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  5. EVERGREEN ENDOSCOPY CENTER, LLC

EVERGREEN ENDOSCOPY CENTER, LLC

Company Details

Entity Name: EVERGREEN ENDOSCOPY CENTER, LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 26 Apr 2006
Business ALEI: 0858249
Annual report due: 31 Mar 2025
NAICS code: 621493 - Freestanding Ambulatory Surgical and Emergency Centers
Business address: 2400 TAMARACK AVENUE SUITE 100, SOUTH WINDSOR, CT, 06074, United States
Mailing address: 2400 TAMARACK AVENUE SUITE 102, SOUTH WINDSOR, CT, United States, 06074
ZIP code: 06074
County: Hartford
Place of Formation: CONNECTICUT
E-Mail: bwollman@evergreenendoscopy.com

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2023 412211130 2024-09-20 EVERGREEN ENDOSCOPY CENTER LLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2022 412211130 2023-07-25 EVERGREEN ENDOSCOPY CENTER LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2021 412211130 2022-05-17 EVERGREEN ENDOSCOPY CENTER LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074

Signature of
Role Plan administrator
Date 2022-05-11
Name of individual signing WILLIAM A WOLLMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-05-11
Name of individual signing WILLIAM A WOLLMAN
Valid signature Filed with authorized/valid electronic signature
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2020 412211130 2021-06-30 EVERGREEN ENDOSCOPY CENTER LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074

Signature of
Role Plan administrator
Date 2021-06-30
Name of individual signing BILL WOLLMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-30
Name of individual signing BILL WOLLMAN
Valid signature Filed with authorized/valid electronic signature
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2019 412211130 2020-04-28 EVERGREEN ENDOSCOPY CENTER LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074

Signature of
Role Plan administrator
Date 2020-04-28
Name of individual signing WILLIAM WOLLMAN JR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-04-28
Name of individual signing WILLIAM WOLLMAN JR
Valid signature Filed with authorized/valid electronic signature
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2018 412211130 2019-06-11 EVERGREEN ENDOSCOPY CENTER LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074

Signature of
Role Plan administrator
Date 2019-06-11
Name of individual signing WILLIAM WOLLMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-11
Name of individual signing WILLIAM WOLLMAN
Valid signature Filed with authorized/valid electronic signature
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2017 412211130 2018-04-13 EVERGREEN ENDOSCOPY CENTER LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074

Signature of
Role Plan administrator
Date 2018-04-09
Name of individual signing WILLIAM WOLLMAN JR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-04-09
Name of individual signing WILLIAM WOLLMAN JR
Valid signature Filed with authorized/valid electronic signature
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2016 412211130 2017-05-04 EVERGREEN ENDOSCOPY CENTER LLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074

Signature of
Role Plan administrator
Date 2017-04-28
Name of individual signing WILLIAM WOLLMAN JR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-28
Name of individual signing WILLIAM WOLLMAN JR
Valid signature Filed with authorized/valid electronic signature
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2015 412211130 2016-04-19 EVERGREEN ENDOSCOPY CENTER LLC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074

Signature of
Role Plan administrator
Date 2016-04-15
Name of individual signing WILLIAM WOLLMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-04-15
Name of individual signing WILLIAM WOLLMAN
Valid signature Filed with authorized/valid electronic signature
EVERGREEN ENDOSCOPY CENTER LLC 401(K) PLAN 2014 412211130 2015-04-15 EVERGREEN ENDOSCOPY CENTER LLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 8605332123
Plan sponsor’s address 2400 TAMARACK AVENUE, SOUTH WINDSOR, CT, 06074

Signature of
Role Plan administrator
Date 2015-04-15
Name of individual signing WILLIAM WOLLMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-15
Name of individual signing WILLIAM WOLLMAN
Valid signature Filed with authorized/valid electronic signature

Officer

Name Role Business address Residence address
CTGI ENDOSCOPY CENTERS HOLDING COMPANY, LLC Officer 85 SEYMOUR STREET SUITE 1000, HARTFORD, CT, 06106, United States No data
Prospect ECHN, Inc. Officer 71 Haynes St, Manchester, CT, 06040-4131, United States No data
ALI HEMACHA M.D. Officer 428 HARTFORD TURNPIKE, SUITE 207, VERNON, CT, 06066, United States 55 SELE DRIVE, SOUTH WINDSOR, CT, 06074, United States
Rachel Scott, DO Officer 6 Northwestern Dr, Suite 305, Bloomfield, CT, 06002-3463, United States 68 Tinkerville Rd, Willington, CT, 06279-1426, United States

Agent

Name Role Business address Mailing address Phone E-Mail Residence address
William Wollman Agent 2400 TAMARACK AVENUE SUITE 100, SOUTH WINDSOR, CT, 06074, United States 2400 TAMARACK AVENUE SUITE 100, SOUTH WINDSOR, CT, 06074, United States +1 860-716-9033 bwollman@evergreenendoscopy.com 1700 K St NW, Washington, DC, 20006, United States

License

Credential Credential type Status Status reason Issue date Effective date Expiration date
ASC.0000324 Out-Patient Surgical Facility ACTIVE CURRENT 2009-02-05 2023-01-01 2024-12-31

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012635248 2024-05-10 2024-05-10 Interim Notice Interim Notice No data
BF-0012105042 2024-03-15 No data Annual Report Annual Report No data
BF-0011413827 2023-05-09 No data Annual Report Annual Report No data
BF-0010869806 2022-12-20 No data Annual Report Annual Report No data
BF-0008105987 2022-12-20 No data Annual Report Annual Report 2020
BF-0009912255 2022-12-20 No data Annual Report Annual Report No data
0006494697 2019-03-26 No data Annual Report Annual Report 2019
0006165473 2018-04-19 No data Annual Report Annual Report 2018
0005818757 2017-04-13 No data Annual Report Annual Report 2017
0005633350 2016-08-18 No data Annual Report Annual Report 2016

Related by officers

William Wollman

FINANCIAL INDUSTRY REGULATORY AUTHORITY, INC. FINRA REGULATION, INC.

Related by address

No related companies by address

Date of last update: 20 Jan 2025

Sources: Connecticut's Official State Website

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