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  5. INTERIM HEALTHCARE OF NORTH HAVEN, INC.

INTERIM HEALTHCARE OF NORTH HAVEN, INC.

Company Details

Entity Name: INTERIM HEALTHCARE OF NORTH HAVEN, INC.
Jurisdiction: Connecticut
Legal type: Stock
Citizenship: Domestic
Status: Forfeited
Date Formed: 15 Jun 1973
Business ALEI: 0036270
Business address: 781 BOSTON POST ROAD, MADISON, CT, 06705, United States
Mailing address: 781 BOSTON POST ROAD PO BOX 1388, MADISON, CT, United States, 06705
ZIP code: 06705
County: New Haven
Place of Formation: CONNECTICUT
Total authorized shares: 0
E-Mail: epetersen@interimhealthcare.com

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2019 060895290 2020-02-19 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 40
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2038878465
Plan sponsor’s address 781 BOSTON POST ROAD, P.O. BOX 1388, MADISON, CT, 06443

Signature of
Role Plan administrator
Date 2020-02-19
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2018 060895290 2019-08-29 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 42
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2035743339
Plan sponsor’s address 541 WOLCOTT STREET, WATERBURY, CT, 06705

Signature of
Role Plan administrator
Date 2019-08-29
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2017 060895290 2018-10-09 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 45
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2035743339
Plan sponsor’s address 541 WOLCOTT STREET, WATERBURY, CT, 06705

Signature of
Role Plan administrator
Date 2018-10-09
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-10-08
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2016 060895290 2017-11-06 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 42
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2032304785
Plan sponsor’s address 278 STATE STREET, NORTH HAVEN, CT, 06473

Signature of
Role Plan administrator
Date 2017-11-06
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2015 060895290 2016-11-18 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 41
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2032304785
Plan sponsor’s address 278 STATE STREET, NORTH HAVEN, CT, 06473

Signature of
Role Plan administrator
Date 2016-11-18
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2014 060895290 2015-09-01 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 45
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2032304785
Plan sponsor’s address 278 STATE STREET, NORTH HAVEN, CT, 06473

Signature of
Role Plan administrator
Date 2015-09-01
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2013 060895290 2015-04-29 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 48
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2032304785
Plan sponsor’s address 278 STATE STREET, NORTH HAVEN, CT, 06473

Signature of
Role Plan administrator
Date 2015-04-29
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2012 060895290 2013-12-04 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 46
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2032304785
Plan sponsor’s address 278 STATE STREET, NORTH HAVEN, CT, 06473

Signature of
Role Plan administrator
Date 2013-12-02
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2011 060895290 2012-12-06 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 45
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2032304785
Plan sponsor’s address 278 STATE STREET, NORTH HAVEN, CT, 06473

Plan administrator’s name and address
Administrator’s EIN 060895290
Plan administrator’s name INTERIM HEALTHCARE OF NORTH HAVEN, INC.
Plan administrator’s address 278 STATE STREET, NORTH HAVEN, CT, 06473
Administrator’s telephone number 2032304785

Signature of
Role Plan administrator
Date 2012-12-06
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature
INTERIM HEALTHCARE OF NORTH HAVEN, INC. 401(K) PROFIT SHARING PLAN 2010 060895290 2011-10-14 INTERIM HEALTHCARE OF NORTH HAVEN, INC. 36
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2004-07-01
Business code 541990
Sponsor’s telephone number 2032304785
Plan sponsor’s address 278 STATE STREET, NORTH HAVEN, CT, 06473

Plan administrator’s name and address
Administrator’s EIN 060895290
Plan administrator’s name INTERIM HEALTHCARE OF NORTH HAVEN, INC.
Plan administrator’s address 278 STATE STREET, NORTH HAVEN, CT, 06473
Administrator’s telephone number 2032304785

Signature of
Role Plan administrator
Date 2011-10-14
Name of individual signing ERIC PETERSEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Business address Mailing address E-Mail Residence address
ERIC R. PETERSEN Agent 12 CIRCLE BEACH ROAD, MADISON, CT, 06443, United States 781 BOSTON POST ROAD, PO BOX 1388, MADISON, CT, 06443, United States epetersen@interimhealthcare.com 12 CIRCLE BEACH ROAD, MADISON, CT, 06443, United States

Officer

Name Role Business address E-Mail Residence address
ERIC R. PETERSEN Officer 541 WOLCOTT ST, WATERBURY, CT, 06705, United States epetersen@interimhealthcare.com 12 CIRCLE BEACH ROAD, MADISON, CT, 06443, United States
LORRIE L. PETERSEN Officer 541 WOLCOTT ST, WATERBURY, CT, 06705, United States No data No data

History

Type Old value New value Date of change
Name change KRISBEN, INC. INTERIM HEALTHCARE OF NORTH HAVEN, INC. 2007-06-26
Name change INTERIM HEALTHCARE OF NEW HAVEN, INC. KRISBEN, INC. 1996-01-18
Name change PERSONNEL POOL, INC. OF NEW HAVEN INTERIM HEALTHCARE OF NEW HAVEN, INC. 1992-08-28

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012039265 2023-10-31 No data Administrative Dissolution Certificate of Dissolution/Revocation No data
BF-0011902665 2023-07-27 No data Administrative Dissolution Notice of Intent to Dissolve/Revoke No data
0006714808 2020-01-08 No data Change of Business Address Business Address Change No data
0006714822 2020-01-08 No data Change of Agent Address Agent Address Change No data
0006558504 2019-05-15 No data Annual Report Annual Report 2019
0006324465 2019-01-17 No data Annual Report Annual Report 2018
0006324461 2019-01-17 No data Annual Report Annual Report 2017
0006324458 2019-01-17 No data Annual Report Annual Report 2016
0006237463 2018-08-24 No data Change of Business Address Business Address Change No data
0005469244 2016-01-22 No data Annual Report Annual Report 2015

Related by officers

ERIC R. PETERSEN

541 WOLCOTT STREET, LLC 12 CIRCLE BEACH ROAD LLC 278 STATE STREET, LLC

LORRIE L. PETERSEN

12 CIRCLE BEACH ROAD LLC 278 STATE STREET, LLC

Related by address

No related companies by address

Date of last update: 25 Nov 2024

Sources: Connecticut's Official State Website

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