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  5. BENEZRA GYNECOLOGY LLC

BENEZRA GYNECOLOGY LLC - Florida Company Profile

Company Details

Entity Name: BENEZRA GYNECOLOGY LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Co.
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 28 Feb 2018 (7 years ago)
Document Number: M18000002082
FEI/EIN Number 824368281

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 129 W HIBISCUS BLVD, MELBOURNE, FL, 32901, US
Mail Address: 129 W HIBISCUS BLVD, MELBOURNE, FL, 32901, US
ZIP code: 32901
County: Brevard
Place of Formation: WYOMING

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1225537731 2018-02-09 2018-11-30 129 W HIBISCUS BOULEVARD SUITE A, MELBOURNE, FL, 329013006, US 129 W HIBISCUS BLVD, STE A, MELBOURNE, FL, 32901, US

Contacts
Phone +1 321-405-3000
Fax 3217227070

Authorized person
Name DR. VICTOR BENEZRA
Role PHYSICIAN
Phone 3059757407

Taxonomy
Taxonomy Code 207VG0400X - Gynecology Physician
License Number ME89256
State FL
Is Primary Yes

Other Provider Identifiers
Issuer FLORIDA BLUE
Number 1QMNM
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2023 824368281 2024-05-03 BENEZRA GYNECOLOGY 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2024-05-03
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2022 824368281 2023-04-07 BENEZRA GYNECOLOGY 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2023-04-07
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2021 824368281 2022-05-24 BENEZRA GYNECOLOGY 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 471637791
Plan administrator’s name ERISA FIDUCIARY SERVICES, INC.
Plan administrator’s address 1373 VETERANS HIGHWAY, SUITE 10, HAUPPAUGE, NY, 11788
Administrator’s telephone number 6312490500

Signature of
Role Plan administrator
Date 2022-05-24
Name of individual signing WRAY BENEZRA
Valid signature Filed with authorized/valid electronic signature
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2020 824368281 2021-04-03 BENEZRA GYNECOLOGY 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Signature of
Role Plan administrator
Date 2021-04-03
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature
BENEZRA GYNECOLOGY 401(K) PROFIT SHARING PLAN & TRUST 2019 824368281 2020-04-09 BENEZRA GYNECOLOGY 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3057887407
Plan sponsor’s address 129 W. HIBISCUS BLVD SUITE A, MELBOURNE, FL, 32901

Signature of
Role Plan administrator
Date 2020-04-09
Name of individual signing ERISA FIDUCIARY SERVICES
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
BENEZRA VICTOR Manager 650 S RIVERSIDE DR, INDIALANTIC, FL, 32903
BENEZRA VICTOR Agent 650 S RIVERSIDE DR, INDIALANTIC, FL, 32903

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G18000047888 BENEZRA WOMEN'S CARE, LLC ACTIVE 2018-04-14 2028-12-31 - 650 S RIVERSIDE DRIVE, INDIALANTIC, FL, 32903

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2018-04-23 129 W HIBISCUS BLVD, SUITE A, MELBOURNE, FL 32901 -
CHANGE OF MAILING ADDRESS 2018-04-23 129 W HIBISCUS BLVD, SUITE A, MELBOURNE, FL 32901 -

Documents

Name Date
ANNUAL REPORT 2025-01-15
ANNUAL REPORT 2024-01-16
ANNUAL REPORT 2023-01-20
ANNUAL REPORT 2022-01-26
ANNUAL REPORT 2021-02-09
ANNUAL REPORT 2020-03-29
ANNUAL REPORT 2019-02-11
Foreign Limited 2018-02-28

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2588637103 2020-04-10 0455 PPP 129 W HIBISCUS BLVD STE A, MELBOURNE, FL, 32901
Loan Status Date 2021-04-22
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 149175
Loan Approval Amount (current) 149175
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 MELBOURNE, BREVARD, FL, 32901-1200
Project Congressional District FL-08
Number of Employees 16
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 194093
Originating Lender Name JPMorgan Chase Bank, National Association
Originating Lender Address CHICAGO, IL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 150571.94
Forgiveness Paid Date 2021-03-25

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Date of last update: 01 Apr 2025

Sources: Florida Department of State

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