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  5. WEST HAVEN MEDICAL GROUP, LLC

WEST HAVEN MEDICAL GROUP, LLC

Company Details

Entity Name: WEST HAVEN MEDICAL GROUP, LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Dissolved
Date Formed: 07 Oct 1998
Date of dissolution: 17 Mar 2021
Business ALEI: 0603996
Business address: 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516
Mailing address: 687 CAMPBELL AVE., WEST HAVEN, CT, 06516
ZIP code: 06516
County: New Haven
Place of Formation: CONNECTICUT
E-Mail: jonofrio@pactmd.com

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WEST HAVEN MEDICAL GROUP, LLC EMPLOYEES 401(K) PROFIT SHARING PLAN 2014 061518711 2015-02-26 WEST HAVEN MEDICAL GROUP, LLC 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2039326481
Plan sponsor’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516

Signature of
Role Plan administrator
Date 2015-02-26
Name of individual signing ANU WALALIYDDA,MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-02-26
Name of individual signing ANU WALALIYDDA,MD
Valid signature Filed with authorized/valid electronic signature
WEST HAVEN MEDICAL GROUP, LLC EMPLOYEES 401(K) PROFIT SHARING PLAN 2013 061518711 2014-05-27 WEST HAVEN MEDICAL GROUP, LLC 88
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2039326481
Plan sponsor’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516

Signature of
Role Plan administrator
Date 2014-05-27
Name of individual signing ANURUDDHA WALALIYADDA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-05-27
Name of individual signing ANURUDDHA WALALIYADDA
Valid signature Filed with authorized/valid electronic signature
WEST HAVEN MEDICAL GROUP, LLC EMPLOYEES 401(K) PROFIT SHARING PLAN 2013 061518711 2014-12-24 WEST HAVEN MEDICAL GROUP, LLC 87
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2039326481
Plan sponsor’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516

Signature of
Role Plan administrator
Date 2014-12-23
Name of individual signing ANURUDDHA WALALIYADDA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-12-23
Name of individual signing ANURUDDHA WALALIYADDA
Valid signature Filed with authorized/valid electronic signature
WEST HAVEN MEDICAL GROUP, LLC EMPLOYEES 401(K) PROFIT SHARING PLAN 2012 061518711 2013-04-29 WEST HAVEN MEDICAL GROUP, LLC 77
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2039326481
Plan sponsor’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516

Signature of
Role Plan administrator
Date 2013-04-26
Name of individual signing ANURUDDHA WALALIYADDA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-04-26
Name of individual signing ANURUDDHA WALALIYADDA
Valid signature Filed with authorized/valid electronic signature
WEST HAVEN MEDICAL GROUP, LLC EMPLOYEES 401(K) PROFIT SHARING PLAN 2011 061518711 2012-10-15 WEST HAVEN MEDICAL GROUP, LLC 67
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2039326481
Plan sponsor’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516

Plan administrator’s name and address
Administrator’s EIN 061518711
Plan administrator’s name WEST HAVEN MEDICAL GROUP, LLC
Plan administrator’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516
Administrator’s telephone number 2039326481

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing ANU WALALIYAADA, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-15
Name of individual signing ANU WALALIYAADA, MD
Valid signature Filed with authorized/valid electronic signature
WEST HAVEN MEDICAL GROUP, LLC EMPLOYEES 401(K) PROFIT SHARING PLAN 2010 061518711 2011-04-11 WEST HAVEN MEDICAL GROUP, LLC 60
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2039326481
Plan sponsor’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516

Plan administrator’s name and address
Administrator’s EIN 061518711
Plan administrator’s name WEST HAVEN MEDICAL GROUP, LLC
Plan administrator’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516
Administrator’s telephone number 2039326481

Signature of
Role Plan administrator
Date 2011-04-08
Name of individual signing ANURUDDHA WALALIYADDA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-04-08
Name of individual signing ANURUDDHA WALALIYADDA
Valid signature Filed with authorized/valid electronic signature
WEST HAVEN MEDICAL GROUP, LLC EMPLOYEES 401(K) PROFIT SHARING PLAN 2009 061518711 2010-07-07 WEST HAVEN MEDICAL GROUP, LLC 51
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 2039326481
Plan sponsor’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516

Plan administrator’s name and address
Administrator’s EIN 061518711
Plan administrator’s name WEST HAVEN MEDICAL GROUP, LLC
Plan administrator’s address 687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516
Administrator’s telephone number 2039326481

Signature of
Role Plan administrator
Date 2010-07-06
Name of individual signing MARK DRABINSKI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-06
Name of individual signing MARK DRABINSKI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Business address E-Mail Residence address
STAN R. DOMBROSKI Agent 205 WHITNEY AVE, NEW HAVEN, CT, 06511, United States jonofrio@pactmd.com 66 HIGH ST #13, GUILFORD, CT, 06437, United States

Officer

Name Role Business address Residence address
ANU WALALIYADDA MD Officer 687 CAMPBELL AVE., WEST HAVEN, CT, 06516, United States 12 COOK ROAD, WALLINGFORD, CT, 06492, United States

History

Type Old value New value Date of change
Name change THE WEST HAVEN MEDICAL GROUP, LLC WEST HAVEN MEDICAL GROUP, LLC 1998-10-22

Filing

Filing number Filing date Effective date Filing category Filing type Report year
0007237630 2021-03-17 2021-03-17 Dissolution Certificate of Dissolution No data
0005188857 2014-09-24 No data Annual Report Annual Report 2014
0004949012 2013-09-24 No data Annual Report Annual Report 2013
0004727530 2012-10-04 No data Annual Report Annual Report 2012
0004636026 2011-10-11 No data Annual Report Annual Report 2011
0004294895 2010-10-07 No data Annual Report Annual Report 2010
0004052556 2009-11-09 No data Annual Report Annual Report 2009
0003795694 2008-10-09 No data Annual Report Annual Report 2008
0003551656 2007-10-09 No data Annual Report Annual Report 2007
0003326439 2006-10-30 No data Annual Report Annual Report 2006

Related by officers

STAN R. DOMBROSKI

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Related by address

687 CAMPBELL AVENUE, WEST HAVEN, CT, 06516

WHMG REALTY LLC NEW ENGLAND HOSPITALIST CORPORATION

Date of last update: 25 Nov 2024

Sources: Connecticut's Official State Website

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