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  5. CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C.

CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C.

Company Details

Entity Name: CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C.
Jurisdiction: Connecticut
Legal type: Stock
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 06 Apr 1994
Business ALEI: 0296899
Annual report due: 06 Apr 2025
NAICS code: 621420 - Outpatient Mental Health and Substance Abuse Centers
Business address: 22 Case Street, Norwich, CT, 06360, United States
Mailing address: 22 Case Street, Norwich, CT, United States, 06360
ZIP code: 06360
County: New London
Place of Formation: CONNECTICUT
Total authorized shares: 20000
E-Mail: whateverpam9699@gmail.com

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
MBXRGGRXK765 2020-12-02 41 FAIRE HARBOUR PL, NEW LONDON, CT, 06320, 4710, USA 41 FAIRE HARBOUR PL, NEW LONDON, CT, 06320, 4710, USA

Business Information
Congressional District 02
State/Country of Incorporation CT, USA
Activation Date 2019-12-03
Initial Registration Date 2019-07-29
Entity Start Date 1991-03-01
Fiscal Year End Close Date Sep 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name DIANA ADCOCK
Role CONTROLLER
Address 41 FAIR HARBOUR PL, NEW LONDON, CT, 06320, USA
Title ALTERNATE POC
Name ANN D SAWYER
Role THERAPIST
Address 26 MILLER RD, PRESTON, CT, 06360, USA
Government Business
Title PRIMARY POC
Name ANN D SAWYER
Role THERAPIST
Address 26 MILLER RD, PRESTON, CT, 06360, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CONNECTICUT BEHAVIORAL HEALTH 401(K) P/S PLAN 2017 061398124 2018-12-06 CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-05
Business code 621420
Sponsor’s telephone number 8604376914
Plan sponsor’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320
CONNECTICUT BEHAVIORAL HEALTH 401(K) P/S PLAN 2016 061398124 2017-12-18 CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 46
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-05
Business code 621420
Sponsor’s telephone number 8604376914
Plan sponsor’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320
CONNECTICUT BEHAVIORAL HEALTH 401(K) P/S PLAN 2015 061398124 2017-05-01 CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-05
Business code 621420
Sponsor’s telephone number 8604376914
Plan sponsor’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320

Signature of
Role Plan administrator
Date 2017-05-01
Name of individual signing DIANA ADCOCK
Valid signature Filed with authorized/valid electronic signature
CONNECTICUT BEHAVIORAL HEALTH 401(K) P/S PLAN 2014 061398124 2016-07-07 CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-05
Business code 621420
Sponsor’s telephone number 8604376914
Plan sponsor’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320

Signature of
Role Plan administrator
Date 2016-07-07
Name of individual signing DIANA ADCOCK
Valid signature Filed with authorized/valid electronic signature
CONNECTICUT BEHAVIORAL HEALTH 401(K) P/S PLAN 2013 061398124 2015-02-20 CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-05
Business code 621420
Sponsor’s telephone number 8604376914
Plan sponsor’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320

Signature of
Role Plan administrator
Date 2015-02-20
Name of individual signing DIANA ADCOCK
Valid signature Filed with authorized/valid electronic signature
CONNECTICUT BEHAVIORAL HEALTH 401(K) P/S PLAN 2012 061398124 2014-04-24 CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-05
Business code 621420
Sponsor’s telephone number 8604376914
Plan sponsor’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320

Signature of
Role Plan administrator
Date 2014-04-24
Name of individual signing DIANA ADCOCK
Valid signature Filed with authorized/valid electronic signature
CONNECTICUT BEHAVIORAL HEALTH 401(K) P/S PLAN 2011 061398124 2013-04-26 CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-05
Business code 621420
Sponsor’s telephone number 8604376914
Plan sponsor’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320

Plan administrator’s name and address
Administrator’s EIN 061398124
Plan administrator’s name CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C.
Plan administrator’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320
Administrator’s telephone number 8604376914

Signature of
Role Plan administrator
Date 2013-04-26
Name of individual signing DIANA ADCOCK
Valid signature Filed with authorized/valid electronic signature
CONNECTICUT BEHAVIORAL HEALTH 401(K) P/S PLAN 2010 061398124 2012-06-11 CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-05
Business code 621420
Sponsor’s telephone number 8604376914
Plan sponsor’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320

Plan administrator’s name and address
Administrator’s EIN 061398124
Plan administrator’s name CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C.
Plan administrator’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320
Administrator’s telephone number 8604376914

Signature of
Role Plan administrator
Date 2012-06-11
Name of individual signing DIANA ADCOCK
Valid signature Filed with authorized/valid electronic signature
CONNECTICUT BEHAVIORAL HEALTH 401(K) P/S PLAN 2009 061398124 2011-07-14 CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-05
Business code 621420
Sponsor’s telephone number 8604376914
Plan sponsor’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320

Plan administrator’s name and address
Administrator’s EIN 061398124
Plan administrator’s name CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C.
Plan administrator’s address 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320
Administrator’s telephone number 8604376914

Signature of
Role Plan administrator
Date 2011-07-14
Name of individual signing DIANA ADCOCK
Valid signature Filed with authorized/valid electronic signature

Officer

Name Role Business address Residence address
BASSAM AWWA M.D. Officer 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320, United States 75 LYME ST., OLD LYME, CT, 06371, United States

Director

Name Role Business address Residence address
BASSAM AWWA M.D. Director 41 FAIRE HARBOUR PLACE, NEW LONDON, CT, 06320, United States 75 LYME ST., OLD LYME, CT, 06371, United States

Agent

Name Role Business address Mailing address Phone E-Mail Residence address
BASSAM AWWA Agent 22 Case Street, Norwich, CT, 06360, United States 22 Case Street, Norwich, CT, 06360, United States +1 860-437-6914 whateverpam9699@gmail.com 75 Lyme St, Old Lyme, CT, 06371-2362, United States

License

Credential Credential type Status Status reason Issue date Effective date Expiration date
CLAB.0000821 Clinical Laboratory ACTIVE CURRENT 2011-04-21 2023-07-01 2025-06-30

History

Type Old value New value Date of change
Name change CONNECTICUT BEHAVIORAL HEALTH ASSOCIATION, P.C. CONNECTICUT BEHAVIORAL HEALTH ASSOCIATES, P.C. 1995-05-26

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012395602 2024-04-10 No data Annual Report Annual Report No data
BF-0011389880 2023-03-22 No data Annual Report Annual Report No data
BF-0010323092 2022-03-11 No data Annual Report Annual Report 2022
BF-0009804107 2021-07-06 No data Annual Report Annual Report No data
0007038183 2020-12-15 No data Interim Notice Interim Notice No data
0006897306 2020-05-04 No data Annual Report Annual Report 2020
0006896424 2020-05-01 No data Annual Report Annual Report 2019
0006122263 2018-03-14 No data Annual Report Annual Report 2018
0005811544 2017-04-05 No data Annual Report Annual Report 2017
0005546277 2016-04-21 No data Annual Report Annual Report 2016

Related by officers

BASSAM AWWA

FIGS AND OLIVES GOURMET KITCHEN, LLC PRM PARENT, LLC BW ADVISORY LLC CENTRAL BEHAVIORAL HEALTH ASSOCIATES, LLC PHOENIX INSTITUTE, LLC SHORELINE COUNSELING GROUP, 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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