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  5. CLOVE LAKES E.N.T., P.C.

CLOVE LAKES E.N.T., P.C.

Company Details

Name: CLOVE LAKES E.N.T., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 09 Aug 1979 (45 years ago)
Entity Number: 574565
ZIP code: 10301
County: Richmond
Place of Formation: New York
Address: 1414 VICTORY BLVD, STATEN ISLAND, NY, United States, 10301

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
CLOVE LAKES E.N.T., P.C. 401(K) PROFIT SHARING PLAN 2023 132994907 2024-05-31 CLOVE LAKES E.N.T., P.C. 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9175967063
Plan sponsor’s address 1414 VICTORY BLVD, STATEN ISLAND, NY, 10301

Signature of
Role Plan administrator
Date 2024-05-31
Name of individual signing HELEN KIM
CLOVE LAKES E.N.T. P.C. DEFINED BENEFIT PENSION PLAN 2023 132994907 2024-09-27 CLOVE LAKES E.N.T., P.C. 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 7184471261
Plan sponsor’s address 1414 VICTORY BLVD., STATEN ISLAND, NY, 103013908

Signature of
Role Plan administrator
Date 2024-09-27
Name of individual signing CHARLES WESTFALL
Valid signature Filed with authorized/valid electronic signature
CLOVE LAKES E.N.T., P.C. 401(K) PROFIT SHARING PLAN 2022 132994907 2023-06-14 CLOVE LAKES E.N.T., P.C. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9175967063
Plan sponsor’s address 1414 VICTORY BLVD, STATEN ISLAND, NY, 10301

Signature of
Role Plan administrator
Date 2023-06-14
Name of individual signing HELEN KIM
CLOVE LAKES E.N.T. P.C. DEFINED BENEFIT PENSION PLAN 2022 132994907 2023-10-16 CLOVE LAKES E.N.T., P.C. 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 7184471261
Plan sponsor’s address 1414 VICTORY BLVD., STATEN ISLAND, NY, 103013908

Signature of
Role Plan administrator
Date 2023-10-16
Name of individual signing CHARLES WESTFALL
CLOVE LAKES E.N.T., P.C. 401(K) PROFIT SHARING PLAN 2021 132994907 2022-06-15 CLOVE LAKES E.N.T., P.C. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9175967063
Plan sponsor’s address 1414 VICTORY BLVD, STATEN ISLAND, NY, 10301

Signature of
Role Plan administrator
Date 2022-06-15
Name of individual signing HELEN KIM
CLOVE LAKES E.N.T. P.C. DEFINED BENEFIT PENSION PLAN 2021 132994907 2022-09-21 CLOVE LAKES E.N.T., P.C. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 7184471261
Plan sponsor’s address 1414 VICTORY BLVD., STATEN ISLAND, NY, 103013908

Signature of
Role Plan administrator
Date 2022-09-21
Name of individual signing CHARLES WESTFALL
CLOVE LAKES E.N.T. P.C. DEFINED BENEFIT PENSION PLAN 2020 132994907 2021-10-08 CLOVE LAKES E.N.T., P.C. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 7184471261
Plan sponsor’s address 1414 VICTORY BLVD., STATEN ISLAND, NY, 103013908

Signature of
Role Plan administrator
Date 2021-10-08
Name of individual signing CHARLES WESTFALL
CLOVE LAKES E.N.T., P.C. 401(K) PROFIT SHARING PLAN 2020 132994907 2021-06-14 CLOVE LAKES E.N.T., P.C. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9175967063
Plan sponsor’s address 1414 VICTORY BLVD, STATEN ISLAND, NY, 10301

Signature of
Role Plan administrator
Date 2021-06-14
Name of individual signing HELEN KIM
CLOVE LAKES E.N.T., P.C. 401(K) PROFIT SHARING PLAN 2019 132994907 2020-06-30 CLOVE LAKES E.N.T., P.C. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 9175967063
Plan sponsor’s address 1414 VICTORY BLVD, STATEN ISLAND, NY, 10301

Signature of
Role Plan administrator
Date 2020-06-30
Name of individual signing HELEN KIM
CLOVE LAKES E.N.T. P.C. DEFINED BENEFIT PENSION PLAN 2019 132994907 2020-10-14 CLOVE LAKES E.N.T., P.C. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 7184471261
Plan sponsor’s address 1414 VICTORY BLVD., STATEN ISLAND, NY, 103013908

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing CHARLES WESTFALL

Chief Executive Officer

Name Role Address
HELEN H KIM, MD Chief Executive Officer 1414 VICTORY BLVD, STATEN ISLAND, NY, United States, 10301

DOS Process Agent

Name Role Address
HELEN H KIM MD DOS Process Agent 1414 VICTORY BLVD, STATEN ISLAND, NY, United States, 10301

History

Start date End date Type Value
2024-05-13 2024-05-29 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-05-13 2024-05-13 Address 1414 VICTORY BLVD, STATEN ISLAND, NY, 10301, USA (Type of address: Chief Executive Officer)
2007-08-16 2024-05-13 Address 1414 VICTORY BLVD, STATEN ISLAND, NY, 10301, USA (Type of address: Service of Process)
2007-08-16 2024-05-13 Address 1414 VICTORY BLVD, STATEN ISLAND, NY, 10301, USA (Type of address: Chief Executive Officer)
2001-08-14 2007-08-16 Address 1460 VICTORY BLVD, STATEN ISLAND, NY, 10301, USA (Type of address: Principal Executive Office)
1993-04-01 2001-08-14 Address 1460 VICTORY BOULEVARD, STATEN ISLAND, NY, 10301, USA (Type of address: Principal Executive Office)
1993-04-01 2007-08-16 Address 1460 VICTORY BOULEVARD, STATEN ISLAND, NY, 10301, USA (Type of address: Chief Executive Officer)
1993-04-01 2007-08-16 Address 1460 VICTORY BOULEVARD, STATEN ISLAND, NY, 10301, USA (Type of address: Service of Process)
1979-08-09 2024-05-13 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
1979-08-09 1993-04-01 Address 1460 VICTORY BLVD, STATEN ISLAND, NY, 10301, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
240513003649 2024-05-13 BIENNIAL STATEMENT 2024-05-13
20201116113 2020-11-16 ASSUMED NAME LLC INITIAL FILING 2020-11-16
190809060002 2019-08-09 BIENNIAL STATEMENT 2019-08-01
170803007396 2017-08-03 BIENNIAL STATEMENT 2017-08-01
150805006336 2015-08-05 BIENNIAL STATEMENT 2015-08-01
130806006106 2013-08-06 BIENNIAL STATEMENT 2013-08-01
110809003044 2011-08-09 BIENNIAL STATEMENT 2011-08-01
090810002688 2009-08-10 BIENNIAL STATEMENT 2009-08-01
070816002986 2007-08-16 BIENNIAL STATEMENT 2007-08-01
050210000475 2005-02-10 CERTIFICATE OF AMENDMENT 2005-02-10

Related by officers

No related officers

Related by address

1414 VICTORY BLVD, STATEN ISLAND, NY, United States, 10301

CLOVE LAKES LASER CENTER, INC.

Date of last update: 16 Nov 2024

Sources: New York Secretary of State

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