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WINDHAM COMMUNITY MEMORIAL HOSPITAL, INC.

Company Details

Entity Name: WINDHAM COMMUNITY MEMORIAL HOSPITAL, INC.
Jurisdiction: Connecticut
Legal type: Non-Stock
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 11 Mar 1908 (Companies founded in March 1908)
Business ALEI: 0099544
Annual report due: 11 Mar 2025
NAICS code: 622110 - General Medical and Surgical Hospitals
Business address: 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States
Mailing address: 112 MANSFIELD AVE., WILLIMANTIC, CT, United States, 06226
ZIP code: 06226 (Companies in Windham, 06226)
County: Windham
Place of Formation: CONNECTICUT
E-Mail: Legal.Support@hhchealth.org

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
LZJLRQULKV53 2024-10-24 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226, 2045, USA 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226, 2045, USA

Business Information
Congressional District 02
State/Country of Incorporation CT, USA
Activation Date 2023-10-27
Initial Registration Date 2010-09-13
Entity Start Date 1908-01-01
Fiscal Year End Close Date Sep 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name SHANAN HARKNESS
Address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226, USA
Government Business
Title PRIMARY POC
Name SHANAN HARKNESS
Address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226, USA
Past Performance Information not Available

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
549300YBRVRL24DVAQ94 0099544 US-CT GENERAL ACTIVE No data

Addresses
Legal C/O CORPORATION SERVICE COMPANY, 100 PEARL STREET, 17TH FLOOR, MC-CSC1, HARTFORD, US-CT, US, 06103
Headquarters One State Street, Suite 19, Hartford, US-CT, US, 06103

Registration details
Registration Date 2019-12-09
Last Update 2023-08-04
Status LAPSED
Next Renewal 2020-12-08
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 0099544

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WINDHAM COMMUNITY MEMORIAL HOSPITAL 403(B) PLAN 2017 060646966 2018-10-08 WINDHAM COMMUNITY MEMORIAL HOSPITAL 50
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2008-10-01
Business code 622000
Sponsor’s telephone number 8606963500
Plan sponsor’s address C/O HHC SYSTEM SUPPORT OFFICE, 389 JOHN DOWNEY DRIVE, NEW BRITAIN, CT, 06051
WINDHAM COMMUNITY MEMORIAL HOSPITAL 403(B) PLAN 2016 060646966 2017-10-24 WINDHAM COMMUNITY MEMORIAL HOSPITAL 52
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2008-10-01
Business code 622000
Sponsor’s telephone number 8606963500
Plan sponsor’s address C/O HHC SYSTEM SUPPORT OFFICE, 389 JOHN DOWNEY DRIVE, NEW BRITAIN, CT, 06051

Signature of
Role Plan administrator
Date 2017-10-24
Name of individual signing MARK LAPIERRE
Valid signature Filed with authorized/valid electronic signature
WINDHAM COMMUNITY MEMORIAL HOSPITAL 403(B) PLAN 2016 060646966 2017-09-14 WINDHAM COMMUNITY MEMORIAL HOSPITAL 52
Three-digit plan number (PN) 004
Effective date of plan 2008-10-01
Business code 622000
Sponsor’s telephone number 8606963185
Plan sponsor’s address 181 PATRICIA M GENOVA DRIVE, 4TH FLOOR, NEWINGTON, CT, 06111

Signature of
Role Plan administrator
Date 2017-09-14
Name of individual signing MARK LAPIERRE
Valid signature Filed with authorized/valid electronic signature
WINDHAM COMMUNITY MEMORIAL HOSPITAL 403(B) PLAN 2015 060646966 2016-10-15 WINDHAM COMMUNITY MEMORIAL HOSPITAL 54
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2008-10-01
Business code 622000
Sponsor’s telephone number 8606963185
Plan sponsor’s address 181 PATRICIA M GENOVA DRIVE, 4TH FLOOR, NEWINGTON, CT, 06111

Signature of
Role Plan administrator
Date 2016-10-15
Name of individual signing MARK LAPIERRE
Valid signature Filed with authorized/valid electronic signature
WINDHAM COMMUNITY MEMORIAL HOSPITAL 403(B) PLAN 2014 060646966 2015-10-15 WINDHAM COMMUNITY MEMORIAL HOSPITAL 52
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2008-10-01
Business code 622000
Sponsor’s telephone number 8604569116
Plan sponsor’s address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing MARK LAPIERRE
Valid signature Filed with authorized/valid electronic signature
CONNECTICARE 2010 060646966 2012-10-19 WINDHAM COMMUNITY MEMORIAL HOSPITAL 627
File View Page
Three-digit plan number (PN) 611
Effective date of plan 2010-11-01
Business code 622000
Sponsor’s telephone number 8604566821
Plan sponsor’s mailing address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226
Plan sponsor’s address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226

Plan administrator’s name and address
Administrator’s EIN 060646966
Plan administrator’s name WINDHAM COMMUNITY MEMORIAL HOSPITAL
Plan administrator’s address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226
Administrator’s telephone number 8604566821

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2012-10-19
Name of individual signing MARTIN LEVINE
Valid signature Filed with authorized/valid electronic signature
ANTHEM BLUE CROSS/BLUE SHIELD DENTAL PLAN 2010 060646966 2012-10-18 WINDHAM COMMUNITY MEMORIAL HOSPITAL 628
File View Page
Three-digit plan number (PN) 504
Effective date of plan 2007-10-01
Business code 622000
Sponsor’s telephone number 8604566821
Plan sponsor’s mailing address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226
Plan sponsor’s address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226

Plan administrator’s name and address
Administrator’s EIN 060646966
Plan administrator’s name WINDHAM COMMUNITY MEMORIAL HOSPITAL
Plan administrator’s address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226
Administrator’s telephone number 8604566821

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2012-10-18
Name of individual signing MARTIN LEVINE
Valid signature Filed with authorized/valid electronic signature
ANTHEM BLUE CROSS/BLUE SHIELD 2010 060646966 2012-10-18 WINDHAM COMMUNITY MEMORIAL HOSPITAL 632
File View Page
Three-digit plan number (PN) 610
Effective date of plan 2007-10-01
Business code 622000
Sponsor’s telephone number 8604566821
Plan sponsor’s mailing address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226
Plan sponsor’s address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226

Plan administrator’s name and address
Administrator’s EIN 060646966
Plan administrator’s name WINDHAM COMMUNITY MEMORIAL HOSPITAL
Plan administrator’s address 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226
Administrator’s telephone number 8604566821

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2012-10-18
Name of individual signing MARTIN LEVINE
Valid signature Filed with authorized/valid electronic signature
INSURANCE WAIVER PLAN FOR EMPLOYEES OF WINDHAM COMMUNITY MEMORIAL HOSPITAL 2010 060646966 2012-10-18 WINDHAM COMMUNITY MEMORIAL HOSPITAL 97
File View Page
Three-digit plan number (PN) 508
Effective date of plan 1991-01-01
Business code 622000
Sponsor’s telephone number 8604566821
Plan sponsor’s mailing address 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226
Plan sponsor’s address 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226

Plan administrator’s name and address
Administrator’s EIN 060646966
Plan administrator’s name WINDHAM COMMUNITY MEMORIAL HOSPITAL
Plan administrator’s address 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226
Administrator’s telephone number 8604566821

Number of participants as of the end of the plan year
Active participants 97
Retired or separated participants receiving benefits 11
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2012-10-18
Name of individual signing MARTIN LEVINE
Valid signature Filed with authorized/valid electronic signature
UNUM LIFE INSURANCE COMPANY 2010 060646966 2012-10-18 WINDHAM COMMUNITY MEMORIAL HOSPITAL 676
File View Page
Three-digit plan number (PN) 503
Effective date of plan 1991-10-01
Business code 622000
Sponsor’s telephone number 8604566821
Plan sponsor’s mailing address 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226
Plan sponsor’s address 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226

Plan administrator’s name and address
Administrator’s EIN 060646966
Plan administrator’s name WINDHAM COMMUNITY MEMORIAL HOSPITAL
Plan administrator’s address 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226
Administrator’s telephone number 8604566821

Number of participants as of the end of the plan year
Active participants 586
Retired or separated participants receiving benefits 83
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0

Signature of
Role Plan administrator
Date 2012-10-18
Name of individual signing MARTIN LEVINE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
CORPORATION SERVICE COMPANY Agent

Director

Name Role Business address Residence address
Joanna Chaurette, MD Director 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States
DONNA HANDLEY Director 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226, United States
ANTHONY A. JOYCE III Director 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States
HENRY E. BECK ESQ. Director 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226, United States
Lee-Ann Gomes Director 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States
Anita Lee Director 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States
MARY E. BARRY MD Director 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States
STEPHEN W. LARCEN PHD Director 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226, United States
MARK TRAMONTOZZI MD Director 112 MANSFIELD AVE, WILLIMANTIC, WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE, WILLIMANTIC, WILLIMANTIC, CT, 06226, United States

Officer

Name Role Business address Residence address
DONNA HANDLEY Officer 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE, WILLIMANTIC, CT, 06226, United States
ANTHONY A. JOYCE III Officer 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE., WILLIMANTIC, CT, 06226, United States
DAVID MACK ESQ. Officer ONE STATE STREET, 19TH FLOOR, HARTFORD, CT, 06103, United States 883 PADDOCK AVENUE, MERIDEN, CT, 06450, United States
MARK TRAMONTOZZI MD Officer 112 MANSFIELD AVE, WILLIMANTIC, WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVE, WILLIMANTIC, WILLIMANTIC, CT, 06226, United States

License

Credential Credential type Status Status reason Issue date Effective date Expiration date
CSP.0023311 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER INACTIVE No data No data 1995-06-29 1996-02-28
CHR.0002972-EXEMPT PUBLIC CHARITY-EXEMPT FROM FINANCIAL REQUIREMENTS ACTIVE No data No data No data No data
CSP.0002734-HOSP CONTROLLED SUBSTANCE REGISTRATION FOR HOSPITALS ACTIVE CURRENT 1999-03-01 2023-03-01 2025-02-28

History

Type Old value New value Date of change
Name change ST. JOSEPH'S HOSPITAL OF WILLIMANTIC (INCORPORATED) WINDHAM COMMUNITY MEMORIAL HOSPITAL, INC. 1933-05-11

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012583284 2024-03-13 2024-03-13 Amendment Certificate of Amendment No data
BF-0012044483 2024-03-04 No data Annual Report Annual Report No data
BF-0011076676 2023-03-01 No data Annual Report Annual Report No data
BF-0010252165 2022-03-30 No data Annual Report Annual Report 2022
BF-0010453311 2022-01-14 2022-01-14 Mass Agent Change � Address Agent Address Change No data
0007266448 2021-03-29 No data Annual Report Annual Report 2021
0006950703 2020-07-06 2020-07-06 Change of Agent Address Agent Address Change No data
0006943532 2020-07-06 2020-07-06 Change of Agent Address Agent Address Change No data
0006923778 2020-06-15 No data Annual Report Annual Report 2020
0006854511 2020-03-30 2020-03-30 Change of Agent Agent Change No data

Related by officers

DONNA HANDLEY

NATCHAUG HOSPITAL, INC. WINDHAM PROFESSIONAL OFFICE CONDOMINIUM ASSOCIATION, INC. BACKUS HEALTH CARE, INC. WWB CORPORATION CONNCARE, INC. NORTHEAST REGIONAL RADIATION ONCOLOGY NETWORK, INC.

ANTHONY A. JOYCE III

NATCHAUG HOSPITAL, INC.

Lee-Ann Gomes

NATCHAUG HOSPITAL, INC.

DAVID MACK ESQ.

RUSHFORD CENTER, INC. NATCHAUG HOSPITAL, INC.

Anita Lee

NATCHAUG HOSPITAL, INC.

MARY E. BARRY MD

NATCHAUG HOSPITAL, INC.

MARK TRAMONTOZZI MD

NATCHAUG HOSPITAL, INC.

Related by address

No related companies by address

Date of last update: 11 Nov 2024

Sources: Connecticut's Official State Website

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