HARRY JACKSON, M.D., P.C.

Company Details

Name:	HARRY JACKSON, M.D., P.C.
Jurisdiction:	New York
Legal type:	DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status:	Active
Date of registration:	09 Jun 1983 (41 years ago)
Entity Number:	847516
County:	Kings
Place of Formation:	New York
Address:	395 CLAFLEN AVE., MAMARONECK, NY, United States, 10543
Address ZIP Code:	10543

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

HARRY JACKSON, M.D., P.C. DEFINED BENEFIT PLAN

2012

061089689

2013-10-15

HARRY JACKSON, M.D., P.C.

4

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2000-01-01
Business code	621399
Sponsor’s telephone number	7186012329
Plan sponsor’s address	2600 NETHERLAND AVENUE, SUITE 716, RIVERDALE, NY, 10463

Signature of

Role	Plan administrator
Date	2013-10-15
Name of individual signing	HARRY JACKSON

Role	Employer/plan sponsor
Date	2013-10-15
Name of individual signing	HARRY JACKSON

HARRY JACKSON, M.D., P.C. DEFINED BENEFIT PLAN

2011

061089689

2012-10-08

HARRY JACKSON, M.D., P.C.

4

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2000-01-01
Business code	621399
Sponsor’s telephone number	7186012329
Plan sponsor’s address	2600 NETHERLAND AVENUE, SUITE 716, RIVERDALE, NY, 10463

Plan administrator’s name and address

Administrator’s EIN	061089689
Plan administrator’s name	HARRY JACKSON, M.D., P.C.
Plan administrator’s address	2600 NETHERLAND AVENUE, SUITE 716, RIVERDALE, NY, 10463
Administrator’s telephone number	7186012329

Signature of

Role	Plan administrator
Date	2012-10-08
Name of individual signing	HARRY JACKSON

Role	Employer/plan sponsor
Date	2012-10-08
Name of individual signing	HARRY JACKSON

HARRY JACKSON, M.D., P.C. DEFINED BENEFIT PLAN

2010

061089689

2011-10-16

HARRY JACKSON, M.D., P.C.

3

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2000-01-01
Business code	621399
Sponsor’s telephone number	7186012329
Plan sponsor’s address	2600 NETHERLAND AVENUE, SUITE 716, RIVERDALE, NY, 10463

Plan administrator’s name and address

Administrator’s EIN	061089689
Plan administrator’s name	HARRY JACKSON, M.D., P.C.
Plan administrator’s address	2600 NETHERLAND AVENUE, SUITE 716, RIVERDALE, NY, 10463
Administrator’s telephone number	7186012329

Signature of

Role	Plan administrator
Date	2011-10-14
Name of individual signing	HARRY JACKSON MD

Role	Employer/plan sponsor
Date	2011-10-14
Name of individual signing	HARRY JACKSON MD

HARRY JACKSON, M.D., P.C. DEFINED BENEFIT PLAN

2009

061089689

2010-09-07

HARRY JACKSON, M.D., P.C.

3

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	2000-01-01
Business code	621399
Sponsor’s telephone number	7186012329
Plan sponsor’s address	2600 NETHERLAND AVENUE, SUITE 716, RIVERDALE, NY, 10463

Plan administrator’s name and address

Administrator’s EIN	061089689
Plan administrator’s name	HARRY JACKSON, M.D., P.C.
Plan administrator’s address	2600 NETHERLAND AVENUE, SUITE 716, RIVERDALE, NY, 10463
Administrator’s telephone number	7186012329

Signature of

Role	Plan administrator
Date	2010-09-06
Name of individual signing	HARRY JACKSON

Role	Employer/plan sponsor
Date	2010-09-06
Name of individual signing	HARRY JACKSON

DOS Process Agent

Name	Role	Address
HARRY JACKSON	DOS Process Agent	395 CLAFLEN AVE., MAMARONECK, NY, United States, 10543

Filings

Filing Number	Date Filed	Type	Effective Date
A988428-5	1983-06-09	CERTIFICATE OF INCORPORATION	1983-06-09

Date of last update: 16 Nov 2024

Sources: New York Secretary of State