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  5. SHAFER SURGICAL, LLC

SHAFER SURGICAL, LLC

Company Details

Name: SHAFER SURGICAL, LLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 04 Feb 2008 (17 years ago)
Entity Number: 3626750
ZIP code: 11417
County: New York
Place of Formation: New York
Address: 535 5TH AVENUE, 33RD FLOOR, NEW YORK, NY, United States, 11417

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SHAFER SURGICAL LLC CASH BALANCE PLAN 2023 262056483 2024-10-15 SHAFER SURGICAL LLC 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 10 EAST 53RD STREET, 25TH FLOOR, NEW YORK, NY, 10022
SHAFER PLASTIC SURGERY 401(K) QRP 2023 262056483 2024-10-14 SHAFER SURGICAL LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-12-31
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 10 EAST 53RD STREET, 25TH FLOOR, NEW YORK, NY, 10022
SHAFER PLASTIC SURGERY 401(K) QRP 2022 262056483 2023-09-22 SHAFER SURGICAL LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-12-31
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 10 EAST 53RD STREET, 25TH FLOOR, NEW YORK, NY, 10022

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2023-09-22
Name of individual signing TARA EVANS, FOR TAG RESOURCES
SHAFER SURGICAL LLC CASH BALANCE PLAN 2022 262056483 2023-08-23 SHAFER SURGICAL LLC 13
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 10 EAST 53RD STREET, 25TH FLOOR, NEW YORK, NY, 10022
SHAFER PLASTIC SURGERY 401(K) QRP 2021 262056483 2023-09-21 SHAFER SURGICAL LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-12-31
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 35 FIFTH AVENUE 33RD FLOOR, NEW YORK, NY, 10017

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2023-09-21
Name of individual signing TARA EVANS, FOR TAG RESOURCES
SHAFER SURGICAL LLC CASH BALANCE PLAN 2021 262056483 2022-09-07 SHAFER SURGICAL LLC 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 10 EAST 53RD STREET, 25TH FLOOR, NEW YORK, NY, 10022
SHAFER PLASTIC SURGERY 401(K) QRP 2021 262056483 2022-09-23 SHAFER SURGICAL LLC 5
Three-digit plan number (PN) 001
Effective date of plan 2009-12-31
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 35 FIFTH AVENUE 33RD FLOOR, NEW YORK, NY, 10017

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2022-09-23
Name of individual signing TARA EVANS
SHAFER PLASTIC SURGERY 401(K) QRP 2020 262056483 2021-05-17 SHAFER SURGICAL LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-12-31
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 10 EAST 53RD STREET, 25TH FLOOR, NEW YORK, NY, 10022

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2021-05-17
Name of individual signing PHIL TISUE
SHAFER SURGICAL LLC CASH BALANCE PLAN 2020 262056483 2021-10-04 SHAFER SURGICAL LLC 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 10 EAST 53RD STREET, 25TH FLOOR, NEW YORK, NY, 10022
SHAFER SURGICAL LLC CASH BALANCE PLAN 2019 262056483 2020-10-15 SHAFER SURGICAL LLC 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 2128887770
Plan sponsor’s address 10 EAST 53RD STREET, 25TH FLOOR, NEW YORK, NY, 10022

DOS Process Agent

Name Role Address
SHAFER SURGICAL, LLC DOS Process Agent 535 5TH AVENUE, 33RD FLOOR, NEW YORK, NY, United States, 11417

History

Start date End date Type Value
2010-03-09 2020-02-07 Address 10 EAST 53RD STREET, 25TH FL, NEW YORK, NY, 10022, USA (Type of address: Service of Process)
2008-02-04 2010-03-09 Address 450 EAST 63RD STREET, #10G, NEW YORK, NY, 10021, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
200207060057 2020-02-07 BIENNIAL STATEMENT 2020-02-01
180209006010 2018-02-09 BIENNIAL STATEMENT 2018-02-01
140207006577 2014-02-07 BIENNIAL STATEMENT 2014-02-01
120315002426 2012-03-15 BIENNIAL STATEMENT 2012-02-01
100309002936 2010-03-09 BIENNIAL STATEMENT 2010-02-01
080703000874 2008-07-03 CERTIFICATE OF PUBLICATION 2008-07-03
080204000609 2008-02-04 ARTICLES OF ORGANIZATION 2008-02-04

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8164957000 2020-04-08 0202 PPP 535 5TH AVE FL 33, NEW YORK, NY, 10017-3312
Loan Status Date 2021-05-08
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 82000
Loan Approval Amount (current) 82000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 35989
Servicing Lender Name Capitol National Bank
Servicing Lender Address 200 Washington Sq North, LANSING, MI, 48933-1320
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address NEW YORK, NEW YORK, NY, 10017-3312
Project Congressional District NY-12
Number of Employees 12
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 35989
Originating Lender Name Capitol National Bank
Originating Lender Address LANSING, MI
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 82840.5
Forgiveness Paid Date 2021-04-22
1616818305 2021-01-19 0202 PPS 535 5th Ave Fl 33, New York, NY, 10017-3665
Loan Status Date 2021-11-06
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 110400
Loan Approval Amount (current) 110400
Undisbursed Amount 0
Franchise Name -
Lender Location ID 35989
Servicing Lender Name Capitol National Bank
Servicing Lender Address 200 Washington Sq North, LANSING, MI, 48933-1320
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address New York, NEW YORK, NY, 10017-3665
Project Congressional District NY-12
Number of Employees 9
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 35989
Originating Lender Name Capitol National Bank
Originating Lender Address LANSING, MI
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 111258.67
Forgiveness Paid Date 2021-10-27

Related by officers

No related officers

Related by address

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Date of last update: 28 Mar 2025

Sources: New York Secretary of State

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