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  5. UPSTATE UROLOGY, INC.

UPSTATE UROLOGY, INC.

Company Details

Name: UPSTATE UROLOGY, INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION (UNIVERSITY FACULTY PRACTICE CORPORATION)
Status: Active
Date of registration: 16 Jul 2008 (16 years ago)
Entity Number: 3696873
ZIP code: 13210
County: Onondaga
Place of Formation: New York
Address: 750 EAST ADAMS STREET, SYRACUSE, NY, United States, 13210

Contact Details

Phone +1 315-361-1041

Phone +1 315-464-6060

Phone +1 315-464-6106

Phone +1 315-551-6003

Phone +1 315-464-1500

Phone +1 315-492-3700

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
5CXB3 Active Non-Manufacturer 2009-03-19 2024-03-10 2025-04-14 2021-10-07

Contact Information
POC MATTHEW HUTZ
Phone +1 315-464-8282
Address 750 E ADAMS ST, SYRACUSE, NY, 13210 2306, UNITED STATES

Ownership of Offeror Information
Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
UPSTATE UROLOGY, INC. 401(A) PROFIT SHARING PLAN & TRUST 2023 262993919 2024-10-11 UPSTATE UROLOGY, INC. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 3154648282
Plan sponsor’s address 750 EAST ADAMS STREET, CWB #230, SYRACUSE, NY, 13210

Signature of
Role Plan administrator
Date 2024-10-11
Name of individual signing GENNADY BRATSLAVSKY
Valid signature Filed with authorized/valid electronic signature
UPSTATE UROLOGY, INC. 401(A) PROFIT SHARING PLAN & TRUST 2022 262993919 2023-10-05 UPSTATE UROLOGY, INC. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 3154648282
Plan sponsor’s address 750 EAST ADAMS STREET, CWB #230, SYRACUSE, NY, 13210

Signature of
Role Plan administrator
Date 2023-10-05
Name of individual signing GENNADY BRATSLAVSKY
UPSTATE UROLOGY, INC. 401(A) PROFIT SHARING PLAN & TRUST 2021 262993919 2022-10-11 UPSTATE UROLOGY, INC. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 3154648282
Plan sponsor’s address 750 EAST ADAMS STREET, CWB #230, SYRACUSE, NY, 13210

Signature of
Role Plan administrator
Date 2022-10-11
Name of individual signing GENNADY BRATSLAVSKY
UPSTATE UROLOGY, INC. 401(A) PROFIT SHARING PLAN & TRUST 2020 262993919 2021-10-08 UPSTATE UROLOGY, INC. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 3154648282
Plan sponsor’s address 750 EAST ADAMS STREET, CWB #230, SYRACUSE, NY, 13210

Signature of
Role Plan administrator
Date 2021-10-08
Name of individual signing GENNADY BRATSLAVSKY
UPSTATE UROLOGY, INC. 401(A) PROFIT SHARING PLAN & TRUST 2019 262993919 2020-10-15 UPSTATE UROLOGY, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 3154648282
Plan sponsor’s address 750 EAST ADAMS STREET, CWB #230, SYRACUSE, NY, 13210

Signature of
Role Plan administrator
Date 2020-10-15
Name of individual signing GENNADY BRATSLAVSKY
UPSTATE UROLOGY 401(K) PLAN 2018 141806334 2020-08-31 UPSTATE UROLOGY 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5188525403
Plan sponsor’s address 1365 WASHINGTON AVE., SUITE 102, ALBANY, NY, 12206

Signature of
Role Plan administrator
Date 2020-08-31
Name of individual signing JERI LYN GILCHREST
Role Employer/plan sponsor
Date 2020-08-31
Name of individual signing JERI LYN GILCHREST
UPSTATE UROLOGY, INC. 401(A) PROFIT SHARING PLAN & TRUST 2018 262993919 2019-10-11 UPSTATE UROLOGY, INC. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 3154648282
Plan sponsor’s address 750 EAST ADAMS STREET, CWB #230, SYRACUSE, NY, 13210

Signature of
Role Plan administrator
Date 2019-10-11
Name of individual signing GENNADY BRATSLAVSKY
UPSTATE UROLOGY 401(K) PLAN 2017 141806334 2018-10-04 UPSTATE UROLOGY 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5188525403
Plan sponsor’s address 1365 WASHINGTON AVE., SUITE 102, ALBANY, NY, 12206

Signature of
Role Plan administrator
Date 2018-10-04
Name of individual signing JERI LYN GILCHREST
Role Employer/plan sponsor
Date 2018-10-04
Name of individual signing JERI LYN GILCHREST
UPSTATE UROLOGY 401(K) PLAN 2017 141806334 2018-11-14 UPSTATE UROLOGY 7
Three-digit plan number (PN) 002
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5188525403
Plan sponsor’s address 1365 WASHINGTON AVE., SUITE 102, ALBANY, NY, 12206

Signature of
Role Plan administrator
Date 2018-11-14
Name of individual signing JERI LYN GILCHREST
Role Employer/plan sponsor
Date 2018-11-14
Name of individual signing JERI LYN GILCHREST
UPSTATE UROLOGY 401(K) PLAN 2017 141806334 2020-08-26 UPSTATE UROLOGY 7
Three-digit plan number (PN) 002
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 5188525403
Plan sponsor’s address 1365 WASHINGTON AVE., SUITE 102, ALBANY, NY, 12206

Signature of
Role Plan administrator
Date 2020-08-26
Name of individual signing JERI LYN GILCHREST
Role Employer/plan sponsor
Date 2020-08-26
Name of individual signing JERI LYN GILCHREST

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 750 EAST ADAMS STREET, SYRACUSE, NY, United States, 13210

History

Start date End date Type Value
2008-07-16 2009-10-28 Address 750 EAST ADAMS STREET, SYRACUSE, NY, 13210, 1834, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
091028000800 2009-10-28 CERTIFICATE OF AMENDMENT 2009-10-28
080716000437 2008-07-16 CERTIFICATE OF INCORPORATION 2008-07-16

Awards

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
DO AWARD VA528C94240 2009-07-01 2009-09-30 2010-12-31
Unique Award Key CONT_AWD_VA528C94240_3600_VA528P0570_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title UROLOGY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q525: UROLOGY SERVICES

Recipient Details
Recipient UPSTATE UROLOGY, INC.
UEI XDCCNLVRC136
Legacy DUNS 828482021
Recipient Address UNITED STATES, 750 E ADAMS ST, SYRACUSE, 132102342
No data IDV VA528P0570 2009-07-01 No data No data
Unique Award Key CONT_IDV_VA528P0570_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title UROLOGY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q525: UROLOGY SERVICES

Recipient Details
Recipient UPSTATE UROLOGY, INC.
UEI XDCCNLVRC136
Legacy DUNS 828482021
Recipient Address UNITED STATES, 750 E ADAMS ST, SYRACUSE, 132102342
PO AWARD VA528C94165 2009-01-01 2009-04-30 2009-04-30
Unique Award Key CONT_AWD_VA528C94165_3600_-NONE-_-NONE-
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title UROLOGY SERVICES
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q525: UROLOGY SERVICES

Recipient Details
Recipient UPSTATE UROLOGY, INC.
UEI XDCCNLVRC136
Legacy DUNS 828482021
Recipient Address UNITED STATES, 750 E ADAMS ST, SYRACUSE, 132102342
DO AWARD VA528C04057 2010-07-01 2010-09-30 2010-09-30
Unique Award Key CONT_AWD_VA528C04057_3600_VA528P0570_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title UROLOGY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q525: UROLOGY SERVICES

Recipient Details
Recipient UPSTATE UROLOGY, INC.
UEI XDCCNLVRC136
Legacy DUNS 828482021
Recipient Address UNITED STATES, 750 E ADAMS ST, SYRACUSE, 132102342
DO AWARD VA528C14088 2011-07-22 2011-09-30 2011-09-30
Unique Award Key CONT_AWD_VA528C14088_3600_VA528P0570_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title UROLOGY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q525: UROLOGY SERVICES

Recipient Details
Recipient UPSTATE UROLOGY, INC.
UEI XDCCNLVRC136
Legacy DUNS 828482021
Recipient Address UNITED STATES, 750 E ADAMS ST, SYRACUSE, 132102342
DO AWARD VA52812J0229 2012-09-25 2012-09-30 2016-05-31
Unique Award Key CONT_AWD_VA52812J0229_3600_VA52812D0004_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title UROLOGY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q525: MEDICAL- UROLOGY

Recipient Details
Recipient UPSTATE UROLOGY, INC.
UEI XDCCNLVRC136
Legacy DUNS 828482021
Recipient Address UNITED STATES OF AMERICA, 750 E ADAMS ST, SYRACUSE, ONONDAGA, NEW YORK, 13210
DO AWARD VA52812J0102 2012-07-03 2011-11-30 2011-11-30
Unique Award Key CONT_AWD_VA52812J0102_3600_VA528P0570_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title UROLOGY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q525: MEDICAL- UROLOGY

Recipient Details
Recipient UPSTATE UROLOGY, INC.
UEI XDCCNLVRC136
Legacy DUNS 828482021
Recipient Address UNITED STATES, 750 E ADAMS ST, SYRACUSE, 132102342
No data IDV VA52812D0004 2011-12-01 No data No data
Unique Award Key CONT_IDV_VA52812D0004_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title UROLOGY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q525: MEDICAL- UROLOGY

Recipient Details
Recipient UPSTATE UROLOGY, INC.
UEI XDCCNLVRC136
Legacy DUNS 828482021
Recipient Address UNITED STATES OF AMERICA, 750 E ADAMS ST, SYRACUSE, ONONDAGA, NEW YORK, 13210

Related by officers

THE CORPORATION

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Related by address

750 EAST ADAMS STREET, SYRACUSE, NY, United States, 13210

EMERGENCY MEDICINE ASSOCIATES IPA, INC. NEUROSURGICAL MEDICAL ASSOCIATES OF CENTRAL NEW YORK, LLP PHYSICAL MEDICINE & REHABILITATION MEDICAL SERVICES GROUP, LLP SUNY HEALTH SCIENCE CENTER AT SYRACUSE COLLEGE OF HEALTH RELATED PROFESSIONS ALUMNI ASSOCIATION, INC. NEUROSURGICAL RESEARCH AND EDUCATION MEMORIAL FUND, INC. UPSTATE MEDICAL ANESTHESIOLOGY GROUP, INC. UPSTATE MEDICAL ANESTHESIOLOGY RESEARCH CORPORATION UPSTATE PROPERTIES DEVELOPMENT, INC. REHABILITATION/SPORTS/MEDICINE CNY, PLLC

Date of last update: 26 Nov 2024

Sources: New York Secretary of State

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