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  5. CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER, INC.

CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER, INC.

Company Details

Name: CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER, INC.
Jurisdiction: New York
Legal type: DOMESTIC BUSINESS CORPORATION
Status: Active
Date of registration: 20 Jun 1997 (28 years ago)
Entity Number: 2155534
ZIP code: 10314
County: Richmond
Place of Formation: New York
Address: P.O. BOX 140703, 25 FANNING ST, STATEN ISLAND, NY, United States, 10314
Principal Address: 25 FANNING ST, STATEN ISLAND, NY, United States, 10314

Contact Details

Phone +1 718-289-7900

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
CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER 401(K) PLAN 2010 133954527 2011-10-04 CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER 380
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1993-05-01
Business code 623000
Sponsor’s telephone number 7182612100
Plan sponsor’s mailing address 25 FANNING STREET, STATEN ISLAND, NY, 10314
Plan sponsor’s address 25 FANNING STREET, STATEN ISLAND, NY, 10314

Plan administrator’s name and address
Administrator’s EIN 133954527
Plan administrator’s name CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER
Plan administrator’s address 25 FANNING STREET, STATEN ISLAND, NY, 10314
Administrator’s telephone number 7182612100

Number of participants as of the end of the plan year
Active participants 250
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 88
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 294
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-03
Name of individual signing NICHOLAS DEMISAY
Valid signature Filed with authorized/valid electronic signature
CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER 401(K) PLAN 2009 133954527 2011-12-28 CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER 380
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1993-05-01
Business code 623000
Sponsor’s telephone number 7182612100
Plan sponsor’s mailing address 25 FANNING STREET, STATEN ISLAND, NY, 10314
Plan sponsor’s address 25 FANNING STREET, STATEN ISLAND, NY, 10314

Plan administrator’s name and address
Administrator’s EIN 133954527
Plan administrator’s name CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER
Plan administrator’s address 25 FANNING STREET, STATEN ISLAND, NY, 10314
Administrator’s telephone number 7182612100

Number of participants as of the end of the plan year
Active participants 281
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 99
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 302
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-12-28
Name of individual signing NICHOLAS DEMISAY
Valid signature Filed with authorized/valid electronic signature
CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER 401(K) PLAN 2009 133954527 2010-10-13 CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER 380
Three-digit plan number (PN) 002
Effective date of plan 1993-05-01
Business code 623000
Sponsor’s telephone number 7182612100
Plan sponsor’s mailing address 25 FANNING STREET, STATEN ISLAND, NY, 10314
Plan sponsor’s address 25 FANNING STREET, STATEN ISLAND, NY, 10314

Plan administrator’s name and address
Administrator’s EIN 133954527
Plan administrator’s name CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER
Plan administrator’s address 25 FANNING STREET, STATEN ISLAND, NY, 10314
Administrator’s telephone number 7182612100

Number of participants as of the end of the plan year
Active participants 281
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 99
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 302
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-10-13
Name of individual signing NICHOLAS DEMISAY
Valid signature Filed with authorized/valid electronic signature

DOS Process Agent

Name Role Address
SOLOMON KLEIN DOS Process Agent P.O. BOX 140703, 25 FANNING ST, STATEN ISLAND, NY, United States, 10314

Chief Executive Officer

Name Role Address
SOLOMON KLEIN Chief Executive Officer 25 FANNING ST, STATEN ISLAND, NY, United States, 10314

History

Start date End date Type Value
2024-10-14 2024-11-26 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-10-08 2024-10-14 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-10-08 2024-10-08 Address 25 FANNING ST, STATEN ISLAND, NY, 10314, USA (Type of address: Chief Executive Officer)
2024-09-26 2024-10-08 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-08-23 2024-09-26 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-08-08 2024-08-23 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-06-13 2024-08-08 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-04-10 2024-06-13 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-04-03 2024-04-10 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2024-03-18 2024-04-03 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0

Filings

Filing Number Date Filed Type Effective Date
241008001882 2024-10-08 BIENNIAL STATEMENT 2024-10-08
210601061632 2021-06-01 BIENNIAL STATEMENT 2021-06-01
210420060204 2021-04-20 BIENNIAL STATEMENT 2019-06-01
110711002639 2011-07-11 BIENNIAL STATEMENT 2011-06-01
090603002707 2009-06-03 BIENNIAL STATEMENT 2009-06-01
070627002026 2007-06-27 BIENNIAL STATEMENT 2007-06-01
050819002525 2005-08-19 BIENNIAL STATEMENT 2005-06-01
030522002649 2003-05-22 BIENNIAL STATEMENT 2003-06-01
010605002878 2001-06-05 BIENNIAL STATEMENT 2001-06-01
990907002123 1999-09-07 BIENNIAL STATEMENT 1999-06-01

Related by officers

SOLOMON KLEIN

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Related by address

No related companies by address

Date of last update: 03 Jan 2025

Sources: New York Secretary of State

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