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  5. ELLIOT W. JACOBS, M.D., P.C.

ELLIOT W. JACOBS, M.D., P.C.

Company Details

Name: ELLIOT W. JACOBS, M.D., P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 19 Nov 1980 (44 years ago)
Entity Number: 664068
ZIP code: 33418
County: New York
Place of Formation: New York
Address: 6491 EASTPOINTE PINES STREET, PALM BEACH GARDENS, FL, United States, 33418

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
ELLIOT W. JACOBS M. D. P. C. 401(K) SAVINGS PLAN 2019 133053333 2021-05-27 ELLIOT W. JACOBS, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2014-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Signature of
Role Plan administrator
Date 2021-05-27
Name of individual signing ELLIOT W. JACOBS
ELLIOT W. JACOBS, M. D. , P. C. 401(K) SAVINGS PLAN 2018 133053333 2020-05-26 ELLIOT W. JACOBS, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2014-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Signature of
Role Plan administrator
Date 2020-05-26
Name of individual signing ELLIOT W JACOBS
ELLIOT W. JACOBS, M. D. , P. C. 401(K) SAVINGS PLAN 2017 133053333 2019-03-18 ELLIOT W. JACOBS, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2014-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Signature of
Role Plan administrator
Date 2019-03-18
Name of individual signing ELLIOT W JACOBS
ELLIOT W. JACOBS, M. D. , P. C. 401(K) SAVINGS PLAN 2016 133053333 2018-05-31 ELLIOT W. JACOBS, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2014-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Signature of
Role Plan administrator
Date 2018-05-31
Name of individual signing ELLIOT W JACOBS
ELLIOT W. JACOBS, M. D. , P. C. 401(K) SAVINGS PLAN 2015 133053333 2017-05-16 ELLIOT W. JACOBS, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2014-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Signature of
Role Plan administrator
Date 2017-05-16
Name of individual signing ELLIOT W JACOBS
ELLIOT W. JACOBS, M.D., P.C. DEFINED BENEFIT PLAN 2014 133053333 2016-03-24 ELLIOT W. JACOBS, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Signature of
Role Plan administrator
Date 2016-03-24
Name of individual signing ELLIOT W. JACOBS
Role Employer/plan sponsor
Date 2016-03-24
Name of individual signing ELLIOT W. JACOBS
ELLIOT W. JACOBS, M. D. , P. C. 401(K) SAVINGS PLAN 2014 133053333 2016-03-30 ELLIOT W. JACOBS, M.D., P.C. 0
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2014-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Signature of
Role Plan administrator
Date 2016-03-30
Name of individual signing ELLIOT W JACOBS
ELLIOT W. JACOBS, M.D., P.C. DEFINED BENEFIT PLAN 2013 133053333 2015-05-04 ELLIOT W. JACOBS, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Signature of
Role Plan administrator
Date 2015-05-04
Name of individual signing ELLIOT W. JACOBS
Role Employer/plan sponsor
Date 2015-05-04
Name of individual signing ELLIOT W. JACOBS
ELLIOT W. JACOBS, M.D., P.C. DEFINED BENEFIT PENS 2012 133053333 2014-04-02 ELLIOT W. JACOBS, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Signature of
Role Plan administrator
Date 2014-04-02
Name of individual signing ELLIOT W. JACOBS
Role Employer/plan sponsor
Date 2014-04-02
Name of individual signing ELLIOT W. JACOBS
ELLIOT W. JACOBS, M.D., P.C. DEFINED BENEFIT PENS 2011 133053333 2013-05-29 ELLIOT W. JACOBS, M.D., P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-11-01
Business code 621111
Sponsor’s telephone number 2125706080
Plan sponsor’s address 815 PARK AVENUE, NEW YORK, NY, 10021

Plan administrator’s name and address
Administrator’s EIN 133053333
Plan administrator’s name ELLIOT W. JACOBS, M.D., P.C.
Plan administrator’s address 815 PARK AVENUE, NEW YORK, NY, 10021
Administrator’s telephone number 2125706080

Signature of
Role Plan administrator
Date 2013-05-29
Name of individual signing ELLIOT W. JACOBS
Role Employer/plan sponsor
Date 2013-05-29
Name of individual signing ELLIOT W. JACOBS

Chief Executive Officer

Name Role Address
ELLIOT W. JACOBS, M.D. Chief Executive Officer 6491 EASTPOINTE PINES STREET, PALM BEACH GARDENS, FL, United States, 33418

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 6491 EASTPOINTE PINES STREET, PALM BEACH GARDENS, FL, United States, 33418

History

Start date End date Type Value
2024-11-01 2024-11-01 Address 815 PARK AVENUE, NEW YORK, NY, 10021, USA (Type of address: Chief Executive Officer)
2024-11-01 2024-11-01 Address 6491 EASTPOINTE PINES STREET, PALM BEACH GARDENS, FL, 33418, USA (Type of address: Chief Executive Officer)
2023-11-13 2023-11-13 Address 6491 EASTPOINTE PINES STREET, PALM BEACH GARDENS, FL, 33418, USA (Type of address: Chief Executive Officer)
2023-11-13 2024-11-01 Address 6491 EASTPOINTE PINES STREET, PALM BEACH GARDENS, FL, 33418, USA (Type of address: Chief Executive Officer)
2023-11-13 2024-11-01 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2023-11-13 2024-11-01 Address 6491 EASTPOINTE PINES STREET, PALM BEACH GARDENS, FL, 33418, USA (Type of address: Service of Process)
2023-11-13 2023-11-13 Address 815 PARK AVENUE, NEW YORK, NY, 10021, USA (Type of address: Chief Executive Officer)
2004-12-09 2023-11-13 Address 815 PARK AVE, NEW YORK, NY, 10021, USA (Type of address: Service of Process)
1993-05-21 2004-12-09 Address 815 PARK AVENUE, NEW YORK, NY, 10021, USA (Type of address: Service of Process)
1993-05-21 2004-12-09 Address 815 PARK AVENUE, NEW YORK, NY, 10021, USA (Type of address: Principal Executive Office)

Filings

Filing Number Date Filed Type Effective Date
241101035911 2024-11-01 BIENNIAL STATEMENT 2024-11-01
231113002399 2023-11-13 BIENNIAL STATEMENT 2022-11-01
201102061541 2020-11-02 BIENNIAL STATEMENT 2020-11-01
181101006101 2018-11-01 BIENNIAL STATEMENT 2018-11-01
161110006389 2016-11-10 BIENNIAL STATEMENT 2016-11-01
141106006505 2014-11-06 BIENNIAL STATEMENT 2014-11-01
121115006440 2012-11-15 BIENNIAL STATEMENT 2012-11-01
101105002548 2010-11-05 BIENNIAL STATEMENT 2010-11-01
081027002471 2008-10-27 BIENNIAL STATEMENT 2008-11-01
061024002548 2006-10-24 BIENNIAL STATEMENT 2006-11-01

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THE CORPORATION

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Related by address

No related companies by address

Date of last update: 16 Nov 2024

Sources: New York Secretary of State

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