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  5. JACOBSON AND CHUBAK ENDODONTICS PLLC

JACOBSON AND CHUBAK ENDODONTICS PLLC

Company Details

Name: JACOBSON AND CHUBAK ENDODONTICS PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 24 Oct 2014 (10 years ago)
Entity Number: 4655797
ZIP code: 10019
County: New York
Place of Formation: New York
Address: 200 West 57th Street, STE 808, NEW YORK, NY, United States, 10019

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JACOBSON AND CHUBAK ENDODONTICS 401(K) PLAN 2023 472179018 2024-05-08 JACOBSON AND CHUBAK ENDODONTICS PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 2127376112
Plan sponsor’s address 200 WEST 57TH STREET, SUITE 808, NEW YORK, NY, 10019

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-05-08
Name of individual signing QIAN LIU
JACOBSON AND CHUBAK ENDODONTICS CASH BALANCE PLAN 2023 472179018 2024-08-29 JACOBSON AND CHUBAK ENDODONTICS, PLLC 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2023-01-01
Business code 621210
Sponsor’s telephone number 2127376112
Plan sponsor’s address 200 W. 57TH ST SUITE 808, NEW YORK, NY, 10019
JACOBSON AND CHUBAK ENDODONTICS 401(K) PLAN 2022 472179018 2023-05-27 JACOBSON AND CHUBAK ENDODONTICS PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 2127376112
Plan sponsor’s address 200 WEST 57TH STREET, SUITE 808, NEW YORK, NY, 10019

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2023-05-26
Name of individual signing CHRISTINE RIMER
JACOBSON AND CHUBAK ENDODONTICS 401(K) PLAN 2021 472179018 2022-05-31 JACOBSON AND CHUBAK ENDODONTICS PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 2127376112
Plan sponsor’s address 200 WEST 57TH STREET, SUITE 808, NEW YORK, NY, 10019

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2022-05-31
Name of individual signing CHRISTINE RIMER
JACOBSON AND CHUBAK ENDODONTICS 401(K) PLAN 2020 472179018 2021-06-08 JACOBSON AND CHUBAK ENDODONTICS PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 2127376112
Plan sponsor’s address 200 WEST 57TH STREET, SUITE 808, NEW YORK, NY, 10019

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-06-07
Name of individual signing CAROL HO
JACOBSON AND CHUBAK ENDODONTICS 401(K) PLAN 2019 472179018 2020-07-11 JACOBSON AND CHUBAK ENDODONTICS PLLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621210
Sponsor’s telephone number 2127376112
Plan sponsor’s address 200 WEST 57TH STREET, SUITE 810, NEW YORK, NY, 10019

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-07-11
Name of individual signing CAROL HO

DOS Process Agent

Name Role Address
JACOBSON AND CHUBAK ENDODONTICS PLLC DOS Process Agent 200 West 57th Street, STE 808, NEW YORK, NY, United States, 10019

History

Start date End date Type Value
2014-10-24 2023-08-07 Address 30 EAST 60TH STREET, UNIT 608, NEW YORK, NY, 10022, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
230807002056 2023-08-07 BIENNIAL STATEMENT 2022-10-01
220801000332 2022-08-01 BIENNIAL STATEMENT 2020-10-01
150113000434 2015-01-13 CERTIFICATE OF CHANGE 2015-01-13
141231000612 2014-12-31 CERTIFICATE OF PUBLICATION 2014-12-31
141024000016 2014-10-24 ARTICLES OF ORGANIZATION 2014-10-24

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 24 Nov 2024

Sources: New York Secretary of State

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