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  5. ITHACA MEDICAL GROUP, PLLC

ITHACA MEDICAL GROUP, PLLC

Company Details

Name: ITHACA MEDICAL GROUP, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 25 Oct 2017 (7 years ago)
Entity Number: 5223877
ZIP code: 14852
County: Cayuga
Place of Formation: New York
Address: P.O. BOX 4507, ITHACA, NY, United States, 14852

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ITHACA MEDICAL GROUP, PLLC 401(K) PLAN 2023 823223382 2024-07-23 ITHACA MEDICAL GROUP, PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 6072797970
Plan sponsor’s address PO BOX 4507, ITHACA, NY, 14852

Signature of
Role Plan administrator
Date 2024-07-23
Name of individual signing DR. TIMOTHY BAEL
Role Employer/plan sponsor
Date 2024-07-23
Name of individual signing ITHACA MEDICAL GROUP
ITHACA MEDICAL GROUP, PLLC 401(K) PLAN 2022 823223382 2023-07-18 ITHACA MEDICAL GROUP, PLLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 6072797970
Plan sponsor’s address PO BOX 4507, ITHACA, NY, 14852

Signature of
Role Plan administrator
Date 2023-07-18
Name of individual signing DR. TIMOTHY BAEL
Role Employer/plan sponsor
Date 2023-07-18
Name of individual signing ITHACA MEDICAL GROUP
ITHACA MEDICAL GROUP, PLLC 401(K) PLAN 2021 823223382 2022-10-17 ITHACA MEDICAL GROUP, PLLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 6072797970
Plan sponsor’s address PO BOX 4507, ITHACA, NY, 14852

Signature of
Role Plan administrator
Date 2022-10-17
Name of individual signing DR. TIMOTHY BAEL
Role Employer/plan sponsor
Date 2022-10-17
Name of individual signing ITHACA MEDICAL GROUP
ITHACA MEDICAL GROUP, PLLC 401(K) PLAN 2020 823223382 2021-10-05 ITHACA MEDICAL GROUP, PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 6072797970
Plan sponsor’s address PO BOX 4507, ITHACA, NY, 14852

Signature of
Role Plan administrator
Date 2021-10-05
Name of individual signing DR. TIMOTHY BAEL
Role Employer/plan sponsor
Date 2021-10-05
Name of individual signing DR. TIMOTHY BAEL
ITHACA MEDICAL GROUP, PLLC 401(K) PLAN 2019 823223382 2020-07-14 ITHACA MEDICAL GROUP, PLLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 6072797970
Plan sponsor’s address PO BOX 4507, ITHACA, NY, 14852

Signature of
Role Plan administrator
Date 2020-07-14
Name of individual signing DR. TIMOTHY BAEL
Role Employer/plan sponsor
Date 2020-07-14
Name of individual signing DR. TIMOTHY BAEL
ITHACA MEDICAL GROUP, PLLC 401(K) PLAN 2018 823223382 2019-08-25 ITHACA MEDICAL GROUP, PLLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-01-01
Business code 621111
Sponsor’s telephone number 6072797970
Plan sponsor’s address PO BOX 4507, ITHACA, NY, 14852

Signature of
Role Plan administrator
Date 2019-08-25
Name of individual signing DR. TIMOTHY BAEL
Role Employer/plan sponsor
Date 2019-08-25
Name of individual signing DR. TIMOTHY BAEL
ITHACA MEDICAL GROUP 401(K) PLAN 2012 020546465 2013-09-27 ITHACA MEDICAL GROUP 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6072725414
Plan sponsor’s address 201 HARRIS B. DATES DRIVE SUITE 102, ITHACA, NY, 14850

Signature of
Role Plan administrator
Date 2013-09-27
Name of individual signing CHARLES GARBO
ITHACA MEDICAL GROUP 401(K) PLAN 2012 020546465 2013-10-04 ITHACA MEDICAL GROUP 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6072725414
Plan sponsor’s address 201 HARRIS B. DATES DRIVE, SUITE 102, ITHACA, NY, 14850

Signature of
Role Plan administrator
Date 2013-10-04
Name of individual signing CHARLES GARBO
ITHACA MEDICAL GROUP 401(K) PLAN 2011 020546465 2012-08-20 ITHACA MEDICAL GROUP 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6072725414
Plan sponsor’s address 201 HARRIS B. DATES DRIVE, SUITE 102, ITHACA, NY, 14850

Plan administrator’s name and address
Administrator’s EIN 020546465
Plan administrator’s name ITHACA MEDICAL GROUP
Plan administrator’s address 201 HARRIS B. DATES DRIVE, SUITE 102, ITHACA, NY, 14850
Administrator’s telephone number 6072725414

Signature of
Role Plan administrator
Date 2012-08-20
Name of individual signing CHARLES GARBO
ITHACA MEDICAL GROUP 401(K) PLAN 2010 020546465 2011-06-27 ITHACA MEDICAL GROUP 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 6072725414
Plan sponsor’s address 201 HARRIS B. DATES DRIVE, SUITE 102, ITHACA, NY, 14850

Plan administrator’s name and address
Administrator’s EIN 020546465
Plan administrator’s name ITHACA MEDICAL GROUP
Plan administrator’s address 201 HARRIS B. DATES DRIVE, SUITE 102, ITHACA, NY, 14850
Administrator’s telephone number 6072725414

Signature of
Role Plan administrator
Date 2011-06-27
Name of individual signing LORI MIGNOT

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent P.O. BOX 4507, ITHACA, NY, United States, 14852

History

Start date End date Type Value
2017-10-25 2020-01-13 Address 878 HIGHLAND ROAD, ITHACA, NY, 14850, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
200113000011 2020-01-13 CERTIFICATE OF CHANGE 2020-01-13
180205000288 2018-02-05 CERTIFICATE OF PUBLICATION 2018-02-05
180110000249 2018-01-10 CERTIFICATE OF AMENDMENT 2018-01-10
171025000458 2017-10-25 ARTICLES OF ORGANIZATION 2017-10-25

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Date of last update: 23 Nov 2024

Sources: New York Secretary of State

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