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  5. LAKESIDE MEMORIAL HOSPITAL, INC.

LAKESIDE MEMORIAL HOSPITAL, INC.

Company Details

Name: LAKESIDE MEMORIAL HOSPITAL, INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 22 Mar 1939 (86 years ago)
Entity Number: 40342
ZIP code: 14420
County: Monroe
Place of Formation: New York
Address: 156 WEST AVENUE, BROCKPORT, NY, United States, 14420

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKESIDE HEALTH SYSTEM DEFINED CONTRIBUTION RETIREMENT PLAN 2018 160743068 2019-10-15 LAKESIDE MEMORIAL HOSPITAL, INC. 260
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-07-01
Business code 621900
Sponsor’s telephone number 5853956095
Plan sponsor’s mailing address 156 WEST AVENUE, BROCKPORT, NY, 14420
Plan sponsor’s address 156 WEST AVENUE, BROCKPORT, NY, 14420

Number of participants as of the end of the plan year
Active participants 15
Other retired or separated participants entitled to future benefits 219
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 1
Number of participants with account balances as of the end of the plan year 228
LAKESIDE HEALTH SYSTEM DEFINED CONTRIBUTION RETIREMENT PLAN 2018 160743068 2019-11-12 LAKESIDE MEMORIAL HOSPITAL, INC. 235
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-07-01
Business code 621900
Sponsor’s telephone number 5853956095
Plan sponsor’s mailing address 156 WEST AVENUE, BROCKPORT, NY, 14420
Plan sponsor’s address 156 WEST AVENUE, BROCKPORT, NY, 14420

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
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 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0
LAKESIDE HEALTH SYSTEM DEFINED CONTRIBUTION RETIREMENT PLAN 2017 160743068 2018-10-15 LAKESIDE MEMORIAL HOSPITAL, INC. 280
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-07-01
Business code 621900
Sponsor’s telephone number 5853956095
Plan sponsor’s mailing address 156 WEST AVENUE, BROCKPORT, NY, 14420
Plan sponsor’s address 156 WEST AVENUE, BROCKPORT, NY, 14420

Number of participants as of the end of the plan year
Active participants 214
Other retired or separated participants entitled to future benefits 45
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 1
Number of participants with account balances as of the end of the plan year 249
LAKESIDE HEALTH SYSTEM DEFINED CONTRIBUTION RETIREMENT PLAN 2016 160743068 2017-10-15 LAKESIDE MEMORIAL HOSPITAL, INC. 295
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-07-01
Business code 621900
Sponsor’s telephone number 5853956095
Plan sponsor’s mailing address 156 WEST AVENUE, BROCKPORT, NY, 14420
Plan sponsor’s address 156 WEST AVENUE, BROCKPORT, NY, 14420

Number of participants as of the end of the plan year
Active participants 240
Other retired or separated participants entitled to future benefits 39
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 1
Number of participants with account balances as of the end of the plan year 269
LAKESIDE HEALTH SYSTEM DEFINED CONTRIBUTION RETIREMENT PLAN 2015 160743068 2016-10-17 LAKESIDE MEMORIAL HOSPITAL, INC. 325
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-07-01
Business code 621900
Sponsor’s telephone number 5853956095
Plan sponsor’s mailing address 156 WEST AVENUE, BROCKPORT, NY, 14420
Plan sponsor’s address 156 WEST AVENUE, BROCKPORT, NY, 14420

Number of participants as of the end of the plan year
Active participants 256
Other retired or separated participants entitled to future benefits 38
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 1
Number of participants with account balances as of the end of the plan year 285
LAKESIDE HEALTH SYSTEM DEFINED CONTRIBUTION RETIREMENT PLAN 2014 160743068 2015-10-14 LAKESIDE MEMORIAL HOSPITAL, INC. 345
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2004-07-01
Business code 621900
Sponsor’s telephone number 5853956095
Plan sponsor’s mailing address 156 WEST AVENUE, BROCKPORT, NY, 14420
Plan sponsor’s address 156 WEST AVENUE, BROCKPORT, NY, 14420

Number of participants as of the end of the plan year
Active participants 287
Other retired or separated participants entitled to future benefits 37
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 1
Number of participants with account balances as of the end of the plan year 314

Agent

Name Role Address
N/A: THE CORP. Agent 156 WEST AVE., BROCKPORT, NY, 14420

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 156 WEST AVENUE, BROCKPORT, NY, United States, 14420

Filings

Filing Number Date Filed Type Effective Date
960109000501 1996-01-09 CERTIFICATE OF AMENDMENT 1996-01-09
A989248-2 1983-06-13 ASSUMED NAME CORP INITIAL FILING 1983-06-13
A164673-2 1974-06-24 CERTIFICATE OF AMENDMENT 1974-06-24
357293 1962-12-21 CERTIFICATE OF AMENDMENT 1962-12-21
28EX-254 1951-12-03 CERTIFICATE OF AMENDMENT 1951-12-03
478Q-90 1947-02-06 CERTIFICATE OF AMENDMENT 1947-02-06
397Q-150 1939-03-22 CERTIFICATE OF INCORPORATION 1939-03-22

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
309979920 0213600 2006-05-19 156 WEST AVENUE, BROCKPORT, NY, 14420
Inspection Type Prog Related
Scope Partial
Safety/Health Safety
Close Conference 2006-05-30
Case Closed 2006-07-06

Related Activity
Type Inspection
Activity Nr 309902906

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100133 A01
Issuance Date 2006-06-02
Abatement Due Date 2006-07-05
Current Penalty 2100.0
Initial Penalty 2625.0
Nr Instances 1
Nr Exposed 1
Gravity 05
Citation ID 01002
Citaton Type Serious
Standard Cited 19100147 F02 II
Issuance Date 2006-06-02
Abatement Due Date 2006-07-05
Current Penalty 2625.0
Initial Penalty 2625.0
Nr Instances 1
Nr Exposed 2
Gravity 05
Citation ID 01003
Citaton Type Serious
Standard Cited 19100333 B02 IIIA
Issuance Date 2006-06-02
Abatement Due Date 2006-07-05
Current Penalty 2625.0
Initial Penalty 2625.0
Nr Instances 1
Nr Exposed 2
Gravity 05
Citation ID 01004A
Citaton Type Serious
Standard Cited 19100147 F02 II
Issuance Date 2006-06-02
Abatement Due Date 2006-07-05
Current Penalty 2625.0
Nr Instances 1
Nr Exposed 2
Gravity 05
Citation ID 01004B
Citaton Type Serious
Standard Cited 19100333 B02 IIIA
Issuance Date 2006-06-02
Abatement Due Date 2006-07-05
Nr Instances 1
Nr Exposed 2
Gravity 05
Citation ID 02001
Citaton Type Other
Standard Cited 19100147 C06 IA
Issuance Date 2006-06-02
Abatement Due Date 2006-07-05
Nr Instances 2
Nr Exposed 2
Gravity 01
Citation ID 02002
Citaton Type Other
Standard Cited 19100147 C06 II
Issuance Date 2006-06-02
Abatement Due Date 2006-07-05
Nr Instances 3
Nr Exposed 2
Gravity 01
309979755 0213600 2006-05-04 156 WEST AVENUE, BROCKPORT, NY, 14420
Inspection Type Prog Related
Scope Complete
Safety/Health Health
Close Conference 2006-06-01
Emphasis N: NURSING, S: ERGONOMICS
Case Closed 2006-06-01

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
16-0743068 Corporation Unconditional Exemption 4107 LAKE RD N, BROCKPORT, NY, 14420-1519 1949-01
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2023-12
Asset 1,000,000 to 4,999,999
Income 1 to 9,999
Filing Requirement 990 - Required to file Form 990-N - Income less than $50,000 per year
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 1464271
Income Amount 496
Form 990 Revenue Amount 496
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name LAKESIDE MEMORIAL HOSPITAL INC
EIN 16-0743068
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name LAKESIDE MEMORIAL HOSPITAL INC
EIN 16-0743068
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name LAKESIDE MEMORIAL HOSPITAL INC
EIN 16-0743068
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name LAKESIDE MEMORIAL HOSPITAL INC
EIN 16-0743068
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name LAKESIDE MEMORIAL HOSPITAL INC
EIN 16-0743068
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name LAKESIDE MEMORIAL HOSPITAL INC
EIN 16-0743068
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name LAKESIDE MEMORIAL HOSPITAL INC
EIN 16-0743068
Tax Period 201612
Filing Type E
Return Type 990
File View File
Organization Name LAKESIDE MEMORIAL HOSPITAL INC
EIN 16-0743068
Tax Period 201512
Filing Type E
Return Type 990
File View File

Related by officers

N/A: THE CORP.

334 AUDUBON SOCIAL CLUB, INC. 336 RIFLE & PISTOL CLUB INC. 338 SOCIAL CLUB, INC. 360 SOCIAL CLUB, INC. 370 FRANKLIN CORPORATION A.T.W./USA, INC. ABE & EDITH ROSENBERG & JAMES & IDA MANDEL FAMILY CIRCLE, INC. ABRAHAM AND LILLIAN ROSENBERG FOUNDATION, INC. ADIRONDACK COMMUNITY ACTION PROGRAMS, INC. ALTERNATIVES COUNSELING SERVICES, INC.

THE CORPORATION

ARSHIA DESIGNS INC. AAA VACUUM CORP. ATLANTICA TELECOM, INC. MISTY SPORTSWEAR, INC. FAT JAMS ELECTRONICS INC. CROQUEMBOUCHE, INC. LONG BEACH PEDIATRIC GROUP, P.C. LAW OFFICES OF JOSEPH A. GRECO, P.C. TEREZ, INC. 732 CINNAMON BEACH INC.

Related by address

156 WEST AVENUE, BROCKPORT, NY, United States, 14420

HIDETAKA SAGAWA, M. D., P. C. HOVANESS H. MARONIAN, M.D., P.C. LAKESIDE PHYSICIAN ORGANIZATION, LLC

Date of last update: 19 Mar 2025

Sources: New York Secretary of State

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