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  5. CAYUGA MEDICAL CENTER AT ITHACA, INC.

CAYUGA MEDICAL CENTER AT ITHACA, INC.

Company Details

Name: CAYUGA MEDICAL CENTER AT ITHACA, INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 16 Dec 1980 (44 years ago)
Entity Number: 665555
ZIP code: 14850
County: Tompkins
Place of Formation: New York
Address: 101 DATES DRIVE, ITHACA, NY, United States, 14850

Contact Details

Phone +1 607-274-4385

Phone +1 607-274-4011

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
XQ13M2XEKT46 2025-01-24 101 DATES DR, ITHACA, NY, 14850, 1342, USA 101 DATES DR, ITHACA, NY, 14850, 1342, USA

Business Information
Congressional District 19
State/Country of Incorporation NY, USA
Activation Date 2024-02-08
Initial Registration Date 2004-06-09
Entity Start Date 1980-10-08
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 622110

Points of Contacts
Electronic Business
Title PRIMARY POC
Name MICHELLE BAY
Role CONTROLLER
Address 101 DATES DRIVE, ITHACA, NY, 14850, USA
Title ALTERNATE POC
Name REBECCA GOULD
Role CFO
Address 101 DATES DRIVE, ITHACA, NY, 14850, USA
Government Business
Title PRIMARY POC
Name REBECCA GOULD
Role CFO
Address 101 DATES DRIVE, ITHACA, NY, 14850, USA
Title ALTERNATE POC
Name MICHELLE BAY
Role CONTROLLER
Address 101 DATES DRIVE, ITHACA, NY, 14850, USA
Past Performance
Title PRIMARY POC
Name MEGHAN WITHEROW-HUNT
Role GRANT WRITER
Address 101 DATES DRIVE, ITHACA, NY, 14850, USA
Title ALTERNATE POC
Name CATHERINE DINH-LE
Role GRANTS COORDINATOR
Address 101 DATES DRIVE, ITHACA, NY, 14850, USA

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
3WSP4 Active Non-Manufacturer 2004-06-10 2024-03-11 2029-02-08 2025-01-24

Contact Information
POC REBECCA GOULD
Phone +1 607-535-7121
Address 101 DATES DR, ITHACA, TOMPKINS, NY, 14850 1342, 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
CAYUGA MEDICAL CENTER 403(B) PLAN (DC2) 2022 222325405 2023-10-13 CAYUGA MEDICAL CENTER AT ITHACA 51
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2021-12-01
Business code 621111
Sponsor’s telephone number 6072523908
Plan sponsor’s address 101 DATES DRIVE, ITHACA, NY, 14850

Signature of
Role Plan administrator
Date 2023-10-13
Name of individual signing REBECCA GOULD
GROUP LONG TERM DISABILITY 2022 222325405 2023-07-24 CAYUGA MEDICAL CENTER AT ITHACA 959
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6072744321
Plan sponsor’s mailing address 101 DATES DR, ITHACA, NY, 148501342
Plan sponsor’s address 101 DATES DR, ITHACA, NY, 148501342

Number of participants as of the end of the plan year
Active participants 978

Signature of
Role Plan administrator
Date 2023-07-24
Name of individual signing REBECCA GOULD
Valid signature Filed with authorized/valid electronic signature
LIFE INSURANCE AND AD&D PLAN 2022 222325405 2023-07-24 CAYUGA MEDICAL CENTER AT ITHACA 1270
File View Page
Three-digit plan number (PN) 504
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6072744321
Plan sponsor’s mailing address 101 DATES DR, ITHACA, NY, 148501342
Plan sponsor’s address 101 DATES DR, ITHACA, NY, 148501342

Number of participants as of the end of the plan year
Active participants 1320

Signature of
Role Plan administrator
Date 2023-07-24
Name of individual signing REBECCA GOULD
Valid signature Filed with authorized/valid electronic signature
DENTAL PLAN - SELF FUNDED 2022 222325405 2023-07-24 CAYUGA MEDICAL CENTER AT ITHACA 939
File View Page
Three-digit plan number (PN) 506
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6072744321
Plan sponsor’s mailing address 101 DATES DR, ITHACA, NY, 14850
Plan sponsor’s address 101 DATES DR, ITHACA, NY, 14850

Number of participants as of the end of the plan year
Active participants 924

Signature of
Role Plan administrator
Date 2023-07-24
Name of individual signing REBECCA GOULD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-24
Name of individual signing REBECCA GOULD
Valid signature Filed with authorized/valid electronic signature
CAYUGA MEDICAL CENTER AT ITHACA PREPAID HEALTH PLAN 2022 222325405 2023-07-24 CAYUGA MEDICAL CENTER AT ITHACA 981
File View Page
Three-digit plan number (PN) 507
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6072744321
Plan sponsor’s mailing address 101 DATES DR, ITHACA, NY, 148501342
Plan sponsor’s address 101 DATES DR, ITHACA, NY, 148501342

Number of participants as of the end of the plan year
Active participants 992

Signature of
Role Plan administrator
Date 2023-07-24
Name of individual signing REBECCA GOULD
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE CHOICE PLAN 2022 222325405 2023-07-20 CAYUGA MEDICAL CENTER AT ITHACA 402
File View Page
Three-digit plan number (PN) 505
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6072744321
Plan sponsor’s mailing address 101 DATES DR, ITHACA, NY, 148501342
Plan sponsor’s address 101 DATES DR, ITHACA, NY, 148501342

Number of participants as of the end of the plan year
Active participants 402

Signature of
Role Plan administrator
Date 2023-07-20
Name of individual signing REBECCA GOULD
Valid signature Filed with authorized/valid electronic signature
DENTAL PLAN - SELF FUNDED 2021 222325405 2022-07-06 CAYUGA MEDICAL CENTER AT ITHACA 922
File View Page
Three-digit plan number (PN) 506
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6072744321
Plan sponsor’s mailing address 101 DATES DR, ITHACA, NY, 14850
Plan sponsor’s address 101 DATES DR, ITHACA, NY, 14850

Number of participants as of the end of the plan year
Active participants 936
Retired or separated participants receiving benefits 3

Signature of
Role Plan administrator
Date 2022-07-06
Name of individual signing BRIAN FORREST
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE CHOICE PLAN 2021 222325405 2022-07-06 CAYUGA MEDICAL CENTER AT ITHACA 365
File View Page
Three-digit plan number (PN) 505
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6072744321
Plan sponsor’s mailing address 101 DATES DR, ITHACA, NY, 148501342
Plan sponsor’s address 101 DATES DR, ITHACA, NY, 148501342

Number of participants as of the end of the plan year
Active participants 367

Signature of
Role Plan administrator
Date 2022-07-06
Name of individual signing BRIAN FORREST
Valid signature Filed with authorized/valid electronic signature
GROUP LONG TERM DISABILITY 2021 222325405 2022-07-06 CAYUGA MEDICAL CENTER AT ITHACA 981
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6072744321
Plan sponsor’s mailing address 101 DATES DR, ITHACA, NY, 148501342
Plan sponsor’s address 101 DATES DR, ITHACA, NY, 148501342

Number of participants as of the end of the plan year
Active participants 959

Signature of
Role Plan administrator
Date 2022-07-06
Name of individual signing BRIAN FORREST
Valid signature Filed with authorized/valid electronic signature
LIFE INSURANCE AND AD&D PLAN 2021 222325405 2022-07-06 CAYUGA MEDICAL CENTER AT ITHACA 1653
File View Page
Three-digit plan number (PN) 504
Effective date of plan 2017-01-01
Business code 622000
Sponsor’s telephone number 6072744321
Plan sponsor’s mailing address 101 DATES DR, ITHACA, NY, 148501342
Plan sponsor’s address 101 DATES DR, ITHACA, NY, 148501342

Number of participants as of the end of the plan year
Active participants 1270

Signature of
Role Plan administrator
Date 2022-07-06
Name of individual signing BRIAN FORREST
Valid signature Filed with authorized/valid electronic signature

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 101 DATES DRIVE, ITHACA, NY, United States, 14850

History

Start date End date Type Value
1980-12-16 1997-04-08 Address 1285 TRUMANSBURG RD., ITHACA, NY, 14850, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
140930000687 2014-09-30 CERTIFICATE OF AMENDMENT 2014-09-30
970408000520 1997-04-08 CERTIFICATE OF AMENDMENT 1997-04-08
A723365-13 1980-12-16 CERTIFICATE OF INCORPORATION 1980-12-16

Awards

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
DO AWARD V528C84070 2007-10-01 2007-12-31 2007-12-31
Unique Award Key CONT_AWD_V528C84070_3600_V528A7P2268_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title CBOC IN CORTLAND COUNTY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q201: GENERAL HEALTH CARE SERVICES

Recipient Details
Recipient CAYUGA MEDICAL CENTER AT ITHACA INC
UEI XQ13M2XEKT46
Legacy DUNS 107741191
Recipient Address UNITED STATES, 101 DATES DR, ITHACA, 148501383
DO AWARD VA528C94047 2008-10-01 2008-12-31 2008-12-31
Unique Award Key CONT_AWD_VA528C94047_3600_V528A7P2268_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title CBOC IN CORTLAND COUNTY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q201: GENERAL HEALTH CARE SERVICES

Recipient Details
Recipient CAYUGA MEDICAL CENTER AT ITHACA INC
UEI XQ13M2XEKT46
Legacy DUNS 107741191
Recipient Address UNITED STATES, 101 DATES DR, ITHACA, 148501383
DO AWARD VA528C04072 2010-09-15 2010-09-30 2011-01-31
Unique Award Key CONT_AWD_VA528C04072_3600_V528A7P2268_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title CBOC IN CORTLAND - TOMPKINS COUNTY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q201: GENERAL HEALTH CARE SERVICES

Recipient Details
Recipient CAYUGA MEDICAL CENTER AT ITHACA INC
UEI XQ13M2XEKT46
Legacy DUNS 107741191
Recipient Address UNITED STATES, 101 DATES DR, ITHACA, 148501383
DO AWARD VA528C14026 2010-10-01 2011-01-31 2011-01-31
Unique Award Key CONT_AWD_VA528C14026_3600_V528A7P2268_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title CBOC IN CORTLAND/TOMPKINS COUNTY
NAICS Code 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Product and Service Codes Q201: GENERAL HEALTH CARE SERVICES

Recipient Details
Recipient CAYUGA MEDICAL CENTER AT ITHACA INC
UEI XQ13M2XEKT46
Legacy DUNS 107741191
Recipient Address UNITED STATES, 101 DATES DR, ITHACA, 148501383

Related by officers

THE CORPORATION

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Related by address

101 DATES DRIVE, ITHACA, NY, United States, 14850

CAP CONNECT, LLC CAYUGA ANESTHESIA ASSOCIATES, PLLC CAYUGA COMMUNITY SERVICES, INC. CAYUGA HEALTH MEDICAL SERVICES PLLC CAYUGA HOLDINGS, INC. CAYUGA INNOVATION LAB, LLC CAYUGA MEDICAL ASSOCIATES, P.C. CAYUGA MEDICAL CENTER AUXILIARY, INC. CAYUGA MEDICAL CENTER FOUNDATION

Date of last update: 16 Nov 2024

Sources: New York Secretary of State

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