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EVERGREEN FAMILY MEDICAL SERVICES, P.C.

Company Details

Name: EVERGREEN FAMILY MEDICAL SERVICES, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 14 Nov 2005 (19 years ago)
Entity Number: 3280645
County: Kings
Place of Formation: New York
Address: 743 58TH STREET, BROOKLYN, NY, United States, 11220
Address ZIP Code: 11220

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
EVERGREEN FAMILY MEDICAL SERVICES P.C DEFINED BENEFIT PENSION PLAN 2022 134315515 2024-10-14 EVERGREEN FAMILY MEDICAL SERVICES P.C. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220
EVERGREEN FAMILY MEDICAL SERVICES PC PROFIT SHARING PLAN 2022 134315515 2024-10-14 EVERGREEN FAMILY MEDICAL SERVICES P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2021-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220
EVERGREEN FAMILY MEDICAL SERVICES PC PROFIT SHARING PLAN 2021 134315515 2023-10-16 EVERGREEN FAMILY MEDICAL SERVICES P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2021-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220
EVERGREEN FAMILY MEDICAL SERVICES P.C DEFINED BENEFIT PENSION PLAN 2021 134315515 2023-10-16 EVERGREEN FAMILY MEDICAL SERVICES P.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220
EVERGREEN FAMILY MEDICAL SERVICES P.C DEFINED BENEFIT PENSION PLAN 2015 134315515 2017-10-05 EVERGREEN FAMILY MEDICAL SERVICES P.C 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220
EVERGREEN FAMILY MEDICAL SERVICES P.C DEFINED BENEFIT PENSION PLAN 2014 134315515 2016-10-11 EVERGREEN FAMILY MEDICAL SERVICES P.C 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220
EVERGREEN FAMILY MEDICAL SERVICES P.C DEFINED BENEFIT PENSION PLAN 2013 134315515 2015-09-24 EVERGREEN FAMILY MEDICAL SERVICES P.C 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220
EVERGREEN FAMILY MEDICAL SERVICES P.C DEFINED BENEFIT PENSION PLAN 2012 134315515 2014-08-22 EVERGREEN FAMILY MEDICAL SERVICES P.C 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220

Signature of
Role Plan administrator
Date 2014-08-22
Name of individual signing RAYMOND CHAN
Role Employer/plan sponsor
Date 2014-08-22
Name of individual signing RAYMOND CHAN
EVERGREEN FAMILY MEDICAL SERVICES P.C DEFINED BENEFIT PENSION PLAN 2011 134315515 2013-10-01 EVERGREEN FAMILY MEDICAL SERVICES P.C 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220

Plan administrator’s name and address
Administrator’s EIN 134315515
Plan administrator’s name EVERGREEN FAMILY MEDICAL SERVICES P.C
Plan administrator’s address 743 58TH STREET, BROOKLYN, NY, 11220
Administrator’s telephone number 7187650088

Signature of
Role Plan administrator
Date 2013-10-01
Name of individual signing RAYMOND CHAN
Role Employer/plan sponsor
Date 2013-10-01
Name of individual signing RAYMOND CHAN
EVERGREEN FAMILY MEDICAL SERVICES PC DEFINED BENEFIT PLAN 2010 134315515 2013-10-01 EVERGREEN FAMILY MEDICAL SERVICES P.C 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-12-31
Business code 621111
Sponsor’s telephone number 7187650088
Plan sponsor’s address 743 58TH STREET, BROOKLYN, NY, 11220

Plan administrator’s name and address
Administrator’s EIN 134315515
Plan administrator’s name EVERGREEN FAMILY MEDICAL SERVICES P.C
Plan administrator’s address 743 58TH STREET, BROOKLYN, NY, 11220
Administrator’s telephone number 7187650088

Signature of
Role Plan administrator
Date 2013-10-01
Name of individual signing RAYMOND CHAN
Role Employer/plan sponsor
Date 2013-10-01
Name of individual signing RAYMOND CHAN

DOS Process Agent

Name Role Address
RAYMOND CHAN DOS Process Agent 743 58TH STREET, BROOKLYN, NY, United States, 11220

Chief Executive Officer

Name Role Address
RAYMOND CHAN Chief Executive Officer 743 58TH STREET, BROOKLYN, NY, United States, 11220

Filings

Filing Number Date Filed Type Effective Date
220628003151 2022-06-28 BIENNIAL STATEMENT 2021-11-01
051114000798 2005-11-14 CERTIFICATE OF INCORPORATION 2005-11-14

Related by officers

RAYMOND CHAN

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Related by address

743 58TH STREET, BROOKLYN, NY, United States, 11220

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Date of last update: 10 Nov 2024

Sources: New York Secretary of State

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