| Entity Name: | CONNECTICUT SPINE INSTITUTE, LLC |
| Jurisdiction: | Connecticut |
| Legal type: | LLC |
| Citizenship: | Domestic |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 29 Nov 2007 (Companies founded in November 2007) |
| Business ALEI: | 0920426 |
| Annual report due: | 31 Mar 2025 |
| NAICS code: | 541690 - Other Scientific and Technical Consulting Services |
| Business address: | 22 Aiken Rd, Greenwich, CT, 06831-2707, United States |
| Mailing address: | 22 Aiken Road, GREENWICH, CT, United States, 06831 |
| ZIP code: | 06831 (Companies in Fairfield, 06831) |
| County: | Fairfield |
| Place of Formation: | CONNECTICUT |
| E-Mail: | Afdouglasmd@gmail.com |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CONNECTICUT SPINE INSTITUTE 401K PLAN | 2014 | 261455702 | 2015-12-03 | CONNECTICUT SPINE INSTITUTE | 11 | |||||||||||||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2015-12-03 |
| Name of individual signing | ANDREA DOUGLAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2036613333 |
| Plan sponsor’s address | 25 VALLEY DRIVE, GREENWICH, CT, 06831 |
Signature of
| Role | Plan administrator |
| Date | 2015-10-02 |
| Name of individual signing | ANDREA DOUGLAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2015-10-02 |
| Name of individual signing | ANDREA DOUGLAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2036613333 |
| Plan sponsor’s address | 25 VALLEY DRIVE, GREENWICH, CT, 06831 |
Signature of
| Role | Plan administrator |
| Date | 2015-12-11 |
| Name of individual signing | ANDREA DOUGLAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2036613333 |
| Plan sponsor’s address | 25 VALLEY DRIVE, GREENWICH, CT, 06831 |
Signature of
| Role | Plan administrator |
| Date | 2014-07-26 |
| Name of individual signing | ANDREA DOUGLAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2007-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2036613333 |
| Plan sponsor’s address | 25 VALLEY DRIVE, GREENWICH, CT, 06831 |
Signature of
| Role | Plan administrator |
| Date | 2013-06-11 |
| Name of individual signing | ANDREA DOUGLAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Business address | Mailing address | Phone | Residence address | |
|---|---|---|---|---|---|---|
| Andrea Douglas | Agent | 22 Aiken Road, GREENWICH, CT, 06831, United States | 22 Aiken Road, GREENWICH, CT, 06831, United States | +1 202-403-7778 | afdouglasmd@gmail.com | 22 Aiken Rd, Greenwich, CT, 06831-2707, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| ANDREA DOUGLAS M.D. | Officer | 22 Aiken Rd, Greenwich, CT, 06831-2707, United States | 22 Aiken Road, GREENWICH, CT, 06831, United States |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0012288331 | 2024-02-07 | No data | Annual Report | Annual Report | No data |
| BF-0011281041 | 2023-05-05 | No data | Annual Report | Annual Report | No data |
| BF-0010357580 | 2022-04-05 | No data | Annual Report | Annual Report | 2022 |
| 0007167337 | 2021-02-16 | No data | Annual Report | Annual Report | 2021 |
| 0007167327 | 2021-02-16 | No data | Annual Report | Annual Report | 2020 |
| 0006436227 | 2019-03-08 | No data | Annual Report | Annual Report | 2019 |
| 0006436226 | 2019-03-08 | No data | Annual Report | Annual Report | 2018 |
| 0006025861 | 2018-01-23 | No data | Annual Report | Annual Report | 2017 |
| 0005705703 | 2016-11-29 | No data | Annual Report | Annual Report | 2016 |
| 0005533911 | 2016-04-11 | No data | Annual Report | Annual Report | 2014 |
Date of last update: 18 Nov 2024
Sources: Connecticut's Official State Website
