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  5. KEESEVILLE PHARMACY, INC.

KEESEVILLE PHARMACY, INC.

Company Details

Name: KEESEVILLE PHARMACY, INC.
Jurisdiction: New York
Legal type: DOMESTIC BUSINESS CORPORATION
Status: Active
Date of registration: 23 Jun 1983 (42 years ago)
Entity Number: 850808
ZIP code: 12944
County: Essex
Place of Formation: New York
Address: 1730 FRONT ST, KEESEVILLE, NY, United States, 12944

Contact Details

Phone +1 518-834-6090

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
KEESEVILLE PHARMACY INC 401(K) PROFIT SHARING PLAN & TRUST 2023 141645082 2024-05-08 KEESEVILLE PHARMACY INC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-06-15
Business code 446110
Sponsor’s telephone number 5182973784
Plan sponsor’s address 1730 FRONT ST, KEESEVILLE, NY, 129443618

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 2024-05-08
Name of individual signing ERISA FIDUCIARY SERVICES
KEESEVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2022 141645082 2023-08-24 KEESEVILLE PHARMACY, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 453990
Sponsor’s telephone number 5188346090
Plan sponsor’s address 1730 FRONT STREET, KEESEVILLE, NY, 12944

Signature of
Role Plan administrator
Date 2023-08-24
Name of individual signing REBECCA CAREY
Role Employer/plan sponsor
Date 2023-08-24
Name of individual signing REBECCA CAREY
KEESEVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2021 141645082 2022-05-05 KEESEVILLE PHARMACY, INC. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 453990
Sponsor’s telephone number 5188346090
Plan sponsor’s address 1730 FRONT STREET, KEESEVILLE, NY, 12944

Signature of
Role Plan administrator
Date 2022-05-05
Name of individual signing REBECCA CAREY
Role Employer/plan sponsor
Date 2022-05-05
Name of individual signing REBECCA CAREY
KEESEVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2020 141645082 2021-09-26 KEESEVILLE PHARMACY, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 453990
Sponsor’s telephone number 5188346090
Plan sponsor’s address 1730 FRONT STREET, KEESEVILLE, NY, 12944

Signature of
Role Plan administrator
Date 2021-09-26
Name of individual signing REBECCA CAREY
Role Employer/plan sponsor
Date 2021-09-26
Name of individual signing REBECCA CAREY
KEESEVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2019 141645082 2020-09-29 KEESEVILLE PHARMACY, INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 453990
Sponsor’s telephone number 5188346090
Plan sponsor’s address 1730 FRONT STREET, KEESEVILLE, NY, 12944

Signature of
Role Plan administrator
Date 2020-09-29
Name of individual signing REBECCA CAREY
Role Employer/plan sponsor
Date 2020-09-29
Name of individual signing REBECCA CAREY
KEESEVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2018 141645082 2019-06-27 KEESEVILLE PHARMACY, INC. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 453990
Sponsor’s telephone number 5188346090
Plan sponsor’s address 1730 FRONT STREET, KEESVILLE, NY, 12944

Signature of
Role Plan administrator
Date 2019-06-27
Name of individual signing REBECCA CAREY
Role Employer/plan sponsor
Date 2019-06-27
Name of individual signing REBECCA CAREY
KEESEVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2017 141645082 2018-07-18 KEESEVILLE PHARMACY, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 453990
Sponsor’s telephone number 5188346090
Plan sponsor’s address 1730 FRONT STREET, KEESVILLE, NY, 12944

Signature of
Role Plan administrator
Date 2018-07-18
Name of individual signing REBECCA CAREY
Role Employer/plan sponsor
Date 2018-07-18
Name of individual signing REBECCA CAREY
KEESEVILLE PHARMACY, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2016 141645082 2017-08-21 KEESEVILLE PHARMACY, INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 453990
Sponsor’s telephone number 5188346090
Plan sponsor’s address 1730 FRONT STREET, KEESVILLE, NY, 12944

Signature of
Role Plan administrator
Date 2017-08-21
Name of individual signing REBECCA CAREY
KEESEVILLE PHARMACY INC 401 K PROFIT SHARING PLAN TRUST 2014 141645082 2015-05-13 KEESEVILLE PHARMACY INC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 453990
Sponsor’s telephone number 5188346090
Plan sponsor’s address 1730 FRONT ST., KEESEVILLE, NY, 12944

Signature of
Role Plan administrator
Date 2015-05-13
Name of individual signing REBECCA CAREY
KEESEVILLE PHARMACY INC 401 K PROFIT SHARING PLAN TRUST 2013 141645082 2014-06-17 KEESEVILLE PHARMACY INC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 453990
Sponsor’s telephone number 5188346090
Plan sponsor’s address 1730 FRONT ST., KEESEVILLE, NY, 12944

Signature of
Role Plan administrator
Date 2014-06-17
Name of individual signing REBECCA CAREY

Chief Executive Officer

Name Role Address
DANIEL A. BOSLEY Chief Executive Officer 1730 FRONT ST, KEESEVILLE, NY, United States, 12944

DOS Process Agent

Name Role Address
DANIEL A. BOSLEY DOS Process Agent 1730 FRONT ST, KEESEVILLE, NY, United States, 12944

Licenses

Number Type Address
729254 Retail grocery store 1730 FRONT ST, KEESEVILLE, NY, 12944

History

Start date End date Type Value
2023-10-03 2023-10-03 Address 1730 FRONT ST, KEESEVILLE, NY, 12944, USA (Type of address: Chief Executive Officer)
2003-05-16 2023-10-03 Address 1730 FRONT ST, KEESEVILLE, NY, 12944, USA (Type of address: Chief Executive Officer)
2003-05-16 2023-10-03 Address 1730 FRONT ST, KEESEVILLE, NY, 12944, USA (Type of address: Service of Process)
1999-06-28 2003-05-16 Address PO BOX 86, 2940 MAIN ST., PERU, NY, 12972, 0086, USA (Type of address: Principal Executive Office)
1999-06-28 2003-05-16 Address PO BOX 86, 2940 MAIN ST., PERU, NY, 12972, 0086, USA (Type of address: Service of Process)
1999-06-28 2003-05-16 Address PO BX 86, 2940 MAIN ST., PERU, NY, 12972, 0086, USA (Type of address: Chief Executive Officer)
1993-04-14 1999-06-28 Address 2993 MAIN STREET, PO BOX 86, PERU, NY, 12972, 0086, USA (Type of address: Principal Executive Office)
1993-04-14 1999-06-28 Address 24 SCHOOL STREET, PO BOX 86, PERU, NY, 12972, 0086, USA (Type of address: Chief Executive Officer)
1993-04-14 1999-06-28 Address 2993 MAIN STREET, PO BOX 86, PERU, NY, 12972, 0086, USA (Type of address: Service of Process)
1983-06-23 1993-04-14 Address 62 BRINKERHOFF ST., PLATTSBURGH, NY, 12901, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
231003001661 2023-10-03 BIENNIAL STATEMENT 2023-06-01
211026003222 2021-10-26 BIENNIAL STATEMENT 2021-10-26
190327002025 2019-03-27 BIENNIAL STATEMENT 2017-06-01
070802002555 2007-08-02 BIENNIAL STATEMENT 2007-06-01
051024002520 2005-10-24 BIENNIAL STATEMENT 2005-06-01
030516002688 2003-05-16 BIENNIAL STATEMENT 2003-06-01
010614002289 2001-06-14 BIENNIAL STATEMENT 2001-06-01
990628002893 1999-06-28 BIENNIAL STATEMENT 1999-06-01
970529002494 1997-05-29 BIENNIAL STATEMENT 1997-06-01
000045004780 1993-09-03 BIENNIAL STATEMENT 1993-06-01

Inspections

Date Inspection Object Address Grade Type Institution Desctiption
2024-09-25 KEESEVILLE PHARMACY 1730 FRONT ST, KEESEVILLE, Essex, NY, 12944 B Food Inspection Department of Agriculture and Markets 09G - Quaternary ammonium sanitizer test strips are unavailable.
2023-11-28 KEESEVILLE PHARMACY 1730 FRONT ST, KEESEVILLE, Essex, NY, 12944 A Food Inspection Department of Agriculture and Markets No data
2022-12-01 KEESEVILLE PHARMACY 1730 FRONT ST, KEESEVILLE, Essex, NY, 12944 A Food Inspection Department of Agriculture and Markets No data

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
9195007005 2020-04-09 0248 PPP 1730 Front Street, KEESEVILLE, NY, 12944-3618
Loan Status Date 2021-03-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 100160
Loan Approval Amount (current) 100160
Undisbursed Amount 0
Franchise Name -
Lender Location ID 47029
Servicing Lender Name Community Bank, National Association
Servicing Lender Address 45-49 Court St, CANTON, NY, 13617-1118
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address KEESEVILLE, CLINTON, NY, 12944-3618
Project Congressional District NY-21
Number of Employees 10
NAICS code 446110
Borrower Race White
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 47029
Originating Lender Name Community Bank, National Association
Originating Lender Address CANTON, NY
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 100994.21
Forgiveness Paid Date 2021-02-17

Related by officers

DANIEL A. BOSLEY

CORNERSTONE DRUG & GIFT, INC.

Related by address

No related companies by address

Date of last update: 17 Mar 2025

Sources: New York Secretary of State

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