| Name: | STATEN ISLAND PHYSICIAN PRACTICE, P.C. |
| Jurisdiction: | New York |
| Legal type: | DOMESTIC PROFESSIONAL SERVICE CORPORATION |
| Status: | Inactive |
| Date of registration: | 06 Apr 2006 (19 years ago) |
| Date of dissolution: | 31 Dec 2016 |
| Entity Number: | 3345425 |
| ZIP code: | 10041 |
| County: | New York |
| Place of Formation: | New York |
| Address: | 55 WATER STREET, NEW YORK, NY, United States, 10041 |
| Principal Address: | 55 WATER ST, NEW YORK, NY, United States, 10041 |
Shares Details
Shares issued 1000
Share Par Value 1
Type PAR VALUE
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STATEN ISLAND PHYSICIAN PRACTICE, P.C. UNION 401(K) PLAN | 2010 | 204659577 | 2010-03-15 | STATEN ISLAND PHYSICIAN PRACTICE, P.C. | 89 | |||||||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 204659577 |
| Plan administrator’s name | STATEN ISLAND PHYSICIAN PRACTICE, P.C. |
| Plan administrator’s address | 2791 RICHMOND AVE., STATEN ISLAND, NY, 10314 |
| Administrator’s telephone number | 7188163850 |
Number of participants as of the end of the plan year
| Active participants | 267 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 1 |
| 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 | 73 |
| 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 | 2010-03-15 |
| Name of individual signing | MEREDITH GAMBLE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| NAVARRA RODRIGUEZ, M.D. | Chief Executive Officer | 55 WATER ST, NEW YORK, NY, United States, 10041 |
| Name | Role | Address |
|---|---|---|
| STATEN ISLAND PHYSICIAN PRACTICE | DOS Process Agent | 55 WATER STREET, NEW YORK, NY, United States, 10041 |
| Start date | End date | Type | Value |
|---|---|---|---|
| 2015-01-12 | 2016-09-23 | Address | 55 WATER ST, NEW YORK, NY, 10041, USA (Type of address: Chief Executive Officer) |
| 2014-07-07 | 2015-01-12 | Address | 441 NINTH AVENUE, 8TH FLOOR, NEW YORK, NY, 10001, USA (Type of address: Chief Executive Officer) |
| 2014-07-07 | 2016-09-23 | Address | 440 9TH AVENUE, 9TH FLOOR, NEW YORK, NY, 10001, USA (Type of address: Service of Process) |
| 2014-07-07 | 2015-01-12 | Address | 441 NINTH AVENUE, 8TH FLOOR, NEW YORK, NY, 10001, USA (Type of address: Principal Executive Office) |
| 2013-04-01 | 2014-07-07 | Address | C/O EMBLEMHEALTH, 441 NINTH AVENUE, NEW YORK, NY, 10001, USA (Type of address: Service of Process) |
| 2010-04-30 | 2013-04-01 | Address | 2791 RICHMOND AVE / SUITE 2, STATEN ISLAND, NY, 10314, USA (Type of address: Service of Process) |
| 2010-04-30 | 2014-07-07 | Address | 2791 RICHMOND AVE / SUITE 201, STATEN ISLAND, NY, 10314, USA (Type of address: Principal Executive Office) |
| 2010-04-30 | 2014-07-07 | Address | 4771 HYLAN BOULEVARD, STATEN ISLAND, NY, 10312, USA (Type of address: Chief Executive Officer) |
| 2009-10-08 | 2010-04-30 | Address | 2791 RICHMOND AVE.,, STE. 2, STATEN ISLAND, NY, 10314, USA (Type of address: Service of Process) |
| 2008-05-19 | 2010-04-30 | Address | 1050 CLOVE RD, STATEN ISLAND, NY, 10301, USA (Type of address: Principal Executive Office) |
| Filing Number | Date Filed | Type | Effective Date |
|---|---|---|---|
| 161216000136 | 2016-12-16 | CERTIFICATE OF MERGER | 2016-12-31 |
| 160923006063 | 2016-09-23 | BIENNIAL STATEMENT | 2016-04-01 |
| 150112002024 | 2015-01-12 | AMENDMENT TO BIENNIAL STATEMENT | 2014-04-01 |
| 140707002064 | 2014-07-07 | BIENNIAL STATEMENT | 2014-04-01 |
| 130401000286 | 2013-04-01 | CERTIFICATE OF AMENDMENT | 2013-04-01 |
| 120529002714 | 2012-05-29 | BIENNIAL STATEMENT | 2012-04-01 |
| 100430002490 | 2010-04-30 | BIENNIAL STATEMENT | 2010-04-01 |
| 091008000461 | 2009-10-08 | CERTIFICATE OF AMENDMENT | 2009-10-08 |
| 080519002634 | 2008-05-19 | BIENNIAL STATEMENT | 2008-04-01 |
| 060406001076 | 2006-04-06 | CERTIFICATE OF INCORPORATION | 2006-04-06 |
Date of last update: 31 Dec 2024
Sources: New York Secretary of State
