| Entity Name: | LIFECHOICE DONOR SERVICES, INC. |
| Jurisdiction: | Connecticut |
| Legal type: | Non-Stock |
| Citizenship: | Domestic |
| Status: | Merged |
| Date Formed: | 29 May 2001 |
| Business ALEI: | 0682696 |
| Annual report due: | 29 May 2021 |
| NAICS code: | 621991 - Blood and Organ Banks |
| Business address: | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States |
| Mailing address: | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, United States, 06002 |
| ZIP code: | 06002 |
| County: | Hartford |
| Place of Formation: | CONNECTICUT |
| E-Mail: | CLS-CTSB-ARMSEvidence@wolterskluwer.com |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LIFECHOICE DONOR SERVICES, INC. 403 (B) RETIREMENT PLAN | 2020 | 061631615 | 2021-06-14 | LIFECHOICE DONOR SERVICES, INC. | 62 | |||||||||||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2021-06-14 |
| Name of individual signing | DARA WASHBURN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2021-06-14 |
| Name of individual signing | DARA WASHBURN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-03-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 6172448000 |
| Plan sponsor’s address | 340 W NEWBERRY RD STE A, BLOOMFIELD, CT, 060021393 |
Signature of
| Role | Plan administrator |
| Date | 2020-07-07 |
| Name of individual signing | DARA WASHBURN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2020-07-07 |
| Name of individual signing | DARA WASHBURN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-03-01 |
| Business code | 621399 |
| Plan sponsor’s address | 340 W NEWBERRY RD STE A, BLOOMFIELD, CT, 060021393 |
Signature of
| Role | Plan administrator |
| Date | 2019-07-10 |
| Name of individual signing | DARA WASHBURN |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2019-07-10 |
| Name of individual signing | DARA WASHBURN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-03-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 8602863120 |
| Plan sponsor’s address | 340 WEST NEWBERRY ROAD SUITE A, BLOOMFIELD, CT, 06002 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-03-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 8602863120 |
| Plan sponsor’s address | 340 WEST NEWBERRY ROAD SUITE A, BLOOMFIELD, CT, 06002 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-03-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 8602863120 |
| Plan sponsor’s address | 340 WEST NEWBERRY ROAD SUITE A, BLOOMFIELD, CT, 06002 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-03-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 8602863120 |
| Plan sponsor’s address | 340 WEST NEWBERRY ROAD SUITE A, BLOOMFIELD, CT, 06002 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-03-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 8602863120 |
| Plan sponsor’s address | 8 GRIFFIN RD N, WINDSOR, CT, 060951573 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-03-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 8602863120 |
| Plan sponsor’s address | 8 GRIFFIN RD N, WINDSOR, CT, 060951573 |
Signature of
| Role | Plan administrator |
| Date | 2013-10-07 |
| Name of individual signing | DEBORAH SAVARIA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-10-07 |
| Name of individual signing | DEBORAH SAVARIA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-03-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 8602863120 |
| Plan sponsor’s address | 8 GRIFFIN RD N, WINDSOR, CT, 060951573 |
Plan administrator’s name and address
| Administrator’s EIN | 061631615 |
| Plan administrator’s name | LIFECHOICE DONOR SERVICES, INC. |
| Plan administrator’s address | 8 GRIFFIN RD N, WINDSOR, CT, 060951573 |
| Administrator’s telephone number | 8602863120 |
Signature of
| Role | Plan administrator |
| Date | 2012-09-28 |
| Name of individual signing | DEBORAH SAVARIA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2012-09-28 |
| Name of individual signing | DEBORAH SAVARIA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| JUDITH PEPE | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 34 APPLE LANE, MIDDLETOWN, CT, 06457, United States |
| FRED SORBO | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States |
| DAVID TRULL | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States |
| KEITH CHURCHWELL | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 17 BARBERRY LANE, MADISON, CT, 06443, United States |
| HOWARD KOH | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 42 LINCOLN CIRCLE EAST, ANDOVER, MA, 01810, United States |
| VALERIE FLEISHMAN | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States |
| LINDSAY MARTIN | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 20 UNIVERSITY ROAD, CAMBRIDGE, MA, 02138, United States |
| JOREN MADSEN | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 280 BEACON STREET, BOSTON, MA, 02116, United States |
| GAYLE MURPHY | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 10 LINDEN STREET, WOODBURY, CT, 06798, United States |
| ALEXANDRA GLAZIER | Officer | 340 WEST NEWBERRY ROAD, SUITE A, BLOOMFIELD, CT, 06002, United States | 390 WESTFORD ROAD, CONCORD, MA, 01742, United States |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Credential | Credential type | Status | Status reason | Issue date | Effective date | Expiration date |
|---|---|---|---|---|---|---|
| BAZR.02171 | BAZAAR PERMIT CLASS 3 | INACTIVE | VERIFICATION STATEMENT OVERDUE | No data | 2017-09-30 | 2017-09-30 |
| CHR.0011198-EXEMPT | PUBLIC CHARITY-EXEMPT FROM FINANCIAL REQUIREMENTS | INACTIVE | No data | No data | 2002-10-30 | No data |
| Type | Old value | New value | Date of change |
|---|---|---|---|
| Name change | LIFE SHARING ALLIANCE, INC. | LIFECHOICE DONOR SERVICES, INC. | 2001-12-07 |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| 0007041433 | 2020-12-18 | 2021-01-01 | Merger | Certificate of Merger | No data |
| 0006905585 | 2020-05-16 | No data | Annual Report | Annual Report | 2020 |
| 0006515659 | 2019-04-01 | No data | Annual Report | Annual Report | 2019 |
| 0006165236 | 2018-04-18 | No data | Annual Report | Annual Report | 2018 |
| 0005852914 | 2017-05-31 | No data | Annual Report | Annual Report | 2017 |
| 0005854535 | 2017-05-17 | 2017-05-17 | Change of Agent | Agent Change | No data |
| 0005833334 | 2017-04-24 | 2017-04-24 | Agent Resignation | Agent Resignation | No data |
| 0005727986 | 2016-12-30 | 2017-01-01 | Amendment | Restated | No data |
| 0005574146 | 2016-05-25 | No data | Interim Notice | Interim Notice | No data |
| 0005574168 | 2016-05-25 | No data | Annual Report | Annual Report | 2016 |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
