ELLICOTTVILLE PHARMACY, INC, NY

Unique Entity ID

Expiration Date

Physical Address

Mailing Address

SAHGMPGR45B4

2025-01-19

6133 ROUTE 219 S STE 1004, ELLICOTTVILLE, NY, 14731, 9613, USA

6133 RT. 219, SUITE 1004, ELLICOTTVILLE, NY, 14731, 1004, USA

Business Information

Congressional District	23
State/Country of Incorporation	NY, USA
Activation Date	2024-01-23
Initial Registration Date	2011-09-08
Entity Start Date	1979-03-14
Fiscal Year End Close Date	Jun 30

Service Classifications

NAICS Codes

456110

Points of Contacts

Electronic Business
Title	PRIMARY POC
Name	ELLICOTTVILLE PHARMACY GILROY
Address	6133 RT. 219, SUITE 1004, ELLICOTTVILLE, NY, 14731, USA

Title	ALTERNATE POC
Name	ELLICOTTVILLE PHARMACY GILROY
Address	6133 RT. 219, SUITE 1004, ELLICOTTVILLE, NY, 14731, USA

Government Business
Title	PRIMARY POC
Name	ELLICOTTVILLE PHARMACY GILROY
Address	6133 RT. 219, SUITE 1004, ELLICOTTVILLE, NY, 14731, USA

Title	ALTERNATE POC
Name	ELLICOTTVILLE PHARMACY GILROY
Address	6133 RT. 219, SUITE 1004, ELLICOTTVILLE, NY, 14731, USA

Past Performance	Information not Available

Commercial and government entity program

CAGE number

Status

Type

Established

CAGE Update Date

CAGE Expiration

SAM Expiration

6J5R6

Active

Non-Manufacturer

2011-09-09

2024-03-12

2029-01-23

2025-01-19

Contact Information

POC	ELLICOTTVILLE PHARMACY GILROY
Phone	+1 716-699-2384
Fax	+1 716-699-5508
Address	6133 ROUTE 219 S STE 1004, ELLICOTTVILLE, NY, 14731 9613, 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

ELLICOTTVILLE PHARMACY INC 401(K) PROFIT SHARING PLAN & TRUST

2023

161148571

2024-05-03

ELLICOTTVILLE PHARMACY INC

9

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1995-01-01
Business code	446110
Sponsor’s telephone number	7166992300
Plan sponsor’s address	6133 ROUTE 219 STE 1004, ELLICOTTVILLE, NY, 147319613

Plan administrator’s name and address

Administrator’s EIN	471637791
Plan administrator’s name	ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address	1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number	6312490500

Signature of

Role	Plan administrator
Date	2024-05-03
Name of individual signing	ERISA FIDUCIARY SERVICES

ELLICOTTVILLE PHARMACY INC 401(K) PROFIT SHARING PLAN & TRUST

2022

161148571

2023-05-18

ELLICOTTVILLE PHARMACY INC

8

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1995-01-01
Business code	446110
Sponsor’s telephone number	7166992300
Plan sponsor’s address	6133 ROUTE 219 STE 1004, ELLICOTTVILLE, NY, 147319613

Plan administrator’s name and address

Administrator’s EIN	471637791
Plan administrator’s name	ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address	1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number	6312490500

Signature of

Role	Plan administrator
Date	2023-05-18
Name of individual signing	ERISA FIDUCIARY SERVICES INC

ELLICOTTVILLE PHARMACY INC 401(K) PROFIT SHARING PLAN & TRUST

2021

161148571

2022-07-04

ELLICOTTVILLE PHARMACY INC

9

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1995-01-01
Business code	446110
Sponsor’s telephone number	7166992300
Plan sponsor’s address	6133 ROUTE 219 STE 1004, ELLICOTTVILLE, NY, 147319613

Plan administrator’s name and address

Administrator’s EIN	471637791
Plan administrator’s name	ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address	1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number	6312490500

Signature of

Role	Plan administrator
Date	2022-07-04
Name of individual signing	ERISA FIDUCIARY SERVICES

ELLICOTTVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN

2012

161148571

2013-09-13

ELLICOTTVILLE PHARMACY INC

15

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1987-07-01
Business code	446110
Sponsor’s telephone number	7169452140
Plan sponsor’s mailing address	445 BROAD STREET, SALAMANCA, NY, 14779
Plan sponsor’s address	445 BROAD STREET, SALAMANCA, NY, 14779

Plan administrator’s name and address

Administrator’s EIN	161148571
Plan administrator’s name	ELLICOTTVILLE PHARMACY INC
Plan administrator’s address	445 BROAD STREET, SALAMANCA, NY, 14779
Administrator’s telephone number	7169452140

Number of participants as of the end of the plan year

Active participants	15
Retired or separated participants receiving benefits	1
Other retired or separated participants entitled to future benefits	1
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	16
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	2013-09-13
Name of individual signing	PETER ILLIG
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2013-09-13
Name of individual signing	PETER ILLIG
Valid signature	Filed with authorized/valid electronic signature

ELLICOTTVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN

2011

161148571

2012-09-28

ELLICOTTVILLE PHARMACY INC

16

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1987-07-01
Business code	446110
Sponsor’s telephone number	7169452140
Plan sponsor’s mailing address	445 BROAD STREET, SALAMANCA, NY, 14779
Plan sponsor’s address	445 BROAD STREET, SALAMANCA, NY, 14779

Plan administrator’s name and address

Administrator’s EIN	161148571
Plan administrator’s name	ELLICOTTVILLE PHARMACY INC
Plan administrator’s address	445 BROAD STREET, SALAMANCA, NY, 14779
Administrator’s telephone number	7169452140

Number of participants as of the end of the plan year

Active participants	14
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	1
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	15
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	2012-09-28
Name of individual signing	PETER ILLIG
Valid signature	Filed with authorized/valid electronic signature

ELLICOTTVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN

2010

161148571

2011-09-02

ELLICOTTVILLE PHARMACY INC

16

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1987-07-01
Business code	446110
Sponsor’s telephone number	7169452140
Plan sponsor’s mailing address	445 BROAD STREET, SALAMANCA, NY, 14779
Plan sponsor’s address	445 BROAD STREET, SALAMANCA, NY, 14779

Plan administrator’s name and address

Administrator’s EIN	161148571
Plan administrator’s name	ELLICOTTVILLE PHARMACY INC
Plan administrator’s address	445 BROAD STREET, SALAMANCA, NY, 14779
Administrator’s telephone number	7169452140

Number of participants as of the end of the plan year

Active participants	14
Retired or separated participants receiving benefits	1
Other retired or separated participants entitled to future benefits	1
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	16
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	2011-09-02
Name of individual signing	PETER ILLIG
Valid signature	Filed with authorized/valid electronic signature

ELLICOTTVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN

2009

161148571

2010-12-28

ELLICOTTVILLE PHARMACY INC

14

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1987-07-01
Business code	446110
Sponsor’s telephone number	7169452140
Plan sponsor’s mailing address	445 BROAD STREET, SALAMANCA, NY, 14779
Plan sponsor’s address	445 BROAD STREET, SALAMANCA, NY, 14779

Plan administrator’s name and address

Administrator’s EIN	161148571
Plan administrator’s name	ELLICOTTVILLE PHARMACY INC
Plan administrator’s address	445 BROAD STREET, SALAMANCA, NY, 14779
Administrator’s telephone number	7169452140

Number of participants as of the end of the plan year

Active participants	14
Retired or separated participants receiving benefits	1
Other retired or separated participants entitled to future benefits	1
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	14
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	2010-12-28
Name of individual signing	PETER ILLIG
Valid signature	Filed with authorized/valid electronic signature

Chief Executive Officer

Name	Role	Address
STEPHEN P WARD	Chief Executive Officer	6133 ROUTE 219, SUITE 1004, ELLICOTTVILLE, NY, United States, 14731

DOS Process Agent

Name	Role	Address
THE CORPORATION	DOS Process Agent	6133 ROUTE 219, SUITE 1004, ELLICOTTVILLE, NY, United States, 14731

History

Start date	End date	Type	Value
2006-09-06	2008-09-15	Address	6133 ROUTE 219, SUITE 1004, ELLICOTTVILLE, NY, 14731, 0368, USA (Type of address: Service of Process)
2006-09-06	2008-09-15	Address	6133 ROUTE 219, SUITE 1004, ELLICOTTVILLE, NY, 14731, 0368, USA (Type of address: Chief Executive Officer)
2006-09-06	2008-09-15	Address	6133 ROUTE 219, SUITE 1004, ELLICOTTVILLE, NY, 14731, 0368, USA (Type of address: Principal Executive Office)
1998-09-15	2006-09-06	Address	13 WASHINGTON, PO BOX 368, ELLICOTTVILLE, NY, 14731, 0368, USA (Type of address: Service of Process)
1998-09-15	2006-09-06	Address	13 WASHINGTON, PO BOX 368, ELLICOTTVILLE, NY, 14731, 0368, USA (Type of address: Principal Executive Office)
1998-09-15	2006-09-06	Address	13 WASHINGTON, PO BOX 368, ELLICOTTVILLE, NY, 14731, 0368, USA (Type of address: Chief Executive Officer)
1993-04-28	1998-09-15	Address	7 WASHINGTON STREET, PO BOX 368, ELLICOTTVILLE, NY, 14731, 0368, USA (Type of address: Chief Executive Officer)
1993-04-28	1998-09-15	Address	7 WASHINGTON STREET, PO BOX 368, ELLICOTTVILLE, NY, 14731, 0368, USA (Type of address: Principal Executive Office)
1993-04-28	1998-09-15	Address	7 WASHINGTON STREET, PO BOX 368, ELLICOTTVILLE, NY, 14731, 0368, USA (Type of address: Service of Process)
1980-09-08	1993-04-28	Address	7 WASHINGTON ST., ELLICOTTVILLE, NY, 14731, USA (Type of address: Service of Process)

Filings

Filing Number	Date Filed	Type	Effective Date
140904006416	2014-09-04	BIENNIAL STATEMENT	2014-09-01
120906006227	2012-09-06	BIENNIAL STATEMENT	2012-09-01
100922002327	2010-09-22	BIENNIAL STATEMENT	2010-09-01
080915002048	2008-09-15	BIENNIAL STATEMENT	2008-09-01
060906002605	2006-09-06	BIENNIAL STATEMENT	2006-09-01
041015002415	2004-10-15	BIENNIAL STATEMENT	2004-09-01
020820002028	2002-08-20	BIENNIAL STATEMENT	2002-09-01
000905002399	2000-09-05	BIENNIAL STATEMENT	2000-09-01
980915002150	1998-09-15	BIENNIAL STATEMENT	1998-09-01
960904002022	1996-09-04	BIENNIAL STATEMENT	1996-09-01
930428003453	1993-04-28	BIENNIAL STATEMENT	1992-09-01
A696736-4	1980-09-08	CERTIFICATE OF INCORPORATION	1980-09-08

Name:	ELLICOTTVILLE PHARMACY, INC.
Jurisdiction:	New York
Legal type:	DOMESTIC BUSINESS CORPORATION
Status:	Active
Date of registration:	08 Sep 1980 (44 years ago)
Entity Number:	649504
ZIP code:	14731
County:	Cattaraugus
Place of Formation:	New York
Address:	6133 ROUTE 219, SUITE 1004, ELLICOTTVILLE, NY, United States, 14731

ELLICOTTVILLE PHARMACY, INC.

Company Details

Unique Entity ID

Commercial and government entity program

form 5500

Chief Executive Officer

DOS Process Agent

History

Filings

Related by officers

Related by address