| Entity Name: | BLOOMFIELD ASC, LLC |
| Jurisdiction: | Connecticut |
| Legal type: | LLC |
| Citizenship: | Domestic |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 14 Apr 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 |
| County: | Hartford |
| Place of Formation: | CONNECTICUT |
| E-Mail: | CLS-CTARMSevidence@wolterskluwer.com |
| 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 | |
| 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 | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2021-05-21 |
| Name of individual signing | RICHARD SEARLES |
| Valid signature | Filed with authorized/valid electronic signature |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| 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 |
| 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 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: 25 Nov 2024
Sources: Connecticut's Official State Website
