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  5. WILLOWS PEDIATRIC GROUP, P.C.

WILLOWS PEDIATRIC GROUP, P.C.

Company Details

Entity Name: WILLOWS PEDIATRIC GROUP, P.C.
Jurisdiction: Connecticut
Legal type: Stock
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 03 Aug 1971
Business ALEI: 0050014
Annual report due: 03 Aug 2025
NAICS code: 621111 - Offices of Physicians (except Mental Health Specialists)
Business address: 1563 POST ROAD EAST, WESTPORT, CT, 06880, United States
Mailing address: 1563 POST ROAD EAST, WESTPORT, CT, United States, 06880
ZIP code: 06880
County: Fairfield
Place of Formation: CONNECTICUT
Total authorized shares: 5000
E-Mail: janagariepy@willowspediatrics.com

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2022 060872603 2023-10-25 WILLOWS PEDIATRIC GROUP, P.C. 44
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2021 060872603 2023-05-11 WILLOWS PEDIATRIC GROUP, P.C. 42
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2020 060872603 2022-04-06 WILLOWS PEDIATRIC GROUP, P.C. 42
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2019 060872603 2021-05-17 WILLOWS PEDIATRIC GROUP, P.C. 40
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939

Signature of
Role Plan administrator
Date 2021-05-17
Name of individual signing JEFFREY OWENS, MD
Valid signature Filed with authorized/valid electronic signature
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2018 060872603 2020-07-09 WILLOWS PEDIATRIC GROUP, P.C. 42
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939

Signature of
Role Plan administrator
Date 2020-07-09
Name of individual signing JEFFREY OWENS, MD
Valid signature Filed with authorized/valid electronic signature
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2017 060872603 2019-05-08 WILLOWS PEDIATRIC GROUP, P.C. 41
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939

Signature of
Role Plan administrator
Date 2019-05-08
Name of individual signing JEFFREY OWENS, MD
Valid signature Filed with authorized/valid electronic signature
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2016 060872603 2018-05-11 WILLOWS PEDIATRIC GROUP, P.C. 42
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939

Signature of
Role Plan administrator
Date 2018-05-11
Name of individual signing JEFFREY OWENS, MD
Valid signature Filed with authorized/valid electronic signature
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2015 060872603 2017-04-24 WILLOWS PEDIATRIC GROUP, P.C. 41
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939

Signature of
Role Plan administrator
Date 2017-04-24
Name of individual signing PETER CZUCZKA MD
Valid signature Filed with authorized/valid electronic signature
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2014 060872603 2016-05-12 WILLOWS PEDIATRIC GROUP, P.C. 41
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939

Signature of
Role Plan administrator
Date 2016-05-12
Name of individual signing PETER CZUCZKA MD
Valid signature Filed with authorized/valid electronic signature
WILLOWS PEDIATRIC GROUP 401K PROFIT SHARING PLAN 2013 060872603 2015-05-12 WILLOWS PEDIATRIC GROUP, P.C. 40
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1971-08-02
Business code 621111
Sponsor’s telephone number 2033193939
Plan sponsor’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602

Plan administrator’s name and address
Administrator’s EIN 060872603
Plan administrator’s name WILLOWS PEDIATRIC GROUP, P.C.
Plan administrator’s address 1563 POST ROAD EAST, WESTPORT, CT, 068805602
Administrator’s telephone number 2033193939

Signature of
Role Plan administrator
Date 2015-05-12
Name of individual signing PETER CZUCZKA MD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Business address Mailing address Phone E-Mail Residence address
JEFFREY OWENS Agent 1563 POST ROAD EAST, WESTPORT, CT, 06880, United States 1563 POST ROAD EAST, WESTPORT, CT, 06880, United States +1 203-319-3939 janagariepy@willowspediatrics.com 166 COLONIAL DRIVE, FAIRFIELD, CT, 06824, United States

Officer

Name Role Business address Residence address
Laura Marks Officer 1563 POST ROAD EAST, WESTPORT, CT, 06880, United States 7 Woodland Way, Weston, CT, 06883, United States
JEFFREY A OWENS MD Officer 1563 POST ROAD EAST, WESTPORT, CT, 06880, United States 166 COLONIAL DRIVW, FAIRFIELD, CT, 06824, United States
Lauren Allison Officer 1563 POST ROAD EAST, WESTPORT, CT, 06880, United States 227 Newtown Turnpike, Weston, CT, 06883, United States
Rachel Cramer Officer 1563 POST ROAD EAST, WESTPORT, CT, 06880, United States 32 Cherry Hill Rd, Fairfield, CT, 06825-1006, United States
Jonathan Sollinger Officer 1563 POST ROAD EAST, WESTPORT, CT, 06880, United States 85 French Street, Fairfield, CT, 06824, United States

License

Credential Credential type Status Status reason Issue date Effective date Expiration date
CLAB.0000814 Clinical Laboratory INACTIVE INACTIVE 2003-06-09 2021-10-01 2023-09-30

History

Type Old value New value Date of change
Name change JACK G. SHILLER, M.D., P.C. WILLOWS PEDIATRIC GROUP, P.C. 1973-06-25

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012219966 2024-08-02 No data Annual Report Annual Report No data
BF-0012473896 2023-11-30 2023-11-30 Interim Notice Interim Notice No data
BF-0011089059 2023-08-03 No data Annual Report Annual Report No data
BF-0010314555 2022-08-03 No data Annual Report Annual Report 2022
BF-0009807138 2021-08-04 No data Annual Report Annual Report No data
0006944241 2020-07-10 No data Annual Report Annual Report 2020
0006593283 2019-07-09 No data Annual Report Annual Report 2019
0006214507 2018-07-12 No data Annual Report Annual Report 2018
0006216166 2018-07-12 2018-07-12 Change of Agent Agent Change No data
0005906447 2017-08-09 No data Annual Report Annual Report 2017

Related by officers

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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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