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  5. OPTIMUM CARE FAMILY MEDICINE, LLC

OPTIMUM CARE FAMILY MEDICINE, LLC

Company Details

Name: OPTIMUM CARE FAMILY MEDICINE, LLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 18 Jun 2008 (17 years ago)
Entity Number: 3685822
ZIP code: 11787
County: Suffolk
Place of Formation: New York
Address: 321 EAST MAIN STREET, SUITE 1, SMITHTOWN, NY, United States, 11787

Contact Details

Phone +1 631-265-4606

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
OPTIMUM CARE FAMILY MEDICINE 401(K) PROFIT SHARING PLAN & TRUST 2023 262870614 2024-04-04 OPTIMUM CARE FAMILY MEDICINE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-02
Business code 621111
Sponsor’s telephone number 6318486798
Plan sponsor’s address 321 MIDDLE COUNTRY RD, SMITHTOWN, NY, 11787

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2024-04-04
Name of individual signing ANNA KAPSALIS-RAMBALAKOS MD
OPTIMUM CARE FAMILY MEDICINE 401(K) PROFIT SHARING PLAN & TRUST 2022 262870614 2023-03-30 OPTIMUM CARE FAMILY MEDICINE 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-02
Business code 621111
Sponsor’s telephone number 6318486798
Plan sponsor’s address 321 MIDDLE COUNTRY RD, SMITHTOWN, NY, 11787

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2023-03-30
Name of individual signing ANNA KAPSALIS-RAMBALAKOS MD
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN 2020 262870614 2021-03-29 OPTIMUM CARE FAMILY MEDICINE LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-10-01
Business code 621111
Sponsor’s telephone number 6312654606
Plan sponsor’s address 321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820

Signature of
Role Plan administrator
Date 2021-03-29
Name of individual signing ANTHONY WARD AS ATTORNEY
OPTIMUM CARE FAMILY MEDICINE LLC PROFIT SHARING PLAN 2020 800433881 2021-08-03 OPTIMUM CARE FAMILY MEDICINE LLC 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 6312654606
Plan sponsor’s address 321 E MAIN ST STE 1, SMITHTOWN, NY, 117872820

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES
Plan administrator’s address 1373 VETERAN'S MEMORIAL HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2021-08-03
Name of individual signing ANTHONY WARD AS ATTORNEY
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN 2020 262870614 2021-03-29 OPTIMUM CARE FAMILY MEDICINE LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-10-01
Business code 621111
Sponsor’s telephone number 6312654606
Plan sponsor’s address 321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820

Signature of
Role Plan administrator
Date 2021-03-29
Name of individual signing ANTHONY WARD AS ATTORNEY
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN 2020 262870614 2021-03-29 OPTIMUM CARE FAMILY MEDICINE LLC 3
Three-digit plan number (PN) 001
Effective date of plan 2017-10-01
Business code 621111
Sponsor’s telephone number 6312654606
Plan sponsor’s address 321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820

Signature of
Role Plan administrator
Date 2021-03-29
Name of individual signing ANTHONY WARD AS ATTORNEY
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN 2020 262870614 2021-03-29 OPTIMUM CARE FAMILY MEDICINE LLC 3
Three-digit plan number (PN) 001
Effective date of plan 2017-10-01
Business code 621111
Sponsor’s telephone number 6312654606
Plan sponsor’s address 321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820

Signature of
Role Plan administrator
Date 2021-03-29
Name of individual signing ANTHONY WARD AS ATTORNEY
OPTIMUM CARE FAMILY MEDICINE LLC 401(K) PENSION PLAN 2019 262870614 2021-03-29 OPTIMUM CARE FAMILY MEDICINE LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-10-01
Business code 621111
Sponsor’s telephone number 6312654606
Plan sponsor’s address 321 E MIDDLE COUNTRY RD, SMITHTOWN, NY, 117872820

Signature of
Role Plan administrator
Date 2021-03-29
Name of individual signing ANTHONY WARD AS ATTORNEY
OPTIMUM CARE FAMILY MEDICINE LLC 401K PENSION PLAN 2019 262870614 2020-09-29 OPTIMUM CARE FAMILY MEDICINE LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-10-01
Business code 621111
Sponsor’s telephone number 6312654606
Plan sponsor’s address 321 MIDDLE COUNTRY ROAD, SMITHTOWN, NY, 11787

Signature of
Role Plan administrator
Date 2020-09-28
Name of individual signing ANNA RAMBALAKOS
OPTIMUM CARE FAMILY MEDICINE LLC 401K PENSION PLAN 2018 262870614 2020-09-28 OPTIMUM CARE FAMILY MEDICINE LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-10-01
Business code 621111
Sponsor’s telephone number 6312654606
Plan sponsor’s address 321 MIDDLE COUNTRY ROAD, SMITHTOWN, NY, 11787

Signature of
Role Plan administrator
Date 2020-09-28
Name of individual signing ANNA RAMBALAKOS

DOS Process Agent

Name Role Address
OPTIMUM CARE FAMILY MEDICINE, LLC DOS Process Agent 321 EAST MAIN STREET, SUITE 1, SMITHTOWN, NY, United States, 11787

History

Start date End date Type Value
2018-08-28 2024-06-14 Address 321 EAST MAIN STREET, SUITE 1, SMITHTOWN, NY, 11787, USA (Type of address: Service of Process)
2012-06-12 2018-08-28 Address 321 MIDDLE COUNTRY ROAD, SUITE 1, SMITHTOWN, NY, 11787, USA (Type of address: Service of Process)
2010-06-29 2012-06-12 Address NICHOLAS LIVRIERI, MD, 321 MIDDLE COUNTRY ROAD / #4, SMITHTOWN, NY, 11787, USA (Type of address: Service of Process)
2008-06-18 2010-06-29 Address NICHOLAS LIVRIERI, M.D., 321 MIDDLE COUNTRY RD STE 4, SMITHTOWN, NY, 11787, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
240614001255 2024-06-14 BIENNIAL STATEMENT 2024-06-14
220622003625 2022-06-22 BIENNIAL STATEMENT 2022-06-01
200602060940 2020-06-02 BIENNIAL STATEMENT 2020-06-01
180828002027 2018-08-28 BIENNIAL STATEMENT 2018-06-01
120612006590 2012-06-12 BIENNIAL STATEMENT 2012-06-01
100629002650 2010-06-29 BIENNIAL STATEMENT 2010-06-01
080813000069 2008-08-13 CERTIFICATE OF PUBLICATION 2008-08-13
080618000113 2008-06-18 ARTICLES OF ORGANIZATION 2008-06-18

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8828868302 2021-01-30 0235 PPS 321 E Main St, Smithtown, NY, 11787-2820
Loan Status Date 2022-09-16
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 82200
Loan Approval Amount (current) 82200
Undisbursed Amount 0
Franchise Name -
Lender Location ID 58771
Servicing Lender Name Legacy Bank
Servicing Lender Address 101 W Main St, HINTON, OK, 73047
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Smithtown, SUFFOLK, NY, 11787-2820
Project Congressional District NY-01
Number of Employees 11
NAICS code 621112
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Sole Proprietorship
Originating Lender ID 58771
Originating Lender Name Legacy Bank
Originating Lender Address HINTON, OK
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 83467.25
Forgiveness Paid Date 2022-09-09
9541617309 2020-05-02 0235 PPP 321 Middle Country Road, Smithtown, NY, 11787
Loan Status Date 2022-02-18
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 61400
Loan Approval Amount (current) 61400
Undisbursed Amount 0
Franchise Name -
Lender Location ID 188567
Servicing Lender Name Loan Source Incorporated
Servicing Lender Address 353 East 83rd Street Suite 3H, NEW YORK, NY, 10028
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Smithtown, SUFFOLK, NY, 11787-0001
Project Congressional District NY-01
Number of Employees 10
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Sole Proprietorship
Originating Lender ID 29599
Originating Lender Name Northeast Bank
Originating Lender Address LEWISTON, ME
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 62118.3
Forgiveness Paid Date 2021-07-13

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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