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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 (26 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

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
9603387210 2020-04-28 0202 PPP 7-11 South Broadway, White Plains, NY, 10601
Loan Status Date 2022-02-19
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 229000
Loan Approval Amount (current) 229000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 188567
Servicing Lender Name Loan Source Incorporated
Servicing Lender Address 353 East 83rd Street Suite 3H, NEW YORK, NY, 10028
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address White Plains, WESTCHESTER, NY, 10601-1000
Project Congressional District NY-16
Number of Employees 30
NAICS code 621498
Borrower Race Unanswered
Borrower Ethnicity Hispanic or Latino
Business Type Corporation
Originating Lender ID 86717
Originating Lender Name Webster Bank National Association
Originating Lender Address Pearl River, NY
Gender Female Owned
Veteran Non-Veteran
Forgiveness Amount 231942.49
Forgiveness Paid Date 2021-08-23

Related by officers

GINA CAPPELLI

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Related by address

No related companies by address

Date of last update: 31 Mar 2025

Sources: New York Secretary of State

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