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  5. POTTER FUNERAL HOME, INC.

POTTER FUNERAL HOME, INC.

Company Details

Entity Name: POTTER FUNERAL HOME, INC.
Jurisdiction: Connecticut
Legal type: Stock
Citizenship: Domestic
Status: Dissolved
Date Formed: 02 Jan 1985
Date of dissolution: 22 Nov 2016
Business ALEI: 0164537
Annual report due: 30 Jan 2017
Business address: 145 SAND HILL RD., HAMPTON, CT, 06247
ZIP code: 06247
County: Windham
Place of Formation: CONNECTICUT
Total authorized shares: 5000
E-Mail: pjcichon@gmail.com

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
POTTER FUNERAL HOME, INC. PROFIT SHARING PLAN 2014 061158759 2015-12-27 POTTER FUNERAL HOME, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 812210
Sponsor’s telephone number 8604232211
Plan sponsor’s address 145 SAND HILL ROAD, HAMPTON, CT, 06247

Signature of
Role Plan administrator
Date 2015-12-24
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature
POTTER FUNERAL HOME, INC. PROFIT SHARING PLAN 2014 061158759 2015-02-06 POTTER FUNERAL HOME, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 812210
Sponsor’s telephone number 8604232211
Plan sponsor’s address 145 SAND HILL ROAD, HAMPTON, CT, 06247

Signature of
Role Plan administrator
Date 2015-02-04
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-02-04
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature
POTTER FUNERAL HOME, INC. PROFIT SHARING PLAN 2013 061158759 2014-05-14 POTTER FUNERAL HOME, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 812210
Sponsor’s telephone number 8604232211
Plan sponsor’s address 456 JACKSON STREET, WILLIMANTIC, CT, 06226

Signature of
Role Plan administrator
Date 2014-05-13
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-05-13
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature
POTTER FUNERAL HOME, INC. PROFIT SHARING PLAN 2012 061158759 2013-05-29 POTTER FUNERAL HOME, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 812210
Sponsor’s telephone number 8604232211
Plan sponsor’s address 456 JACKSON STREET, WILLIMANTIC, CT, 06226

Signature of
Role Plan administrator
Date 2013-05-28
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-28
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature
POTTER FUNERAL HOME, INC. PROFIT SHARING PLAN 2011 061158759 2012-05-09 POTTER FUNERAL HOME, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 812210
Sponsor’s telephone number 8604232211
Plan sponsor’s address 456 JACKSON STREET, WILLIMANTIC, CT, 06226

Plan administrator’s name and address
Administrator’s EIN 061158759
Plan administrator’s name POTTER FUNERAL HOME, INC.
Plan administrator’s address 456 JACKSON STREET, WILLIMANTIC, CT, 06226
Administrator’s telephone number 8604232211

Signature of
Role Plan administrator
Date 2012-05-08
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature
POTTER FUNERAL HOME, INC. PROFIT SHARING PLAN 2010 061158759 2011-05-23 POTTER FUNERAL HOME, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 812210
Sponsor’s telephone number 8604232211
Plan sponsor’s address 456 JACKSON STREET, WILLIMANTIC, CT, 06226

Plan administrator’s name and address
Administrator’s EIN 061158759
Plan administrator’s name POTTER FUNERAL HOME, INC.
Plan administrator’s address 456 JACKSON STREET, WILLIMANTIC, CT, 06226
Administrator’s telephone number 8604232211

Signature of
Role Plan administrator
Date 2011-05-23
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature
POTTER FUNERAL HOME, INC. PROFIT SHARING PLAN 2009 061158759 2010-07-19 POTTER FUNERAL HOME, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1985-01-01
Business code 812210
Sponsor’s telephone number 8604232211
Plan sponsor’s address 456 JACKSON STREET, WILLIMANTIC, CT, 06226

Plan administrator’s name and address
Administrator’s EIN 061158759
Plan administrator’s name POTTER FUNERAL HOME, INC.
Plan administrator’s address 456 JACKSON STREET, WILLIMANTIC, CT, 06226
Administrator’s telephone number 8604232211

Signature of
Role Plan administrator
Date 2010-07-19
Name of individual signing PAUL CICHON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Business address E-Mail Residence address
ROBERT R. POTTER Agent SAME AS RES. pjcichon@gmail.com 65 BEDFORD ST, STAMFORD, CT, United States

Officer

Name Role Residence address
BRETT T. GRANT Officer FOLLETT RD., WINDHAM, CT, 06280, United States
PAUL J. CICHON Officer 145 SAND HILL RD., HAMPTON, CT, 06247, United States

License

Credential Credential type Status Status reason Issue date Effective date Expiration date
FH.000340 Funeral Home INACTIVE INACTIVE 1985-06-30 2014-04-22 2014-06-12

Filing

Filing number Filing date Effective date Filing category Filing type Report year
0005701308 2016-11-22 2016-11-22 Dissolution Certificate of Dissolution No data
0005502066 2016-03-04 No data Annual Report Annual Report 2016
0005451170 2015-12-22 No data Annual Report Annual Report 2015
0005246427 2014-12-30 No data Annual Report Annual Report 2014
0005009474 2013-12-27 No data Annual Report Annual Report 2013
0004761551 2012-12-12 No data Annual Report Annual Report 2012
0004382543 2011-01-11 No data Annual Report Annual Report 2011
0004097843 2010-01-04 No data Annual Report Annual Report 2010
0003860483 2008-12-31 No data Annual Report Annual Report 2009
0003614956 2008-01-18 No data Annual Report Annual Report 2008

Related by officers

ROBERT R. POTTER

47 SELLECK STREET CORPORATION

PAUL J. CICHON

P & B REALTY OF WINDHAM, 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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