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  5. NEW YORK LONG TERM CARE BROKERS LLC

NEW YORK LONG TERM CARE BROKERS LLC

Company Details

Name: NEW YORK LONG TERM CARE BROKERS LLC
Jurisdiction: New York
Legal type: FOREIGN LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 29 Dec 2020 (4 years ago)
Entity Number: 5905026
ZIP code: 12207
County: Saratoga
Place of Formation: Delaware
Address: 80 STATE STREET, ALBANY, NY, United States, 12207

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2020 141764648 2021-05-12 NEW YORK LONG TERM CARE BROKERS 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5186888117
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Signature of
Role Plan administrator
Date 2021-05-12
Name of individual signing JILL O'CONNOR
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2020 141764648 2021-10-06 NEW YORK LONG TERM CARE BROKERS 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5186888117
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Signature of
Role Plan administrator
Date 2021-10-06
Name of individual signing JILL O'CONNOR
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2019 141764648 2020-09-28 NEW YORK LONG TERM CARE BROKERS 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5186888117
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Signature of
Role Plan administrator
Date 2020-09-28
Name of individual signing JILL O'CONNOR
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2018 141764648 2019-07-10 NEW YORK LONG TERM CARE BROKERS 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5183715522
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Plan administrator’s name and address
Administrator’s EIN 141764648
Plan administrator’s name NEW YORK LONG TERM CARE BROKERS
Plan administrator’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065
Administrator’s telephone number 5183715522
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2017 141764648 2018-07-23 NEW YORK LONG TERM CARE BROKERS 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5183715522
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Plan administrator’s name and address
Administrator’s EIN 141764648
Plan administrator’s name NEW YORK LONG TERM CARE BROKERS
Plan administrator’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065
Administrator’s telephone number 5183715522
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2016 141764648 2017-07-11 NEW YORK LONG TERM CARE BROKERS 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5183715522
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Plan administrator’s name and address
Administrator’s EIN 141764648
Plan administrator’s name NEW YORK LONG TERM CARE BROKERS
Plan administrator’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065
Administrator’s telephone number 5183715522
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2015 141764648 2016-07-06 NEW YORK LONG TERM CARE BROKERS 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5183715522
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Plan administrator’s name and address
Administrator’s EIN 141764648
Plan administrator’s name NEW YORK LONG TERM CARE BROKERS
Plan administrator’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065
Administrator’s telephone number 5183715522
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2014 141764648 2015-05-06 NEW YORK LONG TERM CARE BROKERS 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5183715522
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Plan administrator’s name and address
Administrator’s EIN 141764648
Plan administrator’s name NEW YORK LONG TERM CARE BROKERS
Plan administrator’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065
Administrator’s telephone number 5183715522

Signature of
Role Plan administrator
Date 2015-05-06
Name of individual signing KEVIN J. JOHNSON
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2013 141764648 2014-05-13 NEW YORK LONG TERM CARE BROKERS 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5183715522
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Plan administrator’s name and address
Administrator’s EIN 141764648
Plan administrator’s name NEW YORK LONG TERM CARE BROKERS
Plan administrator’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065
Administrator’s telephone number 5183715522

Signature of
Role Plan administrator
Date 2014-05-13
Name of individual signing KEVIN J. JOHNSON
NEW YORK LONG TERM CARE BROKERS RETIREMENT PLAN 2012 141764648 2013-10-09 NEW YORK LONG TERM CARE BROKERS 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 524210
Sponsor’s telephone number 5183715522
Plan sponsor’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065

Plan administrator’s name and address
Administrator’s EIN 141764648
Plan administrator’s name NEW YORK LONG TERM CARE BROKERS
Plan administrator’s address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065
Administrator’s telephone number 5183715522

Signature of
Role Plan administrator
Date 2013-10-09
Name of individual signing KEVIN J. JOHNSON

Agent

Name Role Address
CORPORATION SERVICE COMPANY Agent 80 STATE ST., ALBANY, NY, 12207

DOS Process Agent

Name Role Address
C/O CORPORATION SERVICE COMPANY DOS Process Agent 80 STATE STREET, ALBANY, NY, United States, 12207

History

Start date End date Type Value
2021-09-20 2024-12-02 Address 80 STATE ST., ALBANY, NY, 12207, USA (Type of address: Registered Agent)
2021-09-20 2024-12-02 Address 80 STATE STREET, ALBANY, 12207, 2543, USA (Type of address: Service of Process)
2021-09-14 2021-07-15 Address 28 LIBERTY STREET, NEW YORK, 10005, USA (Type of address: Service of Process)
2021-09-14 2021-07-15 Address 28 LIBERTY STREET, NEW YORK, NY, 10005, USA (Type of address: Registered Agent)
2021-07-15 2021-09-20 Address 28 LIBERTY STREET, NEW YORK, 10005, USA (Type of address: Service of Process)
2021-07-15 2021-09-20 Address 28 LIBERTY STREET, NEW YORK, NY, 10005, USA (Type of address: Registered Agent)
2020-12-29 2021-09-14 Address 11 EXECUTIVE PARK DRIVE, CLIFTON PARK, NY, 12065, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
241202006085 2024-12-02 BIENNIAL STATEMENT 2024-12-02
221206004100 2022-12-06 BIENNIAL STATEMENT 2022-12-01
210920000088 2021-09-20 CERTIFICATE OF CHANGE BY ENTITY 2021-09-20
210715000418 2021-07-15 CERTIFICATE OF CHANGE BY ENTITY 2021-07-15
210914000143 2021-06-21 CERTIFICATE OF PUBLICATION 2021-06-21
201229000290 2020-12-29 APPLICATION OF AUTHORITY 2020-12-29

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C/O CORPORATION SERVICE COMPANY

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Related by address

80 STATE STREET, ALBANY, NY, United States, 12207

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Date of last update: 05 Mar 2025

Sources: New York Secretary of State

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