individual signing |
ANTHONY WARD AS ATTORNEY |
|
|
OPTIMUM CARE FAMILY MEDICINE LLC 401K PENSION PLAN
|
2019
|
262870614
|
2020-09-29
|
OPTIMUM CARE FAMILY MEDICINE LLC
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2017-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
6312654606
|
Plan sponsor’s
address |
321 MIDDLE COUNTRY ROAD, SMITHTOWN, NY, 11787
|
Signature of
Role |
Plan administrator |
Date |
2020-09-28 |
Name of individual signing |
ANNA RAMBALAKOS |
|
|
OPTIMUM CARE FAMILY MEDICINE LLC 401K PENSION PLAN
|
2018
|
262870614
|
2020-09-28
|
OPTIMUM CARE FAMILY MEDICINE LLC
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2017-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
6312654606
|
Plan sponsor’s
address |
321 MIDDLE COUNTRY ROAD, SMITHTOWN, NY, 11787
|
Signature of
Role |
Plan administrator |
Date |
2020-09-28 |
Name of individual signing |
ANNA RAMBALAKOS |
|
|