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FORME MEDICAL CENTER, INC

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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

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

National Provider Identifier

NPI Number:
1083755920
Certification Date:
2025-02-05

Authorized Person:

Name:
MS. GINA CAPPELLI
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QR0400X - Rehabilitation Clinic/Center
Is Primary:
No
Selected Taxonomy:
284300000X - Special Hospital
Is Primary:
No
Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
9149029011
Fax:
9144485275

Form 5500 Series

Employer Identification Number (EIN):
134068415
Plan Year:
2022
Number Of Participants:
12
Sponsors Telephone Number:
Plan Year:
2021
Number Of Participants:
17
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
24
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
46
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
45
Sponsors Telephone Number:

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)

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

USAspending Awards / Financial Assistance

Date:
2021-01-23
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
322500.00
Total Face Value Of Loan:
322500.00
Date:
2020-04-28
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
229000.00
Total Face Value Of Loan:
229000.00

Paycheck Protection Program

Date Approved:
2020-04-28
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Initial Approval Amount:
229000
Current Approval Amount:
229000
Race:
Unanswered
Ethnicity:
Hispanic or Latino
Gender:
Female Owned
Veteran:
Non-Veteran
Forgiveness Amount:
231942.49

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Date of last update: 31 Mar 2025

Sources: New York Secretary of State