| Entity Name: | PEDIATRIC & ADOLESCENT MEDICINE OF CHESHIRE, LLC |
| Jurisdiction: | Connecticut |
| Legal type: | LLC |
| Citizenship: | Domestic |
| Status: | Active |
| Sub status: | Annual report past due |
| Date Formed: | 19 Nov 2001 |
| Business ALEI: | 0696680 |
| Annual report due: | 31 Mar 2024 |
| NAICS code: | 621112 - Offices of Physicians, Mental Health Specialists |
| Business address: | 677 SOUTH MAIN ST. 677 SOUTH MAIN SUITE 4, CHESHIRE, CT, 06410, United States |
| Mailing address: | 677 SOUTH MAIN ST. 677 SOUTH MAIN SUITE 4, CHESHIRE, CT, United States, 06410 |
| ZIP code: | 06410 |
| County: | New Haven |
| Place of Formation: | CONNECTICUT |
| E-Mail: | jchinchillamd@gmail.com |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PEDIATRIC ADOLESCENT MEDICINE OF CHESHIRE, LLC 401 K PLAN | 2018 | 061627848 | 2019-05-23 | PEDIATRIC & ADOLESCENT MEDICINE OF CHESHIRE LLC | 3 | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2019-05-23 |
| Name of individual signing | GUISETTE CHINCHILLA |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2032722382 |
| Plan sponsor’s DBA name | PEDIATRIC & ADOLESCENT MEDICINE OF CHESHIRE LLC |
| Plan sponsor’s address | 677 SOUTH MAIN STREET, CHESHIRE, CT, 06410 |
Signature of
| Role | Plan administrator |
| Date | 2019-05-23 |
| Name of individual signing | GUISETTE CHINCHILLA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2032722382 |
| Plan sponsor’s mailing address | 677 SOUTH MAIN STREET, CHESHIRE, CT, 06410 |
| Plan sponsor’s address | 677 SOUTH MAIN STREET, CHESHIRE, CT, 06410 |
Plan administrator’s name and address
| Administrator’s EIN | 061627848 |
| Plan administrator’s name | PEDIATRIC & ADOLESCENT MEDICINE OF CHESHIRE, LLC |
| Plan administrator’s address | 677 SOUTH MAIN STREET, CHESHIRE, CT, 06410 |
| Administrator’s telephone number | 2032722382 |
Number of participants as of the end of the plan year
| Active participants | 3 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants with account balances as of the end of the plan year | 3 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Plan administrator |
| Date | 2011-11-21 |
| Name of individual signing | GUISETTE CHINCHILLA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Business address | Mailing address | Phone | Residence address | |
|---|---|---|---|---|---|---|
| DAVID R. SCHAEFER ESQ. | Agent | 271 WHITNEY AVE., NEW HAVEN, CT, 06511, United States | 271 WHITNEY AVE., NEW HAVEN, CT, 06511, United States | +1 203-772-2600 | dschaefer@bswlaw.com | 39 BROADFIELD RD., HAMDEN, CT, 06517, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| JEANNETTE CHINCHILLA M.D. | Officer | 677 SOUTH MAIN ST., Suite 4, CHESHIRE, CT, 06410, United States | 110 COPPER BEECH DR., CHESHIRE, CT, 06410, United States |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0009666109 | 2023-05-25 | No data | Annual Report | Annual Report | 2020 |
| BF-0009961819 | 2023-05-25 | No data | Annual Report | Annual Report | No data |
| BF-0009666111 | 2023-05-25 | No data | Annual Report | Annual Report | 2018 |
| BF-0010864481 | 2023-05-25 | No data | Annual Report | Annual Report | No data |
| BF-0011403568 | 2023-05-25 | No data | Annual Report | Annual Report | No data |
| BF-0009666110 | 2023-05-25 | No data | Annual Report | Annual Report | 2019 |
| BF-0011788578 | 2023-05-03 | No data | Administrative Dissolution | Notice of Intent to Dissolve/Revoke | No data |
| 0005968646 | 2017-11-20 | No data | Annual Report | Annual Report | 2013 |
| 0005968655 | 2017-11-20 | No data | Annual Report | Annual Report | 2015 |
| 0005968652 | 2017-11-20 | No data | Annual Report | Annual Report | 2014 |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
