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  5. HEALTHSOURCE MEDICAL SERVICES, PLLC

HEALTHSOURCE MEDICAL SERVICES, PLLC

Company Details

Name: HEALTHSOURCE MEDICAL SERVICES, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 19 Nov 2009 (15 years ago)
Entity Number: 3880616
ZIP code: 11733
County: Suffolk
Place of Formation: New York
Address: P.O. BOX 206, E. SETAUKET, NY, United States, 11733

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2023 271518224 2024-03-29 HEALTHSOURCE MEDICAL SERVICES PLLC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2024-03-29
Name of individual signing JOHN VON LINTIG
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2022 271518224 2023-07-20 HEALTHSOURCE MEDICAL SERVICES PLLC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2023-07-20
Name of individual signing JOHN
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2021 271518224 2022-09-09 HEALTHSOURCE MEDICAL SERVICES PLLC 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2022-09-09
Name of individual signing JOHN
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2020 271518224 2021-09-15 HEALTHSOURCE MEDICAL SERVICES PLLC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2021-09-15
Name of individual signing JOHN
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2019 271518224 2020-07-23 HEALTHSOURCE MEDICAL SERVICES PLLC 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2020-07-23
Name of individual signing JOHN FOLAN
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2018 271518224 2019-04-12 HEALTHSOURCE MEDICAL SERVICES PLLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2019-04-12
Name of individual signing JOHN FOLAN
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2017 271518224 2018-09-18 HEALTHSOURCE MEDICAL SERVICES PLLC 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2018-09-18
Name of individual signing JOHN FOLAN
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2016 271518224 2017-08-17 HEALTHSOURCE MEDICAL SERVICES PLLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2017-08-17
Name of individual signing JOHN FOLAN
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2015 271518224 2016-06-01 HEALTHSOURCE MEDICAL SERVICES PLLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2016-06-01
Name of individual signing JOHN FOLAN
HEALTHSOURCE MEDICAL SERVICES PLLC 401(K) PLAN 2014 271518224 2015-04-15 HEALTHSOURCE MEDICAL SERVICES PLLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621111
Sponsor’s telephone number 6314350110
Plan sponsor’s address 1743 NORTH OCEAN AVENUE, MEDFORD, NY, 11763

Signature of
Role Plan administrator
Date 2015-04-15
Name of individual signing JOHN FOLAN

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent P.O. BOX 206, E. SETAUKET, NY, United States, 11733

Filings

Filing Number Date Filed Type Effective Date
140115002497 2014-01-15 BIENNIAL STATEMENT 2013-11-01
111208002743 2011-12-08 BIENNIAL STATEMENT 2011-11-01
100114000085 2010-01-14 CERTIFICATE OF AMENDMENT 2010-01-14
091119000401 2009-11-19 ARTICLES OF ORGANIZATION 2009-11-19

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
1507948604 2021-03-13 0235 PPS 3001 Express Dr N Ste 200C, Islandia, NY, 11749-5301
Loan Status Date 2022-03-18
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 189787
Loan Approval Amount (current) 189787
Undisbursed Amount 0
Franchise Name -
Lender Location ID 48270
Servicing Lender Name JPMorgan Chase Bank, National Association
Servicing Lender Address 1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator U
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address Islandia, SUFFOLK, NY, 11749-5301
Project Congressional District NY-02
Number of Employees 15
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 48270
Originating Lender Name JPMorgan Chase Bank, National Association
Originating Lender Address COLUMBUS, OH
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 191522.92
Forgiveness Paid Date 2022-02-16
1938537703 2020-05-01 0235 PPP 3001 EXPRESS DR N STE 200C, ISLANDIA, NY, 11749
Loan Status Date 2021-05-22
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 163865
Loan Approval Amount (current) 163865
Undisbursed Amount 0
Franchise Name -
Lender Location ID 48270
Servicing Lender Name JPMorgan Chase Bank, National Association
Servicing Lender Address 1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address ISLANDIA, SUFFOLK, NY, 11749-1302
Project Congressional District NY-02
Number of Employees 14
NAICS code 423450
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 194093
Originating Lender Name JPMorgan Chase Bank, National Association
Originating Lender Address CHICAGO, IL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 165457.49
Forgiveness Paid Date 2021-04-26

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Date of last update: 27 Mar 2025

Sources: New York Secretary of State

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