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  5. FORME MEDICAL CENTER, INC

FORME MEDICAL CENTER, INC

Company Details

Name: FORME MEDICAL CENTER, INC
Jurisdiction: New York
Legal type: DOMESTIC BUSINESS CORPORATION
Status: Active
Date of registration: 02 Jun 1999 (25 years ago)
Entity Number: 2384733
ZIP code: 10601
County: Westchester
Place of Formation: New York
Address: 7-11 South Broadway, Suite 100, WHITE PLAINS, NY, United States, 10601

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
FORME MEDICAL CENTER, INC 401(K) P/S PLAN 2022 134068415 2023-05-23 FORME MEDICAL CENTER, INC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621498
Sponsor’s telephone number 9147234900
Plan sponsor’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601

Plan administrator’s name and address
Administrator’s EIN 134068415
Plan administrator’s name FORME MEDICAL CENTER, INC
Plan administrator’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601
Administrator’s telephone number 9147234900

Signature of
Role Plan administrator
Date 2023-05-23
Name of individual signing GINA CAPPELLI
FORME MEDICAL CENTER, INC 401(K) P/S PLAN 2021 134068415 2022-12-01 FORME MEDICAL CENTER, INC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621498
Sponsor’s telephone number 9147234900
Plan sponsor’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601

Plan administrator’s name and address
Administrator’s EIN 134068415
Plan administrator’s name FORME MEDICAL CENTER, INC
Plan administrator’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601
Administrator’s telephone number 9147234900

Signature of
Role Plan administrator
Date 2022-12-01
Name of individual signing GINA CAPPELLI
FORME MEDICAL CENTER, INC 401(K) P/S PLAN 2020 134068415 2021-07-23 FORME MEDICAL CENTER, INC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621498
Sponsor’s telephone number 9147234900
Plan sponsor’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601

Plan administrator’s name and address
Administrator’s EIN 134068415
Plan administrator’s name FORME MEDICAL CENTER, INC
Plan administrator’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601
Administrator’s telephone number 9147234900

Signature of
Role Plan administrator
Date 2021-07-23
Name of individual signing GINA CAPPELLI
FORME MEDICAL CENTER, INC 401(K) P/S PLAN 2019 134068415 2020-07-13 FORME MEDICAL CENTER, INC 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621498
Sponsor’s telephone number 9147234900
Plan sponsor’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601

Plan administrator’s name and address
Administrator’s EIN 134068415
Plan administrator’s name FORME MEDICAL CENTER, INC
Plan administrator’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601
Administrator’s telephone number 9147234900

Signature of
Role Plan administrator
Date 2020-07-13
Name of individual signing GINA CAPPELLI
FORME MEDICAL CENTER, INC 401(K) P/S PLAN 2018 134068415 2019-06-18 FORME MEDICAL CENTER, INC 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621498
Sponsor’s telephone number 9147234900
Plan sponsor’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601

Plan administrator’s name and address
Administrator’s EIN 134068415
Plan administrator’s name FORME MEDICAL CENTER, INC
Plan administrator’s address 7-11 S BROADWAY, WHITE PLAINS, NY, 10601
Administrator’s telephone number 9147234900

Signature of
Role Plan administrator
Date 2019-06-18
Name of individual signing CHRISTOPHER M. RIVERA
FORME REHABILITATION INC 401 K PROFIT SHARING PLAN TRUST 2017 134068415 2018-06-19 FORME MEDICAL CENTER INC 57
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621111
Sponsor’s telephone number 9147234900
Plan sponsor’s address 7 11 S BROADWAY, WHITE PLAINS, NY, 10601

Signature of
Role Plan administrator
Date 2018-06-19
Name of individual signing JOHANNA FELIX

Chief Executive Officer

Name Role Address
GINA CAPPELLI Chief Executive Officer 7-11 SOUTH BROAWAY, SUITE 100, WHITE PLAINS, NY, United States, 10601

DOS Process Agent

Name Role Address
FORME MEDICAL CENTER, INC DOS Process Agent 7-11 South Broadway, Suite 100, WHITE PLAINS, NY, United States, 10601

History

Start date End date Type Value
2023-06-06 2023-06-06 Address 7-11 SOUTH BROAWAY, SUITE 100, WHITE PLAINS, NY, 10601, USA (Type of address: Chief Executive Officer)
2023-06-06 2023-06-06 Address 7-, SUITE 100, WHITE PLAINS, NY, 10601, USA (Type of address: Chief Executive Officer)
2023-06-06 2023-06-06 Address 5 RENAISSANCE SQ, #11G, WHITE PLAINS, NY, 10601, USA (Type of address: Chief Executive Officer)
2023-05-21 2023-06-06 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
2014-09-09 2023-06-06 Address 5 RENAISSANCE SQ, #11G, WHITE PLAINS, NY, 10601, USA (Type of address: Chief Executive Officer)
2014-09-09 2023-06-06 Address 5 RENAISSANCE SQ, #11G, WHITE PLAINS, NY, 10601, USA (Type of address: Service of Process)
2003-07-21 2014-09-09 Address 139 BOULDER BRIDGE RD, SCARSDALE, NY, 10583, USA (Type of address: Principal Executive Office)
2003-07-21 2014-09-09 Address 1075 CENTRAL PARK AVE, SCARSDALE, NY, 10583, USA (Type of address: Chief Executive Officer)
1999-06-02 2023-05-21 Shares Share type: NO PAR VALUE, Number of shares: 200, Par value: 0
1999-06-02 2014-09-09 Address 1075 CENTRAL PARK AVENUE, SCARSDALE, NY, 00000, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
230606001205 2023-06-06 BIENNIAL STATEMENT 2023-06-01
220907001167 2022-09-07 BIENNIAL STATEMENT 2021-06-01
160418000616 2016-04-18 CERTIFICATE OF AMENDMENT 2016-04-18
140909002024 2014-09-09 BIENNIAL STATEMENT 2013-06-01
060601000621 2006-06-01 CERTIFICATE OF MERGER 2006-06-01
050912002485 2005-09-12 BIENNIAL STATEMENT 2005-06-01
030721002190 2003-07-21 BIENNIAL STATEMENT 2003-06-01
990602000688 1999-06-02 CERTIFICATE OF INCORPORATION 1999-06-02

Related by officers

GINA CAPPELLI

FORME HEALTH & FITNESS, INC. ELC HOLDING, LLC FORME HEALTH MANAGEMENT, LLC

Related by address

No related companies by address

Date of last update: 12 Nov 2024

Sources: New York Secretary of State

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