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  5. EVERGREEN EAR, NOSE & THROAT SURGERY, P.C.

EVERGREEN EAR, NOSE & THROAT SURGERY, P.C.

Company Details

Name: EVERGREEN EAR, NOSE & THROAT SURGERY, P.C.
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE CORPORATION
Status: Active
Date of registration: 28 Aug 2003 (22 years ago)
Entity Number: 2948299
ZIP code: 11561
County: Nassau
Place of Formation: New York
Address: 480 E BAY DR, LONG BEACH, NY, United States, 11561

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 EAR, NOSE & THROAT SURGERY, P.C. PROFIT SHARING PLAN 2023 260069513 2024-10-14 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2024-10-14
Name of individual signing SHEFALI I. SHAH
Valid signature Filed with authorized/valid electronic signature
EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. CASH BALANCE PLAN 2023 260069513 2024-10-14 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2024-10-14
Name of individual signing SHEFALI I. SHAH
Valid signature Filed with authorized/valid electronic signature
EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. PROFIT SHARING PLAN 2022 260069513 2023-07-30 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2023-07-30
Name of individual signing SHEFALI I. SHAH
EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. CASH BALANCE PLAN 2022 260069513 2023-07-30 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2023-07-30
Name of individual signing SHEFALI I. SHAH
EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. PROFIT SHARING PLAN 2021 260069513 2022-10-15 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2022-10-15
Name of individual signing SHEFALI I. SHAH
EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. CASH BALANCE PLAN 2021 260069513 2022-10-15 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2022-10-15
Name of individual signing SHEFALI I. SHAH
EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. PROFIT SHARING PLAN 2020 260069513 2021-10-09 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2021-10-09
Name of individual signing SHEFALI I. SHAH
EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. CASH BALANCE PLAN 2020 260069513 2021-10-09 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2021-10-09
Name of individual signing SHEFALI I. SHAH
EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. CASH BALANCE PLAN 2019 260069513 2020-04-14 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2020-04-14
Name of individual signing SHEFALI I. SHAH
EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. PROFIT SHARING PLAN 2019 260069513 2020-04-14 EVERGREEN EAR, NOSE & THROAT SURGERY, P.C. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 5164310700
Plan sponsor’s address 728 EAST PARK AVENUE, LONG BEACH, NY, 11561

Signature of
Role Plan administrator
Date 2020-04-14
Name of individual signing SHEFALI I. SHAH

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 480 E BAY DR, LONG BEACH, NY, United States, 11561

Chief Executive Officer

Name Role Address
SHEFALI I SHAH MD Chief Executive Officer 480 E BAY DR, LONG BEACH, NY, United States, 11561

History

Start date End date Type Value
2003-08-28 2005-10-14 Address 480 EAST BAY DRIVE, LONG BEACH, NY, 11561, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
150818006005 2015-08-18 BIENNIAL STATEMENT 2015-08-01
130926006011 2013-09-26 BIENNIAL STATEMENT 2013-08-01
110825002427 2011-08-25 BIENNIAL STATEMENT 2011-08-01
090811002177 2009-08-11 BIENNIAL STATEMENT 2009-08-01
070813002955 2007-08-13 BIENNIAL STATEMENT 2007-08-01
051014002461 2005-10-14 BIENNIAL STATEMENT 2005-08-01
030828000679 2003-08-28 CERTIFICATE OF INCORPORATION 2003-08-28

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8342338405 2021-02-13 0235 PPS 728 E Park Ave, Long Beach, NY, 11561-2605
Loan Status Date 2021-09-25
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 85078
Loan Approval Amount (current) 85078
Undisbursed Amount 0
Franchise Name -
Lender Location ID 28811
Servicing Lender Name Capital One, National Association
Servicing Lender Address 1680 Capital One Dr, MCLEAN, VA, 22102-3407
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Long Beach, NASSAU, NY, 11561-2605
Project Congressional District NY-04
Number of Employees 10
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 28811
Originating Lender Name Capital One, National Association
Originating Lender Address MCLEAN, VA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 85491.57
Forgiveness Paid Date 2021-08-23
3936077201 2020-04-27 0235 PPP 728 E. Park Ave., Long Beach, NY, 11561
Loan Status Date 2021-07-17
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 88000
Loan Approval Amount (current) 88000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 28811
Servicing Lender Name Capital One, National Association
Servicing Lender Address 1680 Capital One Dr, MCLEAN, VA, 22102-3407
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Long Beach, NASSAU, NY, 11561-0001
Project Congressional District NY-04
Number of Employees 10
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 28811
Originating Lender Name Capital One, National Association
Originating Lender Address MCLEAN, VA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 88992.44
Forgiveness Paid Date 2021-06-22

Related by officers

THE CORPORATION

ARSHIA DESIGNS INC. AAA VACUUM CORP. ATLANTICA TELECOM, INC. MISTY SPORTSWEAR, INC. FAT JAMS ELECTRONICS INC. CROQUEMBOUCHE, INC. LONG BEACH PEDIATRIC GROUP, P.C. LAW OFFICES OF JOSEPH A. GRECO, P.C. TEREZ, INC. 732 CINNAMON BEACH INC.

Related by address

No related companies by address

Date of last update: 29 Mar 2025

Sources: New York Secretary of State

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