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BLOOMFIELD ASC, LLC

Company Details

Entity Name: BLOOMFIELD ASC, LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Active
Date Formed: 14 Apr 2015 (Companies founded in April 2015)
Business ALEI: 1168285
Annual report due: 31 Mar 2025
NAICS code: 621493 - Freestanding Ambulatory Surgical and Emergency Centers
Business address: 580 COTTAGE GROVE ROAD, BLOOMFIELD, CT, 06002, United States
Mailing address: 580 COTTAGE GROVE ROAD, Suite 211, BLOOMFIELD, CT, United States, 06002
ZIP code: 06002 (Companies in Hartford, 06002)
County: Hartford
Place of Formation: CONNECTICUT
E-Mail: CLS-CTARMSevidence@wolterskluwer.com

Central Index Key

CIK number Mailing Address Business Address Phone
1989827 580 COTTAGE GROVE RD, SUITE 211, BLOOMFIELD, CT, 06002 580 COTTAGE GROVE RD, SUITE 211, BLOOMFIELD, CT, 06002 (860) 242-2193

Filings since 2024-03-07

Form type D
File number 021-506943
Filing date 2024-03-07
File View File

Filings since 2023-08-17

Form type D
File number 021-489989
Filing date 2023-08-17
File View File

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLOOMFIELD ASC, LLC 401(K) RETIREMENT PLAN 2020 474758895 2021-05-21 BLOOMFIELD ASC, LLC 48
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621493
Sponsor’s telephone number 8002422193
Plan sponsor’s address 580 COTTAGE ROAD, SUITE 211, BLOOMFIELD, CT, 06002

Signature of

Role Plan administrator
Date 2021-05-21
Name of individual signing RICHARD SEARLES
Valid signature Filed with authorized/valid electronic signature
BLOOMFIELD ASC, LLC 401(K) RETIREMENT PLAN 2020 474758895 2021-05-21 BLOOMFIELD ASC, LLC 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621493
Sponsor’s telephone number 8002422193
Plan sponsor’s address 580 COTTAGE ROAD, SUITE 211, BLOOMFIELD, CT, 06002

Signature of

Role Plan administrator
Date 2021-05-21
Name of individual signing RICHARD SEARLES
Valid signature Filed with authorized/valid electronic signature
BLOOMFIELD ASC, LLC 401(K) RETIREMENT PLAN 2020 474758895 2021-06-08 BLOOMFIELD ASC, LLC 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621493
Sponsor’s telephone number 8002422193
Plan sponsor’s address 580 COTTAGE ROAD, SUITE 211, BLOOMFIELD, CT, 06002

Signature of

Role Plan administrator
Date 2021-06-08
Name of individual signing RICHARD SEARLES
Valid signature Filed with authorized/valid electronic signature
BLOOMFIELD ASC, LLC 401(K) RETIREMENT PLAN 2019 474758895 2020-06-10 BLOOMFIELD ASC, LLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621493
Sponsor’s telephone number 8002422193
Plan sponsor’s address 580 COTTAGE ROAD, SUITE 211, BLOOMFIELD, CT, 06002

Signature of

Role Plan administrator
Date 2020-06-10
Name of individual signing RICHARD SEARLES
Valid signature Filed with authorized/valid electronic signature
BLOOMFIELD ASC, LLC 401(K) RETIREMENT PLAN 2018 474758895 2019-07-10 BLOOMFIELD ASC, LLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621493
Sponsor’s telephone number 8002422193
Plan sponsor’s address 580 COTTAGE ROAD, SUITE 211, BLOOMFIELD, CT, 06002

Signature of

Role Plan administrator
Date 2019-07-10
Name of individual signing RICHARD SEARLES
Valid signature Filed with authorized/valid electronic signature
BLOOMFIELD ASC, LLC 401(K) RETIREMENT PLAN 2017 474758895 2018-09-04 BLOOMFIELD ASC, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Business code 621493
Sponsor’s telephone number 8002422193
Plan sponsor’s address 580 COTTAGE ROAD, SUITE 211, BLOOMFIELD, CT, 06002

Signature of

Role Plan administrator
Date 2018-09-04
Name of individual signing LORIE DUZAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
C T CORPORATION SYSTEM Agent

Officer

Name Role Business address Residence address
Jennifer Gale Officer 580 COTTAGE GROVE ROAD, Suite 211, BLOOMFIELD, CT, 06002, United States 45 SALEM TURNPIKE, NORWICH, CT, 06360, United States
Andrew Epstein Officer 580 COTTAGE GROVE ROAD, Suite 211, BLOOMFIELD, CT, 06002, United States 670 Mountain Road, Hamden, CT, 06514, United States
Stacey Taylor Officer 580 COTTAGE GROVE ROAD, Suite 211, BLOOMFIELD, CT, 06002, United States 226 WHITE STREET, DANBURY, CT, 06810, United States
Paul Abbate Officer 580 COTTAGE GROVE ROAD, Suite 211, BLOOMFIELD, CT, 06002, United States 226 WHITE STREET, DANBURY, CT, 06810, United States
Deirdre Hennessey Officer 580 COTTAGE GROVE ROAD, Suite 211, BLOOMFIELD, CT, 06002, United States 580 COTTAGE GROVE ROAD, Suite 211, BLOOMFIELD, CT, 06002, United States
Seth M. Brown M.D. Officer No data 21 South Rd, suite 112, Farmington, CT, 06032, United States
Marc Lederman Officer 580 COTTAGE GROVE ROAD, Suite 211, BLOOMFIELD, CT, 06002, United States 6 Livingston Rd, Collinsville, CT, 06019-3050, United States

License

Credential Credential type Status Status reason Issue date Effective date Expiration date
CSP.0062022 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER ACTIVE CURRENT 2016-02-24 2023-03-01 2025-02-28
ASC.0000350 Out-Patient Surgical Facility ACTIVE CURRENT 2015-09-01 2023-07-01 2025-06-30

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012416232 2024-03-01 No data Annual Report Annual Report No data
BF-0011212300 2023-02-08 No data Annual Report Annual Report No data
BF-0010243407 2022-03-24 No data Annual Report Annual Report 2022
0007250673 2021-03-23 No data Annual Report Annual Report 2021
0007033834 2020-12-08 2020-12-08 Change of Agent Agent Change No data
0006794758 2020-02-28 No data Annual Report Annual Report 2020
0006569601 2019-06-05 No data Annual Report Annual Report 2019
0006569599 2019-06-05 No data Annual Report Annual Report 2018
0006013252 2018-01-17 No data Annual Report Annual Report 2017
0005527745 2016-04-04 No data Annual Report Annual Report 2016

Date of last update: 04 Nov 2024

Sources: Connecticut's Official State Website