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  5. CHAMPLAIN SMILES INC.

CHAMPLAIN SMILES INC.

Company Details

Name: CHAMPLAIN SMILES INC.
Jurisdiction: New York
Legal type: DOMESTIC BUSINESS CORPORATION
Status: Active
Date of registration: 20 Apr 2005 (20 years ago)
Entity Number: 3193421
ZIP code: 12901
County: Clinton
Place of Formation: New York
Address: 46 COURT STREET, PLATTSBURGH, NY, United States, 12901
Principal Address: 212 TOM MILLER ROAD, PLATTSBURGH, NY, United States, 12901

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
CHAMPLAIN SMILES INC 401(K) PLAN 2023 810671714 2024-09-17 CHAMPLAIN SMILES INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 212 TOM MILLER RD, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2024-09-17
Name of individual signing JEFF GRAVES
Valid signature Filed with authorized/valid electronic signature
CHAMPLAIN SMILES INC 401(K) PLAN 2019 810671714 2020-11-13 CHAMPLAIN SMILES INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 212 TOM MILLER RD, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2020-11-13
Name of individual signing JEFF GRAVES
CHAMPLAIN SMILES INC 401(K) PLAN 2019 810671714 2020-11-12 CHAMPLAIN SMILES INC 7
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 212 TOM MILLER RD, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2020-11-12
Name of individual signing JEFF GRAVES
CHAMPLAIN SMILES INC 401(K) PLAN 2019 810671714 2020-11-04 CHAMPLAIN SMILES INC 7
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 212 TOM MILLER RD, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2020-11-04
Name of individual signing JEFF GRAVES
CHAMPLAIN SMILES INC 401(K) PLAN 2018 810671714 2019-08-20 CHAMPLAIN SMILES INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 212 TOM MILLER RD, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2019-08-20
Name of individual signing JEFF GRAVES
CHAMPLAIN SMILES INC 401(K) PLAN 2017 810671714 2020-11-12 CHAMPLAIN SMILES INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 212 TOM MILLER RD, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2020-11-12
Name of individual signing JEFF GRAVES
CHAMPLAIN SMILES INC 401(K) PLAN 2016 810671714 2017-07-20 CHAMPLAIN SMILES INC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 212 TOM MILLER RD, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2017-07-20
Name of individual signing JEFF GRAVES
CHAMPLAIN SMILES INC 401(K) PLAN 2015 810671714 2016-10-06 CHAMPLAIN SMILES INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 212 TOM MILLER RD, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2016-10-06
Name of individual signing JEFF GRAVES
CHAMPLAIN SMILES INC 401(K) PLAN 2014 810671714 2016-01-06 CHAMPLAIN SMILES INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 212 TOM MILLER RD, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2016-01-06
Name of individual signing JEFF GRAVES
CHAMPLAIN SMILES, INC. PROFIT SHARING PLAN 2013 810671714 2014-10-15 CHAMPLAIN SMILES, INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621210
Sponsor’s telephone number 5183242273
Plan sponsor’s address 762 STATE ROUTE 3, SUITE 1, PLATTSBURGH, NY, 12901

Signature of
Role Plan administrator
Date 2014-10-15
Name of individual signing ATHENA GRAVES

Chief Executive Officer

Name Role Address
ATHENA A GRAVES Chief Executive Officer 212 TOM MILLER ROAD, PLATTSBURGH, NY, United States, 12901

DOS Process Agent

Name Role Address
GARY L FAVRO DOS Process Agent 46 COURT STREET, PLATTSBURGH, NY, United States, 12901

Agent

Name Role Address
WILLIAM A FAUREAV, ESQ. Agent 206 WEST BAY PLAZA, PLATTSBURGH, NY, 12901

History

Start date End date Type Value
2018-02-21 2021-04-01 Address 46 COURT STREET, PLATTSBURGH, NY, 12901, USA (Type of address: Service of Process)
2009-04-10 2018-02-21 Address 762 STATE ROUTE 3, STE 1, PLATTSBURGH, NY, 12901, USA (Type of address: Chief Executive Officer)
2009-04-10 2018-02-21 Address 762 STATE ROUTE 3, STE 1, PLATTSBURGH, NY, 12901, USA (Type of address: Principal Executive Office)
2005-07-29 2018-02-21 Address 206 WEST BAY PLAZA, PLATTSBURGH, NY, 12901, USA (Type of address: Service of Process)
2005-04-20 2005-07-29 Address 720 CATALINA BLVD, ENDWELL, NY, 13760, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
210401060295 2021-04-01 BIENNIAL STATEMENT 2021-04-01
180221002038 2018-02-21 BIENNIAL STATEMENT 2017-04-01
171018000073 2017-10-18 ANNULMENT OF DISSOLUTION 2017-10-18
DP-2151187 2016-06-29 DISSOLUTION BY PROCLAMATION 2016-06-29
130513002108 2013-05-13 BIENNIAL STATEMENT 2013-04-01
110620002303 2011-06-20 BIENNIAL STATEMENT 2011-04-01
090410002924 2009-04-10 BIENNIAL STATEMENT 2009-04-01
050729000821 2005-07-29 CERTIFICATE OF CHANGE 2005-07-29
050420000001 2005-04-20 CERTIFICATE OF INCORPORATION 2005-04-20

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2768808905 2021-04-27 0248 PPS 212 Tom Miller Rd, Plattsburgh, NY, 12901-6427
Loan Status Date 2021-12-09
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 102964
Loan Approval Amount (current) 102964
Undisbursed Amount 0
Franchise Name -
Lender Location ID 49989
Servicing Lender Name NBT Bank, National Association
Servicing Lender Address 52 S Broad St, NORWICH, NY, 13815-1646
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Plattsburgh, CLINTON, NY, 12901-6427
Project Congressional District NY-21
Number of Employees 7
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 49989
Originating Lender Name NBT Bank, National Association
Originating Lender Address NORWICH, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 103525.37
Forgiveness Paid Date 2021-11-16
2656637302 2020-04-29 0248 PPP 212 TOM MILLER ROAD, PLATTSBURGH, NY, 12901
Loan Status Date 2021-06-09
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 102964
Loan Approval Amount (current) 102964
Undisbursed Amount 0
Franchise Name -
Lender Location ID 49989
Servicing Lender Name NBT Bank, National Association
Servicing Lender Address 52 S Broad St, NORWICH, NY, 13815-1646
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address PLATTSBURGH, CLINTON, NY, 12901-0001
Project Congressional District NY-21
Number of Employees 8
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 49989
Originating Lender Name NBT Bank, National Association
Originating Lender Address NORWICH, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 103979.54
Forgiveness Paid Date 2021-05-04

Related by officers

No related officers

Related by address

46 COURT STREET, PLATTSBURGH, NY, United States, 12901

CLARE & CARL'S, INC. LAW OFFICES OF GARY L. FAVRO PLLC

Date of last update: 29 Mar 2025

Sources: New York Secretary of State

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