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  5. FORESMAN DERMATOLOGY, PLLC

FORESMAN DERMATOLOGY, PLLC

Company Details

Name: FORESMAN DERMATOLOGY, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Inactive
Date of registration: 18 Apr 1997 (28 years ago)
Date of dissolution: 03 Jul 2023
Entity Number: 2134927
ZIP code: 13021
County: Cayuga
Place of Formation: New York
Address: AUBURN MEMORIAL MEDICAL BLDG., 77 NELSON STREET, AUBURN, NY, United States, 13021

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FORESMAN DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2022 161525623 2023-07-24 FORESMAN DERMATOLOGY, PLLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000
FORESMAN DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2022 161525623 2023-09-14 FORESMAN DERMATOLOGY, PLLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000
FORESMAN DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2022 161525623 2023-07-21 FORESMAN DERMATOLOGY, PLLC 6
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000
FORESMAN DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2021 161525623 2022-05-16 FORESMAN DERMATOLOGY, PLLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000

Signature of
Role Plan administrator
Date 2022-05-14
Name of individual signing PAMELA FORESMAN
FORESMAN DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2021 161525623 2022-12-12 FORESMAN DERMATOLOGY, PLLC 6
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000

Signature of
Role Plan administrator
Date 2022-12-09
Name of individual signing PAMELA FORESMAN
FORESMAN DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2020 161525623 2021-07-14 FORESMAN DERMATOLOGY, PLLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000

Signature of
Role Plan administrator
Date 2021-07-14
Name of individual signing PAMELA FORESMAN
FORESMAN DERMATOLOGY, PLLC 401(K) PROFIT SHARING PLAN 2019 161525623 2020-07-15 FORESMAN DERMATOLOGY, PLLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000

Signature of
Role Plan administrator
Date 2020-07-15
Name of individual signing PAMELA FORESMAN
FORESMAN DERMATOLOGY 401(K) PROFIT SHARING PLAN 2018 161525623 2019-05-15 FORESMAN DERMATOLOGY, PLLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000

Signature of
Role Plan administrator
Date 2019-05-15
Name of individual signing PAMELA FORESMAN
FORESMAN DERMATOLOGY 401(K) PROFIT SHARING PLAN 2017 161525623 2018-03-02 FORESMAN DERMATOLOGY, PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000

Signature of
Role Plan administrator
Date 2018-03-01
Name of individual signing PAMELA FORESMAN
FORESMAN DERMATOLOGY 401(K) PROFIT SHARING PLAN 2016 161525623 2017-03-24 FORESMAN DERMATOLOGY, PLLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1969-01-01
Business code 621111
Sponsor’s telephone number 3152527539
Plan sponsor’s address 1 PARK AVE, AUBURN, NY, 130210000

Signature of
Role Plan administrator
Date 2017-03-24
Name of individual signing PAMELA FORESMAN

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent AUBURN MEMORIAL MEDICAL BLDG., 77 NELSON STREET, AUBURN, NY, United States, 13021

History

Start date End date Type Value
1997-04-18 2023-07-03 Address AUBURN MEMORIAL MEDICAL BLDG., 77 NELSON STREET, AUBURN, NY, 13021, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
230703003408 2023-07-03 CERTIFICATE OF DISSOLUTION-CANCELLATION 2023-07-03
030328002071 2003-03-28 BIENNIAL STATEMENT 2003-04-01
010405002036 2001-04-05 BIENNIAL STATEMENT 2001-04-01
990401002087 1999-04-01 BIENNIAL STATEMENT 1999-04-01
970728000182 1997-07-28 AFFIDAVIT OF PUBLICATION 1997-07-28
970728000180 1997-07-28 AFFIDAVIT OF PUBLICATION 1997-07-28
970418000324 1997-04-18 ARTICLES OF ORGANIZATION 1997-04-18

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
1114978405 2021-02-01 0248 PPS 1 Park Ave, Auburn, NY, 13021-1910
Loan Status Date 2021-11-19
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 99539
Loan Approval Amount (current) 99539
Undisbursed Amount 0
Franchise Name -
Lender Location ID 56102
Servicing Lender Name KeyBank National Association
Servicing Lender Address 127 Public Sq, CLEVELAND, OH, 44114-1217
Rural or Urban Indicator R
Hubzone N
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Auburn, CAYUGA, NY, 13021-1910
Project Congressional District NY-24
Number of Employees 6
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 56102
Originating Lender Name KeyBank National Association
Originating Lender Address CLEVELAND, OH
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 100234.41
Forgiveness Paid Date 2021-10-25
3567527710 2020-05-01 0248 PPP 1 Park Ave, Auburn, NY, 13021
Loan Status Date 2020-12-19
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 49600
Loan Approval Amount (current) 49600
Undisbursed Amount 0
Franchise Name -
Lender Location ID 56102
Servicing Lender Name KeyBank National Association
Servicing Lender Address 127 Public Sq, CLEVELAND, OH, 44114-1217
Rural or Urban Indicator U
Hubzone N
LMI Y
Business Age Description Unanswered
Project Address Auburn, CAYUGA, NY, 13021-0001
Project Congressional District NY-24
Number of Employees 6
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 56102
Originating Lender Name KeyBank National Association
Originating Lender Address CLEVELAND, OH
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 49866.35
Forgiveness Paid Date 2020-11-25

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Date of last update: 31 Mar 2025

Sources: New York Secretary of State

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