| Entity Name: | LUTHERAN HOME OF SOUTHBURY, INC. |
| Jurisdiction: | Connecticut |
| Legal type: | Non-Stock |
| Citizenship: | Domestic |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 08 Mar 1983 |
| Business ALEI: | 0140377 |
| Annual report due: | 08 Mar 2025 |
| NAICS code: | 623110 - Nursing Care Facilities (Skilled Nursing Facilities) |
| Business address: | 990 MAIN STREET NORTH, SOUTHBURY, CT, 06488, United States |
| Mailing address: | 11 SHATTUCK STREET, WORCESTER, MA, United States, 01605 |
| ZIP code: | 06488 |
| County: | New Haven |
| Place of Formation: | CONNECTICUT |
| E-Mail: | acaclerk@ascentria.org |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RLRVCMLXP4K7 | 2024-12-03 | 990 MAIN ST N, SOUTHBURY, CT, 06488, 1267, USA | 990 MAIN ST N, SOUTHBURY, CT, 06488, 1267, USA | |||||||||||||||||||||||||||||||||||||||
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| Congressional District | 05 |
| State/Country of Incorporation | CT, USA |
| Activation Date | 2023-12-06 |
| Initial Registration Date | 2022-12-22 |
| Entity Start Date | 1987-06-23 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 623110 |
| Product and Service Codes | Q401 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | ZIAD BAROODY |
| Address | 990 MAIN ST. N., SOUTHBURY, CT, 06488, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | LAURA MCDONNELL |
| Address | 990 MAIN ST. N., SOUTHBURY, CT, 06488, USA |
| Past Performance | Information not Available |
|---|
| Name | Role |
|---|---|
| ASCENTRIA CARE ALLIANCE, INC. | Agent |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| NICHOLAS RUSSO | Officer | 11 Shattuck St, Worcester, MA, 01605-3650, United States | 602 WISTERIA WAY, WAYLAND, MA, 01778, United States |
| TARA E BROWNE | Officer | 11 Shattuck St, Worcester, MA, 01605-3650, United States | 8 HIGH STREET, BROOKFIELD, MA, 01506, United States |
| Nicholas Sousa | Officer | 11 Shattuck Street, Worcester, MA, 01605, United States | 63 Park Rd, Colchester, CT, 06415, United States |
| Kristine Hanscom | Officer | 990 MAIN STREET NORTH, SOUTHBURY, CT, 06488, United States | 14 Audubon Rd, 356, Wakefield, MA, 01880-1258, United States |
| Christine Tappan | Officer | 990 MAIN STREET NORTH, SOUTHBURY, CT, 06488, United States | 27 Harmony Rd, Northwood, NH, 03261-3900, United States |
| ANGELA BOVILL | Officer | 11 Shattuck Street, Worcester, MA, 01605, United States | 11 Maplewood Cir, Falmouth, ME, 04105-1154, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| Keith Robertson | Director | 11 Shattuck St, Worcester, MA, 01605-3650, United States | 235 S Main St, West Hartford, CT, 06107-3659, United States |
| WILLIAM MAYO | Director | 11 Shattuck St, WORCESTER, Worcester, MA, 01605-3650, United States | 15 ROSELIN AVE, QUINCY, MA, 02169, United States |
| Alexander Bartholomew | Director | 11 Shattuck St, Worcester, MA, 01605-3650, United States | 91 Avery Heights Dr, Holden, MA, 01520-1080, United States |
| ANGELA BOVILL | Director | 11 Shattuck Street, Worcester, MA, 01605, United States | 11 Maplewood Cir, Falmouth, ME, 04105-1154, United States |
| ROSS GOODMAN | Director | 11 Shattuck St, Worcester, MA, 01605-3650, United States | 224 Hancock Road, Williamstown, MA, 01267, United States |
| Ashish Cowlagi | Director | 11 Shattuck St, Worcester, MA, 01605-3650, United States | 25 Whippoorwill Dr, Shrewsbury, MA, 01545-3242, United States |
| FREDERICK JENOURE | Director | 11 SHATTUCK STREET, WORCESTER, MA, 01605, United States | 2 GENOA STREET, WORCESTER, MA, 01603, United States |
| Credential | Credential type | Status | Status reason | Issue date | Effective date | Expiration date |
|---|---|---|---|---|---|---|
| CCNH.000699C | Chronic & Convalescent Nursing Home | ACTIVE | CURRENT | 2008-07-01 | 2024-07-01 | 2026-06-30 |
| RCH.1360RCH | Residential Care Facility | ACTIVE | CURRENT | 2007-07-01 | 2022-07-01 | 2025-06-30 |
| HCA.0000235 | HOMEMAKER COMPANION AGENCY | INACTIVE | EXPIRED MORE THAN 3 YEARS - MUST REAPPLY | 2007-06-25 | 2013-11-05 | 2014-10-31 |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0012280964 | 2024-03-28 | No data | Annual Report | Annual Report | No data |
| BF-0011384290 | 2023-03-06 | No data | Annual Report | Annual Report | No data |
| BF-0010333192 | 2022-02-18 | No data | Annual Report | Annual Report | 2022 |
| 0007246433 | 2021-03-19 | No data | Annual Report | Annual Report | 2021 |
| 0006838708 | 2020-03-18 | No data | Annual Report | Annual Report | 2020 |
| 0006667443 | 2019-10-25 | No data | Annual Report | Annual Report | 2019 |
| 0006181480 | 2018-05-10 | No data | Annual Report | Annual Report | 2018 |
| 0006117176 | 2018-02-20 | 2018-02-20 | Amendment | Restated | No data |
| 0005879106 | 2017-07-03 | No data | Annual Report | Annual Report | 2017 |
| 0005615532 | 2016-07-26 | 2016-07-26 | Amendment | Amend | No data |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
