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SOUTHERN TIER FAMILY DENTISTRY, P.C.

SOUTHERN TIER FAMILY DENTISTRY, P.C.

Company Details

Name:	SOUTHERN TIER FAMILY DENTISTRY, P.C.
Jurisdiction:	New York
Legal type:	DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status:	Active
Date of registration:	28 Dec 2012 (12 years ago)
Entity Number:	4338904
ZIP code:	14733
County:	Chautauqua
Place of Formation:	New York
Address:	230 EAST MAIN STREET, FALCONER, NY, United States, 14733

Shares Details

Shares issued 200

Share Par Value 0

Type NO PAR VALUE

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

SOUTHERN TIER FAMILY DENTISTRY, P. C. 401K PLAN

2023

461641421

2024-10-03

SOUTHERN TIER FAMILY DENTISTRY, P.C

16

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	7166659484
Plan sponsor’s address	230 EAST MAIN STREET, FALCONER, NY, 14733

Signature of

Role	Plan administrator
Date	2024-10-03
Name of individual signing	JAMES MITCHENER
Valid signature	Filed with authorized/valid electronic signature

SOUTHERN TIER FAMILY DENTISTRY P.C. 401K PLAN

2022

461641421

2023-08-18

SOUTHERN TIER FAMILY DENTISTRY, P.C.

15

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	7166659484
Plan sponsor’s address	230 EAST MAIN ST, FALCONER, NY, 14733

SOUTHERN TIER FAMILY DENTISTRY P.C. 401K PLAN

2021

461641421

2022-07-27

SOUTHERN TIER FAMILY DENTISTRY, P.C.

13

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	7166659484
Plan sponsor’s address	230 EAST MAIN ST, FALCONER, NY, 14733

SOUTHERN TIER FAMILY DENTISTRY P.C. 401K PLAN

2020

461641421

2021-07-23

SOUTHERN TIER FAMILY DENTISTRY, P.C.

13

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	7166659484
Plan sponsor’s address	230 EAST MAIN ST, FALCONER, NY, 14733

SOUTHERN TIER FAMILY DENTISTRY P.C. 401K PLAN

2019

461641421

2020-10-09

SOUTHERN TIER FAMILY DENTISTRY, P.C.

8

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	7166659484
Plan sponsor’s address	230 EAST MAIN ST, FALCONER, NY, 14733

SOUTHERN TIER FAMILY DENTISTRY P.C. 401K PLAN

2018

461641421

2019-10-10

SOUTHERN TIER FAMILY DENTISTRY, P.C.

7

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2014-01-01
Business code	621210
Sponsor’s telephone number	7166659484
Plan sponsor’s address	230 EAST MAIN ST, FALCONER, NY, 14733

Chief Executive Officer

Name	Role	Address
JAMES MITCHENER	Chief Executive Officer	3795 HARRIS HILL RD, FALCONER, NY, United States, 14733

DOS Process Agent

Name	Role	Address
SOUTHERN TIER FAMILY DENTISTRY, P.C.	DOS Process Agent	230 EAST MAIN STREET, FALCONER, NY, United States, 14733

History

Start date	End date	Type	Value
2012-12-28	2021-02-24	Address	230 EAST MAIN STREET, FALCONER, NY, 14733, USA (Type of address: Service of Process)

Filings

Filing Number	Date Filed	Type	Effective Date
210224060429	2021-02-24	BIENNIAL STATEMENT	2020-12-01
141217006011	2014-12-17	BIENNIAL STATEMENT	2014-12-01
121228000859	2012-12-28	CERTIFICATE OF INCORPORATION	2012-12-28

Paycheck Protection Program

Loan Number

Loan Funded Date

SBA Origination Office Code

Loan Delivery Method

Borrower Street Address

7985027006

2020-04-08

0296

PPP

230 East Main Street, FALCONER, NY, 14733-1318

Loan Status Date	2021-08-07
Loan Status	Paid in Full
Loan Maturity in Months	24
SBA Guaranty Percentage	100
Loan Approval Amount (at origination)	106100
Loan Approval Amount (current)	106100
Undisbursed Amount	0
Franchise Name	-
Lender Location ID	50167
Servicing Lender Name	Five Star Bank
Servicing Lender Address	55 N Main St, WARSAW, NY, 14569-1325
Rural or Urban Indicator	R
Hubzone	Y
LMI	N
Business Age Description	Existing or more than 2 years old
Project Address	FALCONER, CHAUTAUQUA, NY, 14733-1318
Project Congressional District	NY-23
Number of Employees	12
NAICS code	621210
Borrower Race	Unanswered
Borrower Ethnicity	Not Hispanic or Latino
Business Type	Professional Association
Originating Lender ID	50167
Originating Lender Name	Five Star Bank
Originating Lender Address	WARSAW, NY
Gender	Male Owned
Veteran	Non-Veteran
Forgiveness Amount	107423.3
Forgiveness Paid Date	2021-07-19

Date of last update: 26 Mar 2025

Sources: New York Secretary of State