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  5. SAYBROOK DERMATOLOGY, LLC

SAYBROOK DERMATOLOGY, LLC

Company Details

Entity Name: SAYBROOK DERMATOLOGY, LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 06 Jun 2002
Business ALEI: 0717181
Annual report due: 31 Mar 2025
NAICS code: 621111 - Offices of Physicians (except Mental Health Specialists)
Business address: 455 BOSTON POST ROAD SUITE 10, OLD SAYBROOK, CT, 06475, United States
Mailing address: 455 BOSTON POST ROAD SUITE 10, OLD SAYBROOK, CT, United States, 06475
ZIP code: 06475
County: Middlesex
Place of Formation: CONNECTICUT
E-Mail: heather@saybrookdermatology.com

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
YSAVBJKFRNE5 2024-07-24 455 BOSTON POST RD, UNIT 10, OLD SAYBROOK, CT, 06475, 1554, USA 455 BOSTON POST RD, UNIT 10, OLD SAYBROOK, CT, 06475, 1554, USA

Business Information
Congressional District 02
State/Country of Incorporation CT, USA
Activation Date 2023-08-03
Initial Registration Date 2023-07-25
Entity Start Date 2006-01-01
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 621111, 621399
Product and Service Codes Q504

Points of Contacts
Electronic Business
Title PRIMARY POC
Name HEATHER LARSON
Role OFFICE MANAGER
Address 455 BOSTON POST ROAD, SUITE 10, OLD SAYBROOK, CT, 06475, 1554, USA
Government Business
Title PRIMARY POC
Name HEATHER LARSON
Role OFFICE MANAGER
Address 455 BOSTON POST ROAD, SUITE 10, OLD SAYBROOK, CT, 06475, 1554, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SAYBROOK DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2023 460491149 2024-07-25 SAYBROOK DERMATOLOGY LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2024-07-25
Name of individual signing DONALD BRODEUR
Valid signature Filed with authorized/valid electronic signature
SAYBROOK DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 460491149 2023-07-25 SAYBROOK DERMATOLOGY LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2023-07-25
Name of individual signing DONALD BRODEUR
Valid signature Filed with authorized/valid electronic signature
SAYBROOK DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2021 460491149 2022-07-27 SAYBROOK DERMATOLOGY LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2022-07-27
Name of individual signing DONALD S. BRODEUR, JR.
Valid signature Filed with authorized/valid electronic signature
SAYBROOK DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2020 460491149 2021-07-28 SAYBROOK DERMATOLOGY LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2021-07-28
Name of individual signing DONALD S BRODEUR
Valid signature Filed with authorized/valid electronic signature
SAYBROOK DERMATOLOGY LLC 401(K) PROFIT SHARING PLAN & TRUST 2019 460491149 2020-07-30 SAYBROOK DERMATOLOGY LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2020-07-30
Name of individual signing DONALD BRODEUR
Valid signature Filed with authorized/valid electronic signature
SAYBROOK DERMATOLOGY LLC 401 K PROFIT SHARING PLAN TRUST 2018 460491149 2019-07-22 SAYBROOK DERMATOLOGY LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2019-07-22
Name of individual signing DONALD BRODEUR
Valid signature Filed with authorized/valid electronic signature
SAYBROOK DERMATOLOGY LLC 401 K PROFIT SHARING PLAN TRUST 2018 460491149 2019-07-22 SAYBROOK DERMATOLOGY LLC 12
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2019-07-22
Name of individual signing DONALD BRODEUR
Valid signature Filed with authorized/valid electronic signature
SAYBROOK DERMATOLOGY LLC 401 K PROFIT SHARING PLAN TRUST 2017 460491149 2018-07-30 SAYBROOK DERMATOLOGY LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2018-07-30
Name of individual signing DONALD BRODEUR
Valid signature Filed with authorized/valid electronic signature
SAYBROOK DERMATOLOGY LLC 401 K PROFIT SHARING PLAN TRUST 2016 460491149 2017-07-27 SAYBROOK DERMATOLOGY LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2017-07-27
Name of individual signing DONALD BRODEUR
Valid signature Filed with authorized/valid electronic signature
SAYBROOK DERMATOLOGY LLC 401 K PROFIT SHARING PLAN TRUST 2015 460491149 2016-07-28 SAYBROOK DERMATOLOGY LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621112
Sponsor’s telephone number 8603889799
Plan sponsor’s address 455 BOSTON POST RD STE 10, OLD SAYBROOK, CT, 064751554

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing DONALD BRODEUR
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Business address Mailing address Phone E-Mail Residence address
RICHARD G. CONVICER Agent 41 HEBRON AVENUE, GLASTONBURY, CT, 06033, United States 41 HEBRON AVENUE, GLASTONBURY, CT, 06033, United States +1 860-287-0130 heather@saybrookdermatology.com 347 GREAT SWAMP RD., GLASTONBURY, CT, 06033, United States

Officer

Name Role Business address Residence address
DR. MICHELLE HIGGINSON Officer 455 BOSTON POST ROAD, SUITE 10, OLD SAYBROOK, CT, 06475, United States 14 KACHINA WAY, MADISON, CT, 06443, United States
DR. JENNIFER GRAY Officer 455 BOSTON POST ROAD, SUITE 10, OLD SAYBROOK, CT, 06475, United States 9 TIPPING ROCK ROAD, STONINGTON, CT, 06378, United States

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012085292 2024-03-13 No data Annual Report Annual Report No data
BF-0011408742 2023-03-23 No data Annual Report Annual Report No data
BF-0010376296 2022-06-16 No data Annual Report Annual Report 2022
0007277839 2021-03-31 No data Annual Report Annual Report 2021
0006891913 2020-04-24 No data Annual Report Annual Report 2020
0006478629 2019-03-20 No data Annual Report Annual Report 2019
0006238670 2018-08-28 No data Annual Report Annual Report 2018
0006238668 2018-08-28 No data Annual Report Annual Report 2017
0006238665 2018-08-28 No data Annual Report Annual Report 2015
0006238664 2018-08-28 No data Annual Report Annual Report 2014

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RICHARD G. CONVICER

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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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