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  5. EVERGREEN FAMILY MEDICAL SERVICES, P.C.

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
ZIP code: 11220
County: Kings
Place of Formation: New York
Address: 743 58TH STREET, BROOKLYN, NY, United States, 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 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 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 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

Chief Executive Officer

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

DOS Process Agent

Name Role Address
RAYMOND CHAN DOS Process Agent 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

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
7286498407 2021-02-11 0202 PPS 743 58th St, Brooklyn, NY, 11220-3916
Loan Status Date 2021-11-18
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 102870
Loan Approval Amount (current) 102870
Undisbursed Amount 0
Franchise Name -
Lender Location ID 48270
Servicing Lender Name JPMorgan Chase Bank, National Association
Servicing Lender Address 1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Brooklyn, KINGS, NY, 11220-3916
Project Congressional District NY-10
Number of Employees 9
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 48270
Originating Lender Name JPMorgan Chase Bank, National Association
Originating Lender Address COLUMBUS, OH
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 103575.69
Forgiveness Paid Date 2021-10-25
3181037702 2020-05-01 0202 PPP 743 58TH ST, BROOKLYN, NY, 11220
Loan Status Date 2021-06-24
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 94935
Loan Approval Amount (current) 94935
Undisbursed Amount 0
Franchise Name -
Lender Location ID 48270
Servicing Lender Name JPMorgan Chase Bank, National Association
Servicing Lender Address 1111 Polaris Pkwy, COLUMBUS, OH, 43240-2031
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address BROOKLYN, KINGS, NY, 11220-0001
Project Congressional District NY-10
Number of Employees 15
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 194093
Originating Lender Name JPMorgan Chase Bank, National Association
Originating Lender Address CHICAGO, IL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 95888.62
Forgiveness Paid Date 2021-05-06

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Related by address

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

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Date of last update: 29 Mar 2025

Sources: New York Secretary of State

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