| Entity Name: | FAIR HAVEN COMMUNITY HEALTH CLINIC, INC. |
| Jurisdiction: | Connecticut |
| Legal type: | Non-Stock |
| Citizenship: | Domestic |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 04 May 1972 |
| Business ALEI: | 0054289 |
| Annual report due: | 04 May 2025 |
| NAICS code: | 621112 - Offices of Physicians, Mental Health Specialists |
| Business address: | 374 GRAND AVENUE 374 GRAND AVENUE, NEW HAVEN, CT, 06513, United States |
| Mailing address: | 374 GRAND AVENUE 374 GRAND AVE, NEW HAVEN, CT, United States, 06513 |
| ZIP code: | 06513 |
| County: | New Haven |
| Place of Formation: | CONNECTICUT |
| E-Mail: | governmentrelations@fhchc.org |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Q8L3JSL9MDX8 | 2025-04-26 | 374 GRAND AVE, NEW HAVEN, CT, 06513, 3733, USA | 374 GRAND AVENUE, NEW HAVEN, CT, 06513, 3733, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Doing Business As | FAIR HAVEN COMMUNITY HEALTH CLINIC INC |
| URL | http://www.fhchc.org |
| Congressional District | 03 |
| State/Country of Incorporation | CT, USA |
| Activation Date | 2024-04-30 |
| Initial Registration Date | 2006-01-04 |
| Entity Start Date | 1971-09-01 |
| Fiscal Year End Close Date | Jun 30 |
Service Classifications
| NAICS Codes | 621498 |
| Product and Service Codes | Q201 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | AMY TRIMANI |
| Role | CFO |
| Address | 374 GRAND AVENUE, NEW HAVEN, CT, 06513, 3733, USA |
| Title | ALTERNATE POC |
| Name | ABIGAIL PAINE |
| Role | VP OF QUALITY & DATA |
| Address | 374 GRAND AVENUE, NEW HAVEN, CT, 06513, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | SUZANNE LAGARDE |
| Role | CEO |
| Address | 374 GRAND AVENUE, NEW HAVEN, CT, 06513, 3733, USA |
| Title | ALTERNATE POC |
| Name | ABIGAIL PAINE |
| Role | VP OF QUALITY & DATA |
| Address | 374 GRAND AVENUE, NEW HAVEN, CT, 06513, 3733, USA |
| Past Performance | Information not Available |
|---|
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 493D2 | Active | Non-Manufacturer | 2006-01-05 | 2024-04-30 | 2029-04-30 | 2025-04-26 | |||||||||||||||
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| POC | SUZANNE LAGARDE |
| Phone | +1 203-777-7411 |
| Fax | +1 203-777-8506 |
| Address | 374 GRAND AVE, NEW HAVEN, CT, 06513 3733, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FAIR HAVEN COMMUNITY HEALTH CLINIC, INC., MEDICAL PLAN | 2017 | 060883545 | 2018-10-12 | FAIR HAVEN COMMUNITY HEALTH CLINIC, INC. | 97 | |||||||||||||||||||||||||||||||||
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| Active participants | 105 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
Signature of
| Role | Plan administrator |
| Date | 2018-10-12 |
| Name of individual signing | SUZANNE LAGARDE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 502 |
| Effective date of plan | 2017-01-01 |
| Business code | 621498 |
| Sponsor’s telephone number | 2207777411 |
| Plan sponsor’s DBA name | FAIR HAVEN COMMUNITY HEALTH CLINIC, INC., |
| Plan sponsor’s mailing address | 374 GRAND AVE, EAST HAVEN, CT, 065133733 |
| Plan sponsor’s address | 374 GRAND AVE, EAST HAVEN, CT, 065133733 |
Number of participants as of the end of the plan year
| Active participants | 102 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
Signature of
| Role | Plan administrator |
| Date | 2018-10-12 |
| Name of individual signing | SUZANNE LAGARDE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Business address | Phone | Residence address | |
|---|---|---|---|---|---|
| THOMAS R. CANDRICK | Agent | 195 CHURCH STREET, NEW HAVEN, CT, 06509, United States | +1 203-784-3103 | tcandrick@carmodylaw.com | 130 NORTH STREET, WATERTOWN, CT, 06795, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| THOMAS CANDRICK | Officer | No data | 130 NORTH STREET, WATERTOWN, CT, 06795, United States |
| MARIBEL MARTINEZ | Officer | 1 W MAIN STREET, MERIDEN, CT, 06451, United States | 94 JUDWIN AVENUE, NEW HAVEN, CT, 06515, United States |
| MAGDA A. NATAL | Officer | No data | 225 EXCHANGE STREET #1, NEW HAVEN, CT, 06513, United States |
| Credential | Credential type | Status | Status reason | Issue date | Effective date | Expiration date |
|---|---|---|---|---|---|---|
| CHR.0001486-EXEMPT | PUBLIC CHARITY-EXEMPT FROM FINANCIAL REQUIREMENTS | ACTIVE | CURRENT | 2010-11-02 | 2010-11-02 | No data |
| OPC.0000406 | Outpatient Clinic | ACTIVE | CURRENT | 2008-10-01 | 2023-10-01 | 2026-09-30 |
| OPC.0000009 | Outpatient Clinic | ACTIVE | CURRENT | 2008-10-01 | 2023-10-01 | 2026-09-30 |
| OPC.0000407 | Outpatient Clinic | INACTIVE | No data | 2004-10-18 | 2004-10-18 | 2008-09-30 |
| OPC.0000288 | Outpatient Clinic | INACTIVE | No data | 2003-07-01 | 2003-07-01 | 2005-06-30 |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0012220378 | 2024-05-06 | No data | Annual Report | Annual Report | No data |
| BF-0011084618 | 2023-05-23 | No data | Annual Report | Annual Report | No data |
| BF-0011791790 | 2023-05-04 | 2023-05-04 | Amendment | Certificate of Amendment | No data |
| BF-0010328356 | 2022-05-17 | No data | Annual Report | Annual Report | 2022 |
| BF-0010163882 | 2021-11-16 | 2021-11-16 | Change of Agent | Agent Change | No data |
| 0007364884 | 2021-06-09 | No data | Annual Report | Annual Report | 2021 |
| 0006911156 | 2020-05-27 | No data | Annual Report | Annual Report | 2020 |
| 0006563644 | 2019-05-23 | No data | Annual Report | Annual Report | 2019 |
| 0006173348 | 2018-05-01 | No data | Annual Report | Annual Report | 2018 |
| 0005834927 | 2017-05-05 | No data | Annual Report | Annual Report | 2017 |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
