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  5. CLUB AGENCY INSURANCE BROKERAGE, LLC

CLUB AGENCY INSURANCE BROKERAGE, LLC

Headquarter

Company Details

Name: CLUB AGENCY INSURANCE BROKERAGE, LLC
Jurisdiction: New York
Legal type: DOMESTIC LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 20 Apr 2001 (24 years ago)
Entity Number: 2630455
ZIP code: 11530
County: Nassau
Place of Formation: New York
Address: 100 RING ROAD WEST, STE. 200, GARDEN CITY, NY, United States, 11530

Links between entities

Type Company Name Company Number State
Headquarter of CLUB AGENCY INSURANCE BROKERAGE, LLC, Alabama 000-608-229 Alabama
Headquarter of CLUB AGENCY INSURANCE BROKERAGE, LLC, KENTUCKY 0607925 KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CLUB AGENCY INSURANCE BROKERAGE, LLC 401(K) PLAN 2015 113603910 2016-06-27 CLUB AGENCY INSURANCE BROKERAGE, LLC 21
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1994-01-01
Business code 524210
Sponsor’s telephone number 5168732425
Plan sponsor’s address 100 RING ROAD WEST, SUITE 200, GARDEN CITY, NY, 11530

Signature of
Role Plan administrator
Date 2016-06-27
Name of individual signing MARK D. DERRENBERGER
RETIREMENT PLAN FOR EMPLOYEES OF CLUB AGENCY, INC. 2015 113603910 2016-08-16 CLUB AGENCY INSURANCE BROKERAGE, LLC. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1967-01-01
Business code 524210
Sponsor’s telephone number 5168732360
Plan sponsor’s address 100 RING ROAD SUITE 200, GARDEN CITY, NY, 11530

Signature of
Role Plan administrator
Date 2016-08-16
Name of individual signing MARK. D. DERRENBERGER
Role Employer/plan sponsor
Date 2016-08-16
Name of individual signing MARK. D. DERRENBERGER
CLUB AGENCY INSURANCE BROKERAGE, LLC 401(K) PLAN 2014 113603910 2015-10-13 CLUB AGENCY INSURANCE BROKERAGE LLC 19
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1994-01-01
Business code 524210
Sponsor’s telephone number 5168732425
Plan sponsor’s address 100 RING ROAD WEST SUITE 200, GARDEN CITY, NY, 11530

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing CARMEN GIRALDO
RETIREMENT PLAN FOR EMPLOYEES OF CLUB AGENCY, INC. 2014 113603910 2015-10-13 CLUB AGENCY INSURANCE BROKERAGE, LLC. 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1967-01-01
Business code 524210
Sponsor’s telephone number 5168732360
Plan sponsor’s address 100 RING ROAD SUITE 200, GARDEN CITY, NY, 11530

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing MARK D. DERRENBERGER
Role Employer/plan sponsor
Date 2015-10-13
Name of individual signing MARK D. DERRENBERGER
CLUB AGENCY INSURANCE BROKERAGE, LLC 401(K) PLAN 2013 113603910 2014-03-25 CLUB AGENCY INSURANCE BROKERAGE LLC 30
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1994-01-01
Business code 524210
Sponsor’s telephone number 5168732360
Plan sponsor’s address 1051 FRANKLIN AVENUE, GARDEN CITY, NY, 11530

Signature of
Role Plan administrator
Date 2014-03-25
Name of individual signing MARK DERRENBERGER
CLUB AGENCY INSURANCE BROKERAGE, LLC 401(K) PLAN 2012 113603910 2013-02-12 CLUB AGENCY INSURANCE BROKERAGE LLC 26
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1994-01-01
Business code 524210
Sponsor’s telephone number 5168732360
Plan sponsor’s address 1051 FRANKLIN AVENUE, GARDEN CITY, NY, 11530

Signature of
Role Plan administrator
Date 2013-02-12
Name of individual signing MARK DERRENBERGER
CLUB AGENCY INSURANCE BROKERAGE, LLC 401(K) PLAN 2011 113603910 2012-02-27 CLUB AGENCY INSURANCE BROKERAGE LLC 24
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1994-01-01
Business code 524210
Sponsor’s telephone number 5168732360
Plan sponsor’s address 1415 KELLUM PLACE, SUITE 220, GARDEN CITY, NY, 11530

Plan administrator’s name and address
Administrator’s EIN 113603910
Plan administrator’s name CLUB AGENCY INSURANCE BROKERAGE LLC
Plan administrator’s address 1415 KELLUM PLACE, SUITE 220, GARDEN CITY, NY, 11530
Administrator’s telephone number 5168732360

Signature of
Role Plan administrator
Date 2012-02-27
Name of individual signing MARK DERRENBERGER
CLUB AGENCY INSURANCE BROKERAGE, LLC. 401(K) PLAN 2010 113603910 2011-06-07 CLUB AGENCY INSURANCE BROKERAGE, LLC. 21
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1994-01-01
Business code 524210
Sponsor’s telephone number 5168732360
Plan sponsor’s address 1415 KELLUM PLACE, GARDEN CITY, NY, 11530

Plan administrator’s name and address
Administrator’s EIN 113603910
Plan administrator’s name CLUB AGENCY INSURANCE BROKERAGE, LLC.
Plan administrator’s address 1415 KELLUM PLACE, GARDEN CITY, NY, 11530
Administrator’s telephone number 5168732360

Signature of
Role Plan administrator
Date 2011-06-07
Name of individual signing CARMEN GIRALDO
CLUB AGENCY INSURANCE BROKERAGE, LLC. 401(K) PLAN 2009 113603910 2010-07-26 CLUB AGENCY INSURANCE BROKERAGE, LLC. 20
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1994-01-01
Business code 524210
Sponsor’s telephone number 5168732360
Plan sponsor’s address 1415 KELLUM PLACE, GARDEN CITY, NY, 11530

Plan administrator’s name and address
Administrator’s EIN 113603910
Plan administrator’s name CLUB AGENCY INSURANCE BROKERAGE, LLC.
Plan administrator’s address 1415 KELLUM PLACE, GARDEN CITY, NY, 11530
Administrator’s telephone number 5168732360

Signature of
Role Plan administrator
Date 2010-07-26
Name of individual signing KEVIN CROSSLEY

DOS Process Agent

Name Role Address
CLUB AGENCY INSURANCE BROKERAGE, LLC DOS Process Agent 100 RING ROAD WEST, STE. 200, GARDEN CITY, NY, United States, 11530

History

Start date End date Type Value
2003-04-01 2014-09-22 Address 1415 KELLUM PLACE, GARDEN CITY, NY, 11530, USA (Type of address: Service of Process)
2001-04-20 2003-04-01 Address 370 OLD COUNTRY ROAD, GARDEN CITY, NY, 11530, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
170405006537 2017-04-05 BIENNIAL STATEMENT 2017-04-01
140922006305 2014-09-22 BIENNIAL STATEMENT 2013-04-01
110503002226 2011-05-03 BIENNIAL STATEMENT 2011-04-01
090401002552 2009-04-01 BIENNIAL STATEMENT 2009-04-01
070419002024 2007-04-19 BIENNIAL STATEMENT 2007-04-01
050414002149 2005-04-14 BIENNIAL STATEMENT 2005-04-01
030401002295 2003-04-01 BIENNIAL STATEMENT 2003-04-01
020429000789 2002-04-29 CERTIFICATE OF AMENDMENT 2002-04-29
010420000534 2001-04-20 ARTICLES OF ORGANIZATION 2001-04-20

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
9810258510 2021-03-12 0235 PPS 100 Ring Rd W Unit 200, Garden City, NY, 11530-3217
Loan Status Date 2021-12-21
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 133217
Loan Approval Amount (current) 133217
Undisbursed Amount 0
Franchise Name -
Lender Location ID 48270
Servicing Lender Name JPMorgan Chase Bank, National Association
Servicing Lender Address 1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Garden City, NASSAU, NY, 11530-3217
Project Congressional District NY-04
Number of Employees 9
NAICS code 524210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 48270
Originating Lender Name JPMorgan Chase Bank, National Association
Originating Lender Address COLUMBUS, OH
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 134080.1
Forgiveness Paid Date 2021-11-10
2571827105 2020-04-10 0235 PPP 100 RING RD W UNIT 200, GARDEN CITY, NY, 11530
Loan Status Date 2021-08-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 120262
Loan Approval Amount (current) 120262
Undisbursed Amount 0
Franchise Name -
Lender Location ID 48270
Servicing Lender Name JPMorgan Chase Bank, National Association
Servicing Lender Address 1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address GARDEN CITY, NASSAU, NY, 11530-0001
Project Congressional District NY-04
Number of Employees 8
NAICS code 524210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 194093
Originating Lender Name JPMorgan Chase Bank, National Association
Originating Lender Address CHICAGO, IL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 121715.57
Forgiveness Paid Date 2021-07-06

Related by officers

No related officers

Related by address

100 RING ROAD WEST, STE. 200, GARDEN CITY, NY, United States, 11530

RMS CAPITAL HOLDINGS, INC. RMS PROGRAMS LLC BEK ASSOCIATES INC.

Date of last update: 13 Mar 2025

Sources: New York Secretary of State

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