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SELF-IMAGE, INC.

Company Details

Name: SELF-IMAGE, INC.
Jurisdiction: New York
Legal type: DOMESTIC BUSINESS CORPORATION
Status: Active
Date of registration: 19 May 1978 (46 years ago)
Entity Number: 490042
County: Suffolk
Place of Formation: New York
Address: 171 PARK AVENUE, AMITYVILLE, NY, United States, 11701
Address ZIP Code: 11701
Principal Address: 180 BROADWAY, AMITYVILLE, NY, United States, 11701
Principal Address ZIP Code: 11701

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SELF IMAGE INC 401K PROFIT SHARING PLAN AND TRUST 2023 112465245 2024-09-06 SELF IMAGE INC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 446190
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVLLE, NY, 11701

Signature of
Role Plan administrator
Date 2024-09-06
Name of individual signing THOMAS URRARO
Valid signature Filed with authorized/valid electronic signature
SELF IMAGE INC 401K PROFIT SHARING PLAN AND TRUST 2022 112465245 2023-07-10 SELF IMAGE INC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 446190
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVLLE, NY, 11701

Signature of
Role Plan administrator
Date 2023-07-10
Name of individual signing THOMAS URRARO
SELF IMAGE INC 401K PROFIT SHARING PLAN AND TRUST 2021 112465245 2022-06-09 SELF IMAGE INC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 446190
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVLLE, NY, 11701

Signature of
Role Plan administrator
Date 2022-06-09
Name of individual signing THOMAS URRARO
SELF IMAGE INC 401K PROFIT SHARING PLAN AND TRUST 2020 112465245 2021-07-10 SELF IMAGE INC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 446190
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVLLE, NY, 11701

Signature of
Role Plan administrator
Date 2021-07-10
Name of individual signing THOMAS URRARO
SELF IMAGE INC 401K PROFIT SHARING PLAN AND TRUST 2019 112465245 2020-07-09 SELF IMAGE INC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 446190
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVLLE, NY, 11701

Signature of
Role Plan administrator
Date 2020-07-09
Name of individual signing THOMAS URRARO
SELF IMAGE INC 401K PROFIT SHARING PLAN AND TRUST 2018 112465245 2019-09-19 SELF IMAGE INC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 446190
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVLLE, NY, 11701

Signature of
Role Plan administrator
Date 2019-09-19
Name of individual signing THOMAS URRARO
SELF IMAGE INC 401K PROFIT SHARING PLAN AND TRUST 2017 112465245 2018-06-15 SELF IMAGE INC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 446190
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVLLE, NY, 11701

Signature of
Role Plan administrator
Date 2018-06-15
Name of individual signing THOMAS URRARO
SELF IMAGE INC 401 K PROFIT SHARING PLAN TRUST 2016 112465245 2017-05-11 SELF IMAGE INC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 812112
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVILLE, NY, 11701

Signature of
Role Plan administrator
Date 2017-05-11
Name of individual signing THOMAS URRARO
SELF IMAGE, INC. 401 K PROFIT SHARING PLAN TRUST 2015 112465245 2016-06-09 SELF IMAGE INC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 812112
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVILLE, NY, 11701

Signature of
Role Plan administrator
Date 2016-06-09
Name of individual signing THOMAS URRARO
SELF IMAGE, INC. 401(K) PLAN 2013 112465245 2014-07-02 SELF IMAGE, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 812112
Sponsor’s telephone number 6315983055
Plan sponsor’s address 180 BROADWAY, AMITYVILLE, NY, 11701

Plan administrator’s name and address
Administrator’s EIN 112465245
Plan administrator’s name SELF IMAGE, INC.
Plan administrator’s address 180 BROADWAY, AMITYVILLE, NY, 11701
Administrator’s telephone number 6315983055

Signature of
Role Plan administrator
Date 2014-07-02
Name of individual signing THOMAS URRARO

Chief Executive Officer

Name Role Address
THOMAS URRARO Chief Executive Officer 180 BROADWAY, AMITYVILLE, NY, United States, 11701

DOS Process Agent

Name Role Address
JOHN PATAFIO (ATTORNEY) DOS Process Agent 171 PARK AVENUE, AMITYVILLE, NY, United States, 11701

Licenses

Number Type Date End date Address
21SE1337509 Appearance Enhancement Business License 2009-07-30 2027-07-30 180 BROADWAY, AMITYVILLE, NY, 11701

History

Start date End date Type Value
1996-05-31 2012-08-13 Address 390 GARIBALDI AVE, COPIAGUE, NY, 11726, USA (Type of address: Chief Executive Officer)
1996-05-31 2012-08-13 Address 390 GARIBALDI AVE, COPIAGUE, NY, 11726, USA (Type of address: Principal Executive Office)
1978-05-19 2012-08-13 Address 125-10 QUEENS BLVD., KEW GARDENS, NY, 11415, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
20140812061 2014-08-12 ASSUMED NAME LLC INITIAL FILING 2014-08-12
120813002452 2012-08-13 BIENNIAL STATEMENT 2012-05-01
961025000533 1996-10-25 ERRONEOUS ENTRY 1996-10-25
DP-1305175 1996-09-25 DISSOLUTION BY PROCLAMATION 1996-09-25
960531002026 1996-05-31 BIENNIAL STATEMENT 1996-05-01
A487939-3 1978-05-19 CERTIFICATE OF INCORPORATION 1978-05-19

Related by officers

THOMAS URRARO

BROADWAY AMITY REALTY CORP.

Related by address

171 PARK AVENUE, AMITYVILLE, NY, United States, 11701

NORTH AMITYVILLE HOUSING REHABILITATION ASSOC., INC. THE LAW OFFICES OF JOHN T. PATAFIO P.C. EDWARD L. HOWLETTE, P.C. & ASSOCIATES MASSAPEQUA COMMUNITY FUND, INC.

180 BROADWAY, AMITYVILLE, NY, United States, 11701

BROADWAY AMITY REALTY CORP. TRANQUIL TOUCH, INC.

Date of last update: 29 Oct 2024

Sources: New York Secretary of State

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