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  5. FORESTREAM DENTAL, LLC

FORESTREAM DENTAL, LLC

Company Details

Name: FORESTREAM DENTAL, LLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 20 Sep 2004 (21 years ago)
Entity Number: 3103629
ZIP code: 14043
County: Erie
Place of Formation: New York
Address: 4909 TRANSIT ROAD, SUITE 2, LANCASTER, NY, United States, 14043

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FORESTREAM DENTAL GROUP PROFIT SHARING PLAN AND TRUST 2016 201657490 2017-04-05 FORESTREAM DENTAL LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621210
Sponsor’s telephone number 7166568686
Plan sponsor’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888

Plan administrator’s name and address
Administrator’s EIN 201657490
Plan administrator’s name FORESTREAM DENTAL LLC
Plan administrator’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Administrator’s telephone number 7166568686

Signature of
Role Plan administrator
Date 2017-04-05
Name of individual signing LAWRENCE P EVOLA
FORESTREAM DENTAL GROUP PROFIT SHARING PLAN AND TRUST 2016 201657490 2017-11-14 FORESTREAM DENTAL LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621210
Sponsor’s telephone number 7166568686
Plan sponsor’s address 4909 TRANSIT RD, DEPEW, NY, 140434888

Signature of
Role Plan administrator
Date 2017-11-14
Name of individual signing LAWRENCE P EVOLA
FORESTREAM DENTAL GROUP PROFIT SHARING PLAN AND TRUST 2015 201657490 2016-09-12 FORESTREAM DENTAL LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621210
Sponsor’s telephone number 7166568686
Plan sponsor’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888

Plan administrator’s name and address
Administrator’s EIN 201657490
Plan administrator’s name FORESTREAM DENTAL LLC
Plan administrator’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Administrator’s telephone number 7166568686

Signature of
Role Plan administrator
Date 2016-09-12
Name of individual signing LAWRENCE P EVOLA
FORESTREAM DENTAL GROUP PROFIT SHARING PLAN AND TRUST 2014 201657490 2015-10-06 FORESTREAM DENTAL LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621210
Sponsor’s telephone number 7166568686
Plan sponsor’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888

Plan administrator’s name and address
Administrator’s EIN 201657490
Plan administrator’s name FORESTREAM DENTAL LLC
Plan administrator’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Administrator’s telephone number 7166568686

Signature of
Role Plan administrator
Date 2015-10-06
Name of individual signing LAWRENCE P EVOLA
FORESTREAM DENTAL GROUP PROFIT SHARING PLAN AND TRUST 2013 201657490 2014-09-17 FORESTREAM DENTAL LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621210
Sponsor’s telephone number 7166568686
Plan sponsor’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888

Plan administrator’s name and address
Administrator’s EIN 201657490
Plan administrator’s name FORESTREAM DENTAL LLC
Plan administrator’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Administrator’s telephone number 7166568686

Signature of
Role Plan administrator
Date 2014-09-17
Name of individual signing LAWRENCE P EVOLA
FORESTREAM DENTAL GROUP PROFIT SHARING PLAN AND TRUST 2012 201657490 2013-07-17 FORESTREAM DENTAL LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621210
Sponsor’s telephone number 7166568686
Plan sponsor’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888

Plan administrator’s name and address
Administrator’s EIN 201657490
Plan administrator’s name FORESTREAM DENTAL LLC
Plan administrator’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Administrator’s telephone number 7166568686

Signature of
Role Plan administrator
Date 2013-07-17
Name of individual signing LAWRENCE P EVOLA
FORESTREAM DENTAL GROUP PROFIT SHARING PLAN AND TRUST 2011 201657490 2012-08-26 FORESTREAM DENTAL LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621210
Sponsor’s telephone number 7166568686
Plan sponsor’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888

Plan administrator’s name and address
Administrator’s EIN 201657490
Plan administrator’s name FORESTREAM DENTAL LLC
Plan administrator’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Administrator’s telephone number 7166568686

Signature of
Role Plan administrator
Date 2012-08-26
Name of individual signing LAWRENCE P EVOLA
FORESTREAM DENTAL GROUP PROFIT SHARING PLAN AND TRUST 2010 201657490 2011-04-06 FORESTREAM DENTAL LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621210
Sponsor’s telephone number 7166568686
Plan sponsor’s mailing address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Plan sponsor’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888

Plan administrator’s name and address
Administrator’s EIN 201657490
Plan administrator’s name FORESTREAM DENTAL LLC
Plan administrator’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Administrator’s telephone number 7166568686

Number of participants as of the end of the plan year
Active participants 3
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 3
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-04-06
Name of individual signing LAWRENCE P EVOLA
Valid signature Filed with authorized/valid electronic signature
FORESTREAM DENTAL GROUP PROFIT SHARING PLAN AND TRUST 2009 201657490 2010-06-09 FORESTREAM DENTAL LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 621210
Sponsor’s telephone number 7166568686
Plan sponsor’s mailing address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Plan sponsor’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888

Plan administrator’s name and address
Administrator’s EIN 201657490
Plan administrator’s name FORESTREAM DENTAL LLC
Plan administrator’s address 4711 TRANSIT RD 4, DEPEW, NY, 140434888
Administrator’s telephone number 7166568686

Number of participants as of the end of the plan year
Active participants 3
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 3
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-06-09
Name of individual signing LAWRENCE EVOLA
Valid signature Filed with authorized/valid electronic signature

DOS Process Agent

Name Role Address
FORESTREAM DENTAL, LLC DOS Process Agent 4909 TRANSIT ROAD, SUITE 2, LANCASTER, NY, United States, 14043

History

Start date End date Type Value
2012-10-02 2014-09-18 Address 4711 TRANSIT ROAD, SUITE 4, LANCASTER, NY, 14043, USA (Type of address: Service of Process)
2006-09-18 2012-10-02 Address 4711 TRANSIT ROAD / SUITE 4, LANCASTER, NY, 14043, USA (Type of address: Service of Process)
2004-09-20 2006-09-18 Address 4711 TRANSIT ROAD, SUITE 4, LANCASTER, NY, 14043, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
201005062024 2020-10-05 BIENNIAL STATEMENT 2020-09-01
181015006026 2018-10-15 BIENNIAL STATEMENT 2018-09-01
161006006174 2016-10-06 BIENNIAL STATEMENT 2016-09-01
140918006332 2014-09-18 BIENNIAL STATEMENT 2014-09-01
121002002205 2012-10-02 BIENNIAL STATEMENT 2012-09-01
100910002560 2010-09-10 BIENNIAL STATEMENT 2010-09-01
080820002366 2008-08-20 BIENNIAL STATEMENT 2008-09-01
060918002006 2006-09-18 BIENNIAL STATEMENT 2006-09-01
060531001314 2006-05-31 AFFIDAVIT OF PUBLICATION 2006-05-31
060531001310 2006-05-31 AFFIDAVIT OF PUBLICATION 2006-05-31

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
1396897101 2020-04-10 0296 PPP 4909 Transit Road, DEPEW, NY, 14043-4624
Loan Status Date 2021-08-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 31100
Loan Approval Amount (current) 31100
Undisbursed Amount 0
Franchise Name -
Lender Location ID 56102
Servicing Lender Name KeyBank National Association
Servicing Lender Address 127 Public Sq, CLEVELAND, OH, 44114-1217
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address DEPEW, ERIE, NY, 14043-4624
Project Congressional District NY-23
Number of Employees 6
NAICS code 621210
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 56102
Originating Lender Name KeyBank National Association
Originating Lender Address CLEVELAND, OH
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 31492.8
Forgiveness Paid Date 2021-07-22

Related by officers

No related officers

Related by address

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Date of last update: 29 Mar 2025

Sources: New York Secretary of State

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