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UPSTATE COMMUNITY MEDICAL, P.C.

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Company Details

Name: UPSTATE COMMUNITY MEDICAL, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 17 Nov 2005 (20 years ago)
Entity Number: 3282731
ZIP code: 13215
County: Onondaga
Place of Formation: New York
Address: 4900 BROAD ROAD, SUITE 1507, SYRACUSE, NY, United States, 13215

Contact Details

Phone +1 315-492-5875

Phone +1 315-635-1571

Phone +1 315-635-1573

Phone +1 315-464-5774

Phone +1 315-488-5588

Phone +1 315-492-5660

Phone +1 315-492-2520

Phone +1 315-492-5305

Shares Details

Shares issued 200

Share Par Value 1

Type PAR VALUE

Chief Executive Officer

Name Role Address
AMY TUCKER, MD Chief Executive Officer 4900 BROAD ROAD, SYRACUSE, NY, United States, 13215

DOS Process Agent

Name Role Address
UPSTATE COMMUNITY MEDICAL, P.C. DOS Process Agent 4900 BROAD ROAD, SUITE 1507, SYRACUSE, NY, United States, 13215

National Provider Identifier

NPI Number:
1689620163
Certification Date:
2021-03-03

Authorized Person:

Name:
AMY TUCKER
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
207X00000X - Orthopaedic Surgery Physician
Is Primary:
No
Selected Taxonomy:
208600000X - Surgery Physician
Is Primary:
No
Selected Taxonomy:
208M00000X - Hospitalist Physician
Is Primary:
Yes

Contacts:

Fax:
3158835407
Fax:
3154925320

Form 5500 Series

Employer Identification Number (EIN):
203889761
Plan Year:
2018
Number Of Participants:
111
Sponsors Telephone Number:
Plan Year:
2017
Number Of Participants:
78
Sponsors Telephone Number:
Plan Year:
2016
Number Of Participants:
66
Sponsors Telephone Number:
Plan Year:
2015
Number Of Participants:
57
Sponsors Telephone Number:

History

Start date End date Type Value
2024-06-28 2024-06-28 Address 4900 BROAD RD, SYRACUSE, NY, 13215, USA (Type of address: Chief Executive Officer)
2024-06-28 2024-06-28 Address 4900 BROAD ROAD, SYRACUSE, NY, 13215, USA (Type of address: Chief Executive Officer)
2023-06-11 2024-06-28 Shares Share type: PAR VALUE, Number of shares: 200, Par value: 1
2014-09-09 2024-06-28 Address 4900 BROAD RD, SYRACUSE, NY, 13215, USA (Type of address: Chief Executive Officer)
2013-05-02 2014-09-04 Name UPSTATE HEALTH PROVIDERS, P.C.

Filings

Filing Number Date Filed Type Effective Date
240628001388 2024-06-28 BIENNIAL STATEMENT 2024-06-28
140909002069 2014-09-09 BIENNIAL STATEMENT 2013-11-01
140904000592 2014-09-04 CERTIFICATE OF AMENDMENT 2014-09-04
130502000134 2013-05-02 CERTIFICATE OF AMENDMENT 2013-05-02
111205000568 2011-12-05 CERTIFICATE OF AMENDMENT 2011-12-05

Tax Exempt

Employer Identification Number (EIN) :
20-3889761
Classification:
Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Ruling Date:
2015-07
National Taxonomy Of Exempt Entities:
Health Care: Community Health Systems
Deductibility:
Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Determination Letters

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Date of last update: 29 Mar 2025

Sources: New York Secretary of State