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  5. HAVEN MANOR HEALTH CARE CENTER, LLC

HAVEN MANOR HEALTH CARE CENTER, LLC

Company Details

Name: HAVEN MANOR HEALTH CARE CENTER, LLC
Jurisdiction: New York
Legal type: DOMESTIC LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 27 Sep 2007 (18 years ago)
Entity Number: 3573254
ZIP code: 11691
County: Queens
Place of Formation: New York
Address: 1441 GATEWAY BLVD., FAR ROCKAWAY, NY, United States, 11691

Contact Details

Phone +1 718-471-1500

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HAVEN MANOR HEALTH CARE CENTER 401(K) SALARY REDUCTION PLAN 2023 113102777 2024-09-12 HAVEN MANOR HEALTH CARE CENTER 35
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316
HAVEN MANOR HEALTH RELATED FACILITY MONEY-PURCHASE PENSION PLAN 2023 113102777 2024-09-12 HAVEN MANOR HEALTH CARE CENTER 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316
HAVEN MANOR HEALTH RELATED FACILITY MONEY-PURCHASE PENSION PLAN 2022 113102777 2023-10-16 HAVEN MANOR HEALTH CARE CENTER 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316

Signature of
Role Plan administrator
Date 2023-10-16
Name of individual signing ARON CYTRYN
Role Employer/plan sponsor
Date 2023-10-16
Name of individual signing ARON CYTRYN
HAVEN MANOR HEALTH CARE CENTER 401(K) SALARY REDUCTION PLAN 2022 113102777 2023-10-16 HAVEN MANOR HEALTH CARE CENTER 38
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316

Signature of
Role Plan administrator
Date 2023-10-16
Name of individual signing ARON CYTRYN
Role Employer/plan sponsor
Date 2023-10-16
Name of individual signing ARON CYTRYN
HAVEN MANOR HEALTH RELATED FACILITY MONEY-PURCHASE PENSION PLAN 2021 113102777 2022-09-14 HAVEN MANOR HEALTH CARE CENTER 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316

Signature of
Role Plan administrator
Date 2022-09-14
Name of individual signing ARON CYTRYN
HAVEN MANOR HEALTH CARE CENTER 401(K) SALARY REDUCTION PLAN 2021 113102777 2022-09-15 HAVEN MANOR HEALTH CARE CENTER 32
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316

Signature of
Role Plan administrator
Date 2022-09-15
Name of individual signing ARON CYTRYN
HAVEN MANOR HEALTH CARE CENTER 401(K) SALARY REDUCTION PLAN 2020 113102777 2022-01-21 HAVEN MANOR HEALTH CARE CENTER 46
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316

Signature of
Role Plan administrator
Date 2022-01-21
Name of individual signing ARON CYTRYN
HAVEN MANOR HEALTH CARE CENTER 401(K) SALARY REDUCTION PLAN 2020 113102777 2022-09-14 HAVEN MANOR HEALTH CARE CENTER 46
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1987-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316

Signature of
Role Plan administrator
Date 2022-09-14
Name of individual signing ARON CYTRYN
HAVEN MANOR HEALTH RELATED FACILITY MONEY-PURCHASE PENSION PLAN 2020 113102777 2022-01-21 HAVEN MANOR HEALTH CARE CENTER 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316

Signature of
Role Plan administrator
Date 2022-01-21
Name of individual signing ARON CYTRYN
HAVEN MANOR HEALTH RELATED FACILITY MONEY-PURCHASE PENSION PLAN 2019 113102777 2020-10-14 HAVEN MANOR HEALTH CARE CENTER 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-01-01
Business code 623000
Sponsor’s telephone number 7184711500
Plan sponsor’s address 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 116914316

Signature of
Role Plan administrator
Date 2020-10-14
Name of individual signing ARON CYTRYN

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 1441 GATEWAY BLVD., FAR ROCKAWAY, NY, United States, 11691

Filings

Filing Number Date Filed Type Effective Date
150904006126 2015-09-04 BIENNIAL STATEMENT 2015-09-01
131016006820 2013-10-16 BIENNIAL STATEMENT 2013-09-01
110926002513 2011-09-26 BIENNIAL STATEMENT 2011-09-01
090904002524 2009-09-04 BIENNIAL STATEMENT 2009-09-01
070927000058 2007-09-27 CERTIFICATE OF CONVERSION 2007-09-27

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
345857387 0215600 2022-03-25 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 11691
Inspection Type FollowUp
Scope Partial
Safety/Health Health
Close Conference 2022-03-25
Emphasis N: COVID-19
Case Closed 2022-09-23

Related Activity
Type Inspection
Activity Nr 1486085
Health Yes
345190789 0215600 2021-03-10 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 11691
Inspection Type Complaint
Scope Partial
Safety/Health Safety
Close Conference 2021-03-10
Case Closed 2021-07-14

Related Activity
Type Complaint
Activity Nr 1743959
Health Yes
344860853 0215600 2020-07-31 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 11691
Inspection Type Fat/Cat
Scope Partial
Safety/Health Health
Close Conference 2020-10-15
Case Closed 2022-06-07

Related Activity
Type Accident
Activity Nr 1634012

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100134 F02
Issuance Date 2020-10-15
Abatement Due Date 2020-12-03
Current Penalty 8500.0
Initial Penalty 12145.0
Contest Date 2020-10-23
Final Order 2020-11-05
Nr Instances 1
Nr Exposed 7
Gravity 10
FTA Current Penalty 0.0
Citation text line 29 CFR 1910.134(f)(2): Employee(s) using tight-fitting facepiece respirators were not fit tested prior to initial use of the respirator: (a) Haven Manor Health Care Center, LLC, 1441 Gateway Boulevard, Far Rockaway, New York: On or about April 8, 2020 and after, the employer did not provide fit tests for employees such as, but not limited to, Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs) who were required to wear N95 respirators when providing direct care to confirmed or suspected COVID-19 residents.

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5992788409 2021-02-09 0202 PPS 1441 Gateway Blvd, Far Rockaway, NY, 11691-4316
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) 2000000
Loan Approval Amount (current) 2000000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 224478
Servicing Lender Name Signature Bank
Servicing Lender Address 565 5th Ave, 12th Fl, NEW YORK CITY, NY, 10017-2496
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Far Rockaway, QUEENS, NY, 11691-4316
Project Congressional District NY-05
Number of Employees 163
NAICS code 623110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 224478
Originating Lender Name Signature Bank
Originating Lender Address NEW YORK CITY, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 2016164.38
Forgiveness Paid Date 2021-12-03
9234317204 2020-04-28 0202 PPP 1441 GATEWAY BLVD, FAR ROCKAWAY, NY, 11691
Loan Status Date 2021-07-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 2800000
Loan Approval Amount (current) 2800000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 224478
Servicing Lender Name Signature Bank
Servicing Lender Address 565 5th Ave, 12th Fl, NEW YORK CITY, NY, 10017-2496
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address FAR ROCKAWAY, QUEENS, NY, 11691-0001
Project Congressional District NY-05
Number of Employees 181
NAICS code 623110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 224478
Originating Lender Name Signature Bank
Originating Lender Address NEW YORK CITY, NY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 2830761.64
Forgiveness Paid Date 2021-06-11

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Date of last update: 28 Mar 2025

Sources: New York Secretary of State

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