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LAKE CHAMPLAIN OB-GYN, P.C.

LAKE CHAMPLAIN OB-GYN, P.C.

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Company Details

Name:	LAKE CHAMPLAIN OB-GYN, P.C.
Jurisdiction:	New York
Legal type:	DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status:	Active
Date of registration:	16 Feb 1994 (31 years ago)
Entity Number:	1796195
ZIP code:	12901
County:	Clinton
Place of Formation:	New York
Address:	206 CORNELIA STREET / #306, PLATTSBURGH, NY, United States, 12901

Contact Details

Phone +1 518-566-9452

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

DOS Process Agent

Name	Role	Address
THE CORPORATION	DOS Process Agent	206 CORNELIA STREET / #306, PLATTSBURGH, NY, United States, 12901

Chief Executive Officer

Name	Role	Address
JEFFREY A. DODGE, DO	Chief Executive Officer	206 CORNELIA ST / SUITE #306, PLATTSBURGH, NY, United States, 12901

National Provider Identifier

NPI Number:

1891708095

Link:

View on NPI website

Authorized Person:

Name:

JEANNIE S VAN NOSTRAND

Role:

OFFICE MANAGER

Phone:

5185669452

Taxonomy:

Selected Taxonomy:

207V00000X - Obstetrics & Gynecology Physician

Is Primary:

Yes

Contacts:

Phone:

+1 518-566-9452

Fax:

5195627189

Form 5500 Series

Employer Identification Number (EIN):

141767548

Plan Year:

2023

Number Of Participants:

27

Sponsors Telephone Number:

5185669452

File:

Plan Year:

2022

Number Of Participants:

30

Sponsors Telephone Number:

5185669452

File:

Plan Year:

2021

Number Of Participants:

31

Sponsors Telephone Number:

5185669452

File:

Plan Year:

2020

Number Of Participants:

29

Sponsors Telephone Number:

5185669452

File:

Plan Year:

2019

Number Of Participants:

30

Sponsors Telephone Number:

5185669452

File:

History

Start date	End date	Type	Value
2022-11-08	2023-10-16	Shares	Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2004-02-25	2008-02-11	Address	DUANE C RECORD MD, 206 CORNELIA ST STE 306, PLATTSBURGH, NY, 12901, USA (Type of address: Service of Process)
2004-02-25	2008-02-11	Address	DUANE C RECORD MD, 206 CORNELIA ST STE 306, PLATTSBURGH, NY, 12901, USA (Type of address: Principal Executive Office)
2004-02-25	2008-02-11	Address	206 CORNELIA ST., STE 306, PLATTSBURGH, NY, 12901, USA (Type of address: Chief Executive Officer)
1996-03-06	2004-02-25	Address	ROBERT J VIROSTEK, 206 CORNELIA ST SUITE 306, PLATTSBURGH, NY, 12901, USA (Type of address: Principal Executive Office)

Filings

Filing Number	Date Filed	Type	Effective Date
140325002039	2014-03-25	BIENNIAL STATEMENT	2014-02-01
120320002950	2012-03-20	BIENNIAL STATEMENT	2012-02-01
100308002404	2010-03-08	BIENNIAL STATEMENT	2010-02-01
080211002517	2008-02-11	BIENNIAL STATEMENT	2008-02-01
060302002615	2006-03-02	BIENNIAL STATEMENT	2006-02-01

USAspending Awards / Financial Assistance

Date:

2020-04-15

Link:

View on USAspending

Awarding Agency Name:

Small Business Administration

Transaction Description:

TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.

Obligated Amount:

0.00

Face Value Of Loan:

437500.00

Total Face Value Of Loan:

437500.00

Paycheck Protection Program

Jobs Reported:

28

Initial Approval Amount:

$437,500

Date Approved:

2020-04-15

Loan Status:

Paid in Full

SBA Guaranty Percentage:

100

Current Approval Amount:

$437,500

Race:

Unanswered

Ethnicity:

Unknown/NotStated

Gender:

Unanswered

Veteran:

Unanswered

Forgiveness Amount:

$442,421.88

Servicing Lender:

Glens Falls National Bank and Trust Company

Use of Proceeds:

Payroll: $437,500

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Date of last update: 15 Mar 2025

Sources: New York Secretary of State