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POURKAVOOS MEDICAL CENTER, LLC

Company Details

Entity Name: POURKAVOOS MEDICAL CENTER, LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 06 Jun 2003 (Companies founded in June 2003)
Business ALEI: 0751014
Annual report due: 31 Mar 2025
NAICS code: 621111 - Offices of Physicians (except Mental Health Specialists)
Business address: 1 Cherry Tree Ln, Avon, CT, 06001-4344, United States
Mailing address: 1 Cherry Tree Ln, Avon, CT, United States, 06001-4344
ZIP code: 06001 (Companies in Hartford, 06001)
County: Hartford
Place of Formation: CONNECTICUT
E-Mail: khosro06001@gmail.com

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
POURKAVOOS MEDICAL CENTER, LLC 401(K) RETIREMENT PLAN 2014 320005547 2015-06-15 POURKAVOOS MEDICAL CENTER, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8604896363
Plan sponsor’s address 18 TERRACE DRIVE, AVON, CT, 060012314
POURKAVOOS MEDICAL CENTER, LLC 401(K) RETIREMENT PLAN 2013 320005547 2014-06-07 POURKAVOOS MEDICAL CENTER, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8606760090
Plan sponsor’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001
POURKAVOOS MEDICAL CENTER, LLC 401(K) RETIREMENT PLAN 2012 320005547 2013-06-24 POURKAVOOS MEDICAL CENTER, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8606760090
Plan sponsor’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001

Signature of
Role Plan administrator
Date 2013-06-24
Name of individual signing KHOSRO POURKAVOOS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-24
Name of individual signing KHOSRO POURKAVOOS, M.D.
Valid signature Filed with authorized/valid electronic signature
POURKAVOOS MEDICAL CENTER, LLC 401(K) RETIREMENT PLAN 2011 320005547 2012-06-22 POURKAVOOS MEDICAL CENTER, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8606760090
Plan sponsor’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001

Plan administrator’s name and address
Administrator’s EIN 320005547
Plan administrator’s name POURKAVOOS MEDICAL CENTER, LLC
Plan administrator’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001
Administrator’s telephone number 8606760090

Signature of
Role Plan administrator
Date 2012-06-22
Name of individual signing KHOSRO POURKAVOOS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-22
Name of individual signing KHOSRO POURKAVOOS, M.D.
Valid signature Filed with authorized/valid electronic signature
POURKAVOOS MEDICAL CENTER, LLC 401(K) RETIREMENT PLAN 2010 320005547 2011-06-17 POURKAVOOS MEDICAL CENTER, LLC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8606760090
Plan sponsor’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001

Plan administrator’s name and address
Administrator’s EIN 320005547
Plan administrator’s name POURKAVOOS MEDICAL CENTER, LLC
Plan administrator’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001
Administrator’s telephone number 8606760090

Signature of
Role Plan administrator
Date 2011-06-17
Name of individual signing KHOSRO POURKAVOOS, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-17
Name of individual signing KHOSRO POURKAVOOS, M.D.
Valid signature Filed with authorized/valid electronic signature
POURKAVOOS MEDICAL CENTER, LLC 401(K) RETIREMENT PLAN 2009 320005547 2010-07-23 POURKAVOOS MEDICAL CENTER, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8606760090
Plan sponsor’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001

Plan administrator’s name and address
Administrator’s EIN 320005547
Plan administrator’s name POURKAVOOS MEDICAL CENTER, LLC
Plan administrator’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001
Administrator’s telephone number 8606760090

Signature of
Role Plan administrator
Date 2010-07-23
Name of individual signing KHOSRO POURKAVOOS, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-23
Name of individual signing KHOSRO POURKAVOOS, MD
Valid signature Filed with authorized/valid electronic signature
POURKAVOOS MEDICAL CENTER, LLC 401(K) RETIREMENT PLAN 2009 320005547 2010-07-23 POURKAVOOS MEDICAL CENTER, LLC 4
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 8606760090
Plan sponsor’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001

Plan administrator’s name and address
Administrator’s EIN 320005547
Plan administrator’s name POURKAVOOS MEDICAL CENTER, LLC
Plan administrator’s address 35 NOD ROAD, SUITE 205, AVON, CT, 06001
Administrator’s telephone number 8606760090

Signature of
Role Plan administrator
Date 2010-07-23
Name of individual signing KHOSRO POURKAVOOS
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-07-23
Name of individual signing KHOSRO POURKAVOOS
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Business address Mailing address Phone E-Mail Residence address
KHOSRO POURKAVOOS Agent 1 Cherry Tree Ln, Avon, CT, 06001-4344, United States 1 Cherry Tree Ln, Avon, CT, 06001-4344, United States +1 860-881-7463 khosro06001@gmail.com 1 Cherry Tree Ln, Avon, CT, 06001-4344, United States

Officer

Name Role Business address Phone E-Mail Residence address
KHOSRO POURKAVOOS Officer 1 CHERRY TREE LANE, AVON, CT, 06001, United States +1 860-881-7463 khosro06001@gmail.com 1 Cherry Tree Ln, Avon, CT, 06001-4344, United States

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012210641 2024-01-24 No data Annual Report Annual Report No data
BF-0011273806 2023-01-27 No data Annual Report Annual Report No data
BF-0010298365 2022-04-10 No data Annual Report Annual Report 2022
0007077399 2021-01-25 No data Annual Report Annual Report 2021
0006775251 2020-02-24 No data Annual Report Annual Report 2020
0006360632 2019-02-04 No data Annual Report Annual Report 2019
0006360625 2019-02-04 No data Annual Report Annual Report 2018
0006053861 2018-02-03 No data Annual Report Annual Report 2017
0005583214 2016-06-08 No data Annual Report Annual Report 2016
0005345056 2015-06-08 No data Annual Report Annual Report 2015

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 11 Nov 2024

Sources: Connecticut's Official State Website

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