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  5. PALM BEACH MEDICAL CLINIC, LLC

PALM BEACH MEDICAL CLINIC, LLC

Company Details

Entity Name: PALM BEACH MEDICAL CLINIC, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 31 May 2007 (18 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 09 Dec 2010 (14 years ago)
Document Number: L07000057387
FEI/EIN Number 223964887
Address: 9123 N. MILITARY TRAIL, 102, PALM BEACH GARDENS, FL, 33410
Mail Address: 13833 WELLINGTON TRACE, SUITE E-4 #204, WELLINGTON, FL, 33414
ZIP code: 33410
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1710183744 2007-06-26 2008-05-15 13833 WELLINGTON TRCE, E4-#204, WELLINGTON, FL, 334142116, US 9123 N MILITARY TRL, SUITE 102, WEST PALM BEACH, FL, 334105990, US

Contacts
Phone +1 561-584-4142
Phone +1 561-630-9339

Authorized person
Name DR. STEPHEN KWASHIE WOYOME
Role CHIEF EXECUTIVE OFFICER OWNER
Phone 5615844142

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
License Number ME9587
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICARE PTAN
Number AH265
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PALM BEACH MEDICAL CLINIC LLC 401(K) PS PLAN 2023 223964887 2024-10-10 PALM BEACH MEDICAL CLINIC, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621111
Sponsor’s telephone number 5619063292
Plan sponsor’s address 13833 WELLINGTON TRCE E-4, #204, WELLINGTON, FL, 33414

Signature of
Role Plan administrator
Date 2024-10-06
Name of individual signing STEPHEN WOYOME
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-06
Name of individual signing STEPHEN WOYOME
Valid signature Filed with authorized/valid electronic signature
PALM BEACH MEDICAL CLINIC, LLC 401(K) P/S PLAN 2022 223964887 2023-09-04 PALM BEACH MEDICAL CLINIC, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621111
Sponsor’s telephone number 5619063292
Plan sponsor’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 223964887
Plan administrator’s name PALM BEACH MEDICAL CLINIC, LLC
Plan administrator’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414
Administrator’s telephone number 5619063292

Signature of
Role Plan administrator
Date 2023-09-04
Name of individual signing ABIGAIL WOYOME
Valid signature Filed with authorized/valid electronic signature
PALM BEACH MEDICAL CLINIC, LLC 401(K) P/S PLAN 2021 223964887 2023-04-16 PALM BEACH MEDICAL CLINIC, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621111
Sponsor’s telephone number 5619063292
Plan sponsor’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 223964887
Plan administrator’s name PALM BEACH MEDICAL CLINIC, LLC
Plan administrator’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414
Administrator’s telephone number 5619063292

Signature of
Role Plan administrator
Date 2023-04-16
Name of individual signing ABIGAIL WOYOME
Valid signature Filed with authorized/valid electronic signature
PALM BEACH MEDICAL CLINIC, LLC 401(K) P/S PLAN 2020 223964887 2021-10-14 PALM BEACH MEDICAL CLINIC, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621111
Sponsor’s telephone number 5619063292
Plan sponsor’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 223964887
Plan administrator’s name PALM BEACH MEDICAL CLINIC, LLC
Plan administrator’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414
Administrator’s telephone number 5619063292

Signature of
Role Plan administrator
Date 2021-10-14
Name of individual signing ABIGAIL WOYOME
Valid signature Filed with authorized/valid electronic signature
PALM BEACH MEDICAL CLINIC, LLC 401(K) P/S PLAN 2019 223964887 2020-09-25 PALM BEACH MEDICAL CLINIC, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621111
Sponsor’s telephone number 5619063292
Plan sponsor’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 223964887
Plan administrator’s name PALM BEACH MEDICAL CLINIC, LLC
Plan administrator’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414
Administrator’s telephone number 5619063292

Signature of
Role Plan administrator
Date 2020-09-25
Name of individual signing ABIGAIL WOYOME
Valid signature Filed with authorized/valid electronic signature
PALM BEACH MEDICAL CLINIC, LLC 401(K) P/S PLAN 2018 223964887 2019-07-12 PALM BEACH MEDICAL CLINIC, LLC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621111
Sponsor’s telephone number 5619063292
Plan sponsor’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 223964887
Plan administrator’s name PALM BEACH MEDICAL CLINIC, LLC
Plan administrator’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414
Administrator’s telephone number 5619063292

Signature of
Role Plan administrator
Date 2019-07-12
Name of individual signing ABIGAIL WOYOME
Valid signature Filed with authorized/valid electronic signature
PALM BEACH MEDICAL CLINIC, LLC 401(K) P/S PLAN 2017 223964887 2018-10-05 PALM BEACH MEDICAL CLINIC, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621111
Sponsor’s telephone number 5619063292
Plan sponsor’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414

Plan administrator’s name and address
Administrator’s EIN 223964887
Plan administrator’s name PALM BEACH MEDICAL CLINIC, LLC
Plan administrator’s address 13833 WELLINGTON TRCE E-4 #204, WELLINGTON, FL, 33414
Administrator’s telephone number 5619063292

Signature of
Role Plan administrator
Date 2018-10-05
Name of individual signing ABIGAIL WOYOME
Valid signature Filed with authorized/valid electronic signature
PALM BEACH MEDICAL CLINIC LLC 401(K) PLAN 2016 223964887 2017-06-30 PALM BEACH MEDICAL CLINIC LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621111
Sponsor’s telephone number 5619063292
Plan sponsor’s address 9123 N MILITAY TRL STE 102, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2017-06-30
Name of individual signing STEPHEN WOYOME
Valid signature Filed with authorized/valid electronic signature
PALM BEACH MEDICAL CLINIC LLC 401(K) PLAN 2015 223964887 2016-09-27 PALM BEACH MEDICAL CLINIC LLC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-10-01
Business code 621111
Sponsor’s telephone number 5619063292
Plan sponsor’s address 9123 N MILITAY TRL STE 102, PALM BEACH GARDENS, FL, 33410

Signature of
Role Plan administrator
Date 2016-09-27
Name of individual signing STEPHEN WOYOME
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
WOYOME STEPHEN K Agent 13833 WELLINGTON TRACE, WELLINGTON, FL, 33414

Managing Member

Name Role Address
WOYOME STEPHEN K Managing Member 13833 WELLINGTON TRACE E-4 #204, WELLINGTON, FL, 33414

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2012-04-29 9123 N. MILITARY TRAIL, 102, PALM BEACH GARDENS, FL 33410 No data
LC AMENDMENT 2010-12-09 No data No data
REGISTERED AGENT ADDRESS CHANGED 2010-09-16 13833 WELLINGTON TRACE, E-4 #204, WELLINGTON, FL 33414 No data
CHANGE OF MAILING ADDRESS 2010-09-16 9123 N. MILITARY TRAIL, 102, PALM BEACH GARDENS, FL 33410 No data
LC AMENDMENT 2010-04-14 No data No data
CANCEL ADM DISS/REV 2009-04-21 No data No data
REGISTERED AGENT NAME CHANGED 2009-04-21 WOYOME, STEPHEN K No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2008-09-26 No data No data

Documents

Name Date
ANNUAL REPORT 2024-03-05
ANNUAL REPORT 2023-03-04
ANNUAL REPORT 2022-04-06
ANNUAL REPORT 2021-03-17
ANNUAL REPORT 2020-04-10
ANNUAL REPORT 2019-09-02
ANNUAL REPORT 2018-04-28
ANNUAL REPORT 2017-04-17
ANNUAL REPORT 2016-04-29
ANNUAL REPORT 2015-04-29

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8586727905 2020-06-18 0455 PPP 9123 NORTH MILITARY TRAIL SUITE 102, PALM BEACH GARDENS, FL, 33410-5968
Loan Status Date 2021-06-10
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 11550
Loan Approval Amount (current) 11550
Undisbursed Amount 0
Franchise Name -
Lender Location ID 12096
Servicing Lender Name Wells Fargo Bank, National Association
Servicing Lender Address 101 N Philips Ave, SIOUX FALLS, SD, 57104-6738
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address PALM BEACH GARDENS, PALM BEACH, FL, 33410-5968
Project Congressional District FL-21
Number of Employees 3
NAICS code 621111
Borrower Race Black or African American
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 12096
Originating Lender Name Wells Fargo Bank, National Association
Originating Lender Address SIOUX FALLS, SD
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 11645.25
Forgiveness Paid Date 2021-05-04
8737068608 2021-03-25 0455 PPS 9123 N Military Trl Ste 102, Palm Beach Gardens, FL, 33410-5968
Loan Status Date 2021-09-28
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 9381
Loan Approval Amount (current) 9381
Undisbursed Amount 0
Franchise Name -
Lender Location ID 456756
Servicing Lender Name Cross River Bank
Servicing Lender Address 885 Teaneck Rd, TEANECK, NJ, 07666-4546
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Palm Beach Gardens, PALM BEACH, FL, 33410-5968
Project Congressional District FL-21
Number of Employees 3
NAICS code 621111
Borrower Race Black or African American
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 456756
Originating Lender Name Cross River Bank
Originating Lender Address TEANECK, NJ
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 9419.04
Forgiveness Paid Date 2021-08-25

Related by officers

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Related by address

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Date of last update: 02 Feb 2025

Sources: Florida Department of State

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