PENFIELD COUNTRY CLUB, INC, NY

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

ETF ADVISOR K MEP

2021

160834954

2022-07-19

PENFIELD COUNTRY CLUB

32

File	View Page
Three-digit plan number (PN)	336
Effective date of plan	2014-01-01
Business code	713900
Sponsor’s telephone number	5853771240
Plan sponsor’s address	1784 JACKSON RD., PENFIELD, NY, 14526

Plan administrator’s name and address

Administrator’s EIN	813799174
Plan administrator’s name	FIDUCIARY WISE, LLC
Plan administrator’s address	2487 SOUTH GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number	4808554017

Signature of

Role	Plan administrator
Date	2022-07-19
Name of individual signing	KRISTI DALLEY

ETF ADVISOR K MEP

2020

160834954

2021-07-07

PENFIELD COUNTRY CLUB

53

File	View Page
Three-digit plan number (PN)	336
Effective date of plan	2014-01-01
Business code	713900
Sponsor’s telephone number	5853771240
Plan sponsor’s address	1784 JACKSON RD., PENFIELD, NY, 14526

Plan administrator’s name and address

Administrator’s EIN	813799174
Plan administrator’s name	FIDUCIARY WISE, LLC
Plan administrator’s address	2487 SOUTH GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number	4808554017

Signature of

Role	Plan administrator
Date	2021-07-07
Name of individual signing	KRISTI DALLEY

ETF ADVISOR K MEP

2019

160834954

2020-07-24

PENFIELD COUNTRY CLUB

57

File	View Page
Three-digit plan number (PN)	336
Effective date of plan	2014-01-01
Business code	713900
Sponsor’s telephone number	5853771240
Plan sponsor’s address	1784 JACKSON RD., PENFIELD, NY, 14526

Plan administrator’s name and address

Administrator’s EIN	813799174
Plan administrator’s name	FIDUCIARY WISE, LLC
Plan administrator’s address	2487 SOUTH GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number	4808554017

Signature of

Role	Plan administrator
Date	2020-07-24
Name of individual signing	KRISTI DALLEY

ETF ADVISOR K MEP

2018

160834954

2019-06-17

PENFIELD COUNTRY CLUB

37

File	View Page
Three-digit plan number (PN)	336
Effective date of plan	2014-01-01
Business code	713900
Sponsor’s telephone number	5853771240
Plan sponsor’s address	1784 JACKSON RD., PENFIELD, NY, 14526

Plan administrator’s name and address

Administrator’s EIN	813799174
Plan administrator’s name	FIDUCIARY WISE, LLC
Plan administrator’s address	2487 SOUTH GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number	4808554017

Signature of

Role	Plan administrator
Date	2019-06-17
Name of individual signing	KRISTI DALLEY

ETF ADVISOR K MEP

2017

160834954

2018-07-03

PENFIELD COUNTRY CLUB

25

File	View Page
Three-digit plan number (PN)	336
Effective date of plan	2014-01-01
Business code	713900
Sponsor’s telephone number	5853771240
Plan sponsor’s address	1784 JACKSON RD., PENFIELD, NY, 14526

Plan administrator’s name and address

Administrator’s EIN	813799174
Plan administrator’s name	FIDUCIARY WISE, LLC
Plan administrator’s address	2487 SOUTH GILBERT ROAD, SUITE 106-455, GILBERT, AZ, 85295
Administrator’s telephone number	4808554017

Signature of

Role	Plan administrator
Date	2018-07-03
Name of individual signing	T R BICK

Agent

Name	Role	Address
PENFIELD COUNTRY CLUB, INC.	Agent	P.O. BOX 66, PENFIELD, NY, 14526

Licenses

Number	Type	Date	Last renew date	End date	Address	Description
0426-24-309121	Alcohol sale	2024-04-04	2024-04-04	2024-10-31	1784 JACKSON RD, PENFIELD, NY, 14526	Additional Bar-Seasonal
0426-24-309119	Alcohol sale	2024-04-04	2024-04-04	2024-10-31	1784 JACKSON RD, PENFIELD, NY, 14526	Additional Bar-Seasonal
0426-24-309122	Alcohol sale	2024-04-04	2024-04-04	2024-10-31	1784 JACKSON RD, PENFIELD, NY, 14526	Additional Bar-Seasonal
0349-22-317613	Alcohol sale	2022-09-21	2022-09-21	2024-09-30	1784 JACKSON RD, PENFIELD, New York, 14526	Club
0423-22-303735	Alcohol sale	2022-09-21	2022-09-21	2024-09-30	1784 JACKSON RD, PENFIELD, New York, 14526	Additional Bar

Filings

Filing Number	Date Filed	Type	Effective Date
B290121-2	1985-11-19	ASSUMED NAME CORP INITIAL FILING	1985-11-19
A47426-2	1973-02-05	CERTIFICATE OF AMENDMENT	1973-02-05
118795	1958-08-08	CERTIFICATE OF INCORPORATION	1958-08-08

Inspections

Date	Inspection Object	Address	Grade	Type	Institution	Desctiption
2024-11-08	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	12E - Handwashing facilities inaccessible, improperly located, dirty, in disrepair, improper fixtures, soap, and single service towels or hand drying devices missing
2024-10-23	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	15A - Floors, walls, ceilings, not smooth, properly constructed, in disrepair, dirty surfaces
2024-05-30	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	12E - Handwashing facilities inaccessible, improperly located, dirty, in disrepair, improper fixtures, soap, and single service towels or hand drying devices missing
2024-05-08	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	12E - Handwashing facilities inaccessible, improperly located, dirty, in disrepair, improper fixtures, soap, and single service towels or hand drying devices missing
2023-09-28	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	10B - Non-food contact surfaces and equipment are improperly designed, constructed, installed, maintained (equipment not readily accessible for cleaning, surface not smooth finish)
2023-06-28	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	10B - Non-food contact surfaces and equipment are improperly designed, constructed, installed, maintained (equipment not readily accessible for cleaning, surface not smooth finish)
2023-06-09	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	8B - In use food dispensing utensils improperly stored
2022-01-19	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	10A - Food (ice) contact surfaces are improperly designed, constructed, installed, located (cracks, open seams, pitted surfaces, tin cans reused, uncleanable or corroded food contact surfaces)
2021-10-08	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	10B - Non-food contact surfaces and equipment are improperly designed, constructed, installed, maintained (equipment not readily accessible for cleaning, surface not smooth finish)
2020-10-14	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	15B - Lighting and ventilation inadequate, fixtures not shielded, dirty ventilation hoods, ductwork, filters, exhaust fans
2019-12-04	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	8E - Accurate thermometers not available or used to evaluate refrigerated or heated storage temperatures
2019-05-21	No data	1784 JACKSON ROAD, PENFIELD	Critical Violation	Food Service Establishment Inspections	New York State Department of Health	1C - Home canned goods, or canned goods from unapproved processor found on premises
2018-12-13	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	11D - Non food contact surfaces of equipment not clean
2018-05-25	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	15A - Floors, walls, ceilings, not smooth, properly constructed, in disrepair, dirty surfaces
2017-07-31	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	15B - Lighting and ventilation inadequate, fixtures not shielded, dirty ventilation hoods, ductwork, filters, exhaust fans
2016-06-08	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	12E - Handwashing facilities inaccessible, improperly located, dirty, in disrepair, improper fixtures, soap, and single service towels or hand drying devices missing
2015-02-03	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	10B - Non-food contact surfaces and equipment are improperly designed, constructed, installed, maintained (equipment not readily accessible for cleaning, surface not smooth finish)
2014-09-29	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	10A - Food (ice) contact surfaces are improperly designed, constructed, installed, located (cracks, open seams, pitted surfaces, tin cans reused, uncleanable or corroded food contact surfaces)
2013-10-29	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	11D - Non food contact surfaces of equipment not clean
2013-08-20	No data	1784 JACKSON ROAD, PENFIELD	Critical Violation	Food Service Establishment Inspections	New York State Department of Health	2C - Cooked or prepared foods are subject to cross-contamination from raw foods.
2012-02-01	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	10B - Non-food contact surfaces and equipment are improperly designed, constructed, installed, maintained (equipment not readily accessible for cleaning, surface not smooth finish)
2012-01-04	No data	1784 JACKSON ROAD, PENFIELD	Critical Violation	Food Service Establishment Inspections	New York State Department of Health	4A - Toxic chemicals are improperly labeled, stored or used so that contamination of food can occur.
2010-07-14	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	15B - Lighting and ventilation inadequate, fixtures not shielded, dirty ventilation hoods, ductwork, filters, exhaust fans
2010-06-22	No data	1784 JACKSON ROAD, PENFIELD	Critical Violation	Food Service Establishment Inspections	New York State Department of Health	5A - Potentially hazardous foods are not kept at or below 45°F during cold holding, except smoked fish not kept at or below 38°F during cold holding.
2009-07-22	No data	1784 JACKSON ROAD, PENFIELD	Not Critical Violation	Food Service Establishment Inspections	New York State Department of Health	8C - Improper use and storage of clean, sanitized equipment and utensils
2009-07-08	No data	1784 JACKSON ROAD, PENFIELD	Critical Violation	Food Service Establishment Inspections	New York State Department of Health	2C - Cooked or prepared foods are subject to cross-contamination from raw foods.

Name:	PENFIELD COUNTRY CLUB, INC.
Jurisdiction:	New York
Legal type:	DOMESTIC NOT-FOR-PROFIT CORPORATION
Status:	Active
Date of registration:	08 Aug 1958 (66 years ago)
Entity Number:	112691
County:	Monroe
Place of Formation:	New York

PENFIELD COUNTRY CLUB, INC.

Company Details

form 5500

Agent

Licenses

Filings

Inspections

Related by officers

Related by address