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  5. CENTRAL SUFFOLK HOSPITAL

CENTRAL SUFFOLK HOSPITAL

Company Details

Name: CENTRAL SUFFOLK HOSPITAL
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 07 Nov 1945 (79 years ago)
Entity Number: 46179
ZIP code: 11901
County: Suffolk
Place of Formation: New York
Address: ATTENTION: PRESIDENT, 1300 ROANOKE AVENUE, RIVERHEAD, NY, United States, 11901

Contact Details

Phone +1 631-548-6000

Phone +1 631-245-6432

Phone +1 631-548-6101

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
CG83RZZR2Q89 2025-04-08 1 HEROES WAY, RIVERHEAD, NY, 11901, 2058, USA PECONIC BAY MEDICAL CENTER - PT. ACCOUNTING, 1 HEROES WAY, RIVERHEAD, NY, 11901, USA

Business Information
Division Name CENTRAL SUFFOLK HOSPITAL D.B.A. PECONIC BAY MEDICAL CENTER
Division Number CENTRAL SU
Congressional District 01
State/Country of Incorporation NY, USA
Activation Date 2024-04-10
Initial Registration Date 2022-07-05
Entity Start Date 1951-01-01
Fiscal Year End Close Date Dec 31

Points of Contacts
Electronic Business
Title PRIMARY POC
Name JACQUELINE MYRON
Role SENIOR MANAGER
Address 1 HEROES WAY, RIVERHEAD, NY, 11901, USA
Government Business
Title PRIMARY POC
Name DARRIAN GARAY
Role DIRECTOR
Address 1 HEROES WAY, RIVERHEAD, NY, 11901, USA
Past Performance Information not Available

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
3HX15 Obsolete Non-Manufacturer 2003-09-17 2024-03-03 No data 2023-04-07

Contact Information
POC DARRIEN GARAY
Phone +1 631-548-6820
Fax +1 631-548-6048
Address 1300 ROANOKE AVE, RIVERHEAD, NY, 11901 2031, 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
CENTRAL SUFFOLK HOSPITAL EMPLOYEE LIFE INSURANCE PLAN 2010 111661359 2011-10-17 CENTRAL SUFFOLK HOSPITAL 474
Three-digit plan number (PN) 501
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 474
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with incorrect/unrecognized electronic signature
CENTRAL SUFFOLK HOSPITAL EMPLOYEE MEDICAL PLAN 2010 111661359 2011-10-17 CENTRAL SUFFOLK HOSPITAL 381
Three-digit plan number (PN) 502
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 410
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with incorrect/unrecognized electronic signature
CENTRAL SUFFOLK HOSPITAL EMPLOYEE DENTAL PLAN 2010 111661359 2011-10-17 CENTRAL SUFFOLK HOSPITAL 407
Three-digit plan number (PN) 503
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 432
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with incorrect/unrecognized electronic signature
CENTRAL SUFFOLK HOSPITAL EMPLOYEE LIFE INSURANCE PLAN 2010 111661359 2011-10-17 CENTRAL SUFFOLK HOSPITAL 474
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 474
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with authorized/valid electronic signature
CENTRAL SUFFOLK HOSPITAL EMPLOYEE MEDICAL PLAN 2010 111661359 2011-10-17 CENTRAL SUFFOLK HOSPITAL 381
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 410
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with authorized/valid electronic signature
CENTRAL SUFFOLK HOSPITAL EMPLOYEE DENTAL PLAN 2010 111661359 2011-10-17 CENTRAL SUFFOLK HOSPITAL 407
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 432
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-17
Name of individual signing MONICA RAULS
Valid signature Filed with authorized/valid electronic signature
CENTRAL SUFFOLK HOSPITAL EMPLOYEE DENTAL PLAN 2010 111661359 2011-10-14 CENTRAL SUFFOLK HOSPITAL 407
Three-digit plan number (PN) 503
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 432
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing MONICA RAULS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2011-10-14
Name of individual signing MONICA RAULS
Valid signature Filed with incorrect/unrecognized electronic signature
CENTRAL SUFFOLK HOSPITAL EMPLOYEE DENTAL PLAN 2009 111661359 2010-10-06 CENTRAL SUFFOLK HOSPITAL 378
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 407
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-10-06
Name of individual signing GARY O'CONNOR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-06
Name of individual signing GARY O'CONNOR
Valid signature Filed with authorized/valid electronic signature
CENTRAL SUFFOLK HOSPITAL EMPLOYEE MEDICAL PLAN 2009 111661359 2010-10-06 CENTRAL SUFFOLK HOSPITAL 341
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 381
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-10-06
Name of individual signing GARY O'CONNOR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-06
Name of individual signing GARY O'CONNOR
Valid signature Filed with authorized/valid electronic signature
CENTRAL SUFFOLK HOSPITAL EMPLOYEE LIFE INSURANCE PLAN 2009 111661359 2010-10-06 CENTRAL SUFFOLK HOSPITAL 503
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1998-01-01
Business code 622000
Sponsor’s telephone number 6315486000
Plan sponsor’s mailing address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Plan sponsor’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031

Plan administrator’s name and address
Administrator’s EIN 111661359
Plan administrator’s name CENTRAL SUFFOLK HOSPITAL
Plan administrator’s address 1300 ROANOKE AVE, RIVERHEAD, NY, 119012031
Administrator’s telephone number 6315486000

Number of participants as of the end of the plan year
Active participants 474
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-10-06
Name of individual signing GARY O'CONNOR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-06
Name of individual signing GARY O'CONNOR
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CENTRAL SUFFOLK HOSPITAL ASSOCIATION Agent 1300 ROANOKE AVE., RIVERHEAD, NY

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent ATTENTION: PRESIDENT, 1300 ROANOKE AVENUE, RIVERHEAD, NY, United States, 11901

History

Start date End date Type Value
2015-12-10 2016-01-14 Address ATTENTION: PRESIDENT, 1300 ROANOKE AVENUE, RIVERHEAD, NY, 11901, USA (Type of address: Service of Process)
2009-04-02 2015-12-10 Address 1300 ROANOKE AVENUE, ATTN: PRESIDENT, RIVERHEAD, NY, 11901, USA (Type of address: Service of Process)
2006-06-09 2009-04-02 Address ATTN: PRESIDENT, 1300 ROANOKE AVENUE, RIVERHEAD, NY, 11901, USA (Type of address: Service of Process)
1998-12-14 2006-06-09 Address ATTN: PRESIDENT, 1300 ROANOKE AVE., RIVERHEAD, NY, 11901, USA (Type of address: Service of Process)
1982-12-31 1998-12-14 Address 1300 ROANOKE AVE., RIVERHEAD, NY, 11901, USA (Type of address: Service of Process)
1950-12-12 1975-04-04 Name CENTRAL SUFFOLK HOSPITAL ASSOCIATION
1945-11-07 1950-12-12 Name RIVERHEAD HOSPITAL ASSOCIATION

Filings

Filing Number Date Filed Type Effective Date
160114000327 2016-01-14 CERTIFICATE OF AMENDMENT 2016-01-14
151210000514 2015-12-10 CERTIFICATE OF AMENDMENT 2015-12-10
090402000709 2009-04-02 CERTIFICATE OF AMENDMENT 2009-04-02
060609000195 2006-06-09 CERTIFICATE OF AMENDMENT 2006-06-09
981214000289 1998-12-14 CERTIFICATE OF AMENDMENT 1998-12-14
C243610-2 1997-02-03 ASSUMED NAME CORP INITIAL FILING 1997-02-03
B533134-17 1987-08-13 CERTIFICATE OF MERGER 1987-08-13
A936448-7 1982-12-31 CERTIFICATE OF AMENDMENT 1982-12-31
A224670-5 1975-04-04 CERTIFICATE OF AMENDMENT 1975-04-04
A91650-3 1973-08-10 CERTIFICATE OF AMENDMENT 1973-08-10

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Related by address

No related companies by address

Date of last update: 17 Nov 2024

Sources: New York Secretary of State

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