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  5. EVERGREEN INSURANCE AGENCY, INC.

EVERGREEN INSURANCE AGENCY, INC.

Company Details

Entity Name: EVERGREEN INSURANCE AGENCY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 19 Jul 2006 (19 years ago)
Last Event: REINSTATEMENT
Event Date Filed: 04 Oct 2010 (14 years ago)
Document Number: P06000095049
FEI/EIN Number 205297323
Address: 583 105TH AVENUE NO., STE. 2, ROYAL PALM BEACH, FL, 33411
Mail Address: 583 105TH AVENUE NO., STE. 2, ROYAL PALM BEACH, FL, 33411
ZIP code: 33411
County: Palm Beach
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EVERGREEN INSURANCE AGENCY INC 401(K) PROFIT SHARING PLAN & TRUST 2022 205297323 2023-05-09 EVERGREEN INSURANCE AGENCY INC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524210
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2023-05-09
Name of individual signing JENNIFER MCDEAVITT
Valid signature Filed with authorized/valid electronic signature
EVERGREEN INSURANCE AGENCY INC 401(K) PROFIT SHARING PLAN & TRUST 2021 205297323 2022-04-12 EVERGREEN INSURANCE AGENCY INC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524210
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2022-04-12
Name of individual signing JENNIFER MCDEAVITT
Valid signature Filed with authorized/valid electronic signature
EVERGREEN INSURANCE AGENCY INC 401(K) PROFIT SHARING PLAN & TRUST 2020 205297323 2021-05-26 EVERGREEN INSURANCE AGENCY INC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524210
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2021-05-26
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
EVERGREEN INSURANCE AGENCY INC 401(K) PROFIT SHARING PLAN & TRUST 2019 205297323 2020-07-02 EVERGREEN INSURANCE AGENCY INC 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524210
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2020-07-02
Name of individual signing EDWARD ROJAS
Valid signature Filed with authorized/valid electronic signature
EVERGREEN INSURANCE AGENCY INC 401K PROFIT SHARING PLAN 2017 205297323 2018-07-26 EVERGREEN INSURANCE AGENCY 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524210
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE N. STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2018-07-26
Name of individual signing JENNIFER MCDEAVITT
Valid signature Filed with authorized/valid electronic signature
EVERGREEN INSURANCE AGENCY INC 401K PROFIT SHARING PLAN 2016 205297323 2017-05-16 EVERGREEN INSURANCE AGENCY 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524150
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE N. STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2017-05-16
Name of individual signing JENNIFER MCDEAVITT
Valid signature Filed with authorized/valid electronic signature
EVERGREEN INSURANCE AGENCY INC 401K PROFIT SHARING PLAN 2015 205297323 2016-09-07 EVERGREEN INSURANCE AGENCY 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524150
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE N. STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2016-09-07
Name of individual signing JENNIFER MCDEAVITT
Valid signature Filed with authorized/valid electronic signature
EVERGREEN INSURANCE AGENCY INC 401K PROFIT SHARING PLAN 2014 205297323 2015-07-20 EVERGREEN INSURANCE AGENCY 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524150
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE N. STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2015-07-20
Name of individual signing JENNIFER MCDEAVITT
Valid signature Filed with authorized/valid electronic signature
EVERGREEN INSURANCE AGENCY INC 401 K PROFIT SHARING PLAN TRUST 2013 205297323 2014-07-08 EVERGREEN INSURANCE AGENCY INC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524210
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE N STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2014-07-08
Name of individual signing JENNIFER L MCDEAVITT
Valid signature Filed with authorized/valid electronic signature
EVERGREEN INSURANCE AGENCY INC 401 K PROFIT SHARING PLAN TRUST 2012 205297323 2013-07-26 EVERGREEN INSURANCE AGENCY INC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 524210
Sponsor’s telephone number 5619668883
Plan sponsor’s address 583 105TH AVE N STE 2, ROYAL PALM BEACH, FL, 33411

Signature of
Role Plan administrator
Date 2013-07-26
Name of individual signing EVERGREEN INSURANCE AGENCY INC
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MCDEAVITT JENNIFER L Agent 583 105TH AVE NO, ROYAL PALM BEACH, FL, 33411

President

Name Role Address
MCDEAVITT JENNIFER L President 583 105TH AVE NO. STE-2, ROYAL PALM BEACH, FL, 33411

Vice President

Name Role Address
Oria Abel Vice President 583 105TH AVENUE NO., ROYAL PALM BEACH, FL, 33411

Treasurer

Name Role Address
McDeavitt David PJr. Treasurer 583 105th Ave No. Suite-2, Royal Palm Beach, FL, 33411

Secretary

Name Role Address
Zeller Christopher Secretary 583 105TH AVENUE NO., ROYAL PALM BEACH, FL, 33411

Events

Event Type Filed Date Value Description
REINSTATEMENT 2010-10-04 No data No data
REGISTERED AGENT NAME CHANGED 2010-10-04 MCDEAVITT, JENNIFER L No data
REGISTERED AGENT ADDRESS CHANGED 2010-10-04 583 105TH AVE NO, SUITE-2, ROYAL PALM BEACH, FL 33411 No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2010-09-24 No data No data
CHANGE OF PRINCIPAL ADDRESS 2009-05-06 583 105TH AVENUE NO., STE. 2, ROYAL PALM BEACH, FL 33411 No data
CHANGE OF MAILING ADDRESS 2009-05-06 583 105TH AVENUE NO., STE. 2, ROYAL PALM BEACH, FL 33411 No data

Documents

Name Date
ANNUAL REPORT 2024-04-03
ANNUAL REPORT 2023-04-04
ANNUAL REPORT 2022-04-07
ANNUAL REPORT 2021-04-06
ANNUAL REPORT 2020-05-12
ANNUAL REPORT 2019-04-10
ANNUAL REPORT 2018-01-16
ANNUAL REPORT 2017-01-26
ANNUAL REPORT 2016-01-15
ANNUAL REPORT 2015-01-20

Related by officers

MCDEAVITT JENNIFER L

BASIC INSURANCE, LLC THE PINK MAFIA, INC PALM SPRINGS HOLDINGS, LLC DACOUR ENTERPRISES, INC. JENIDA INSURANCE AGENCY, LLC

Oria Abel

EVERGREEN BUSINESS MANAGEMENT INC

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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