| Entity Name: | JOHNSON MEMORIAL HOSPITAL, INC. |
| Jurisdiction: | Connecticut |
| Legal type: | Non-Stock |
| Citizenship: | Domestic |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 24 Nov 2015 (Companies founded in November 2015) |
| Business ALEI: | 1188474 |
| Annual report due: | 24 Nov 2024 |
| NAICS code: | 622110 - General Medical and Surgical Hospitals |
| Business address: | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076, United States |
| Mailing address: | 114 WOODLAND STREET, HARTFORD, CT, United States, 06105 |
| ZIP code: | 06076 (Companies in Tolland, 06076) |
| County: | Tolland |
| Place of Formation: | CONNECTICUT |
| E-Mail: | legaldepartment@trinityhealthofne.org |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHNSON MEMORIAL HOSPITAL 403(B) PLAN | 2020 | 060646696 | 2021-06-07 | JOHNSON MEMORIAL HOSPITAL | 53 | |||||||||||||||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2021-06-07 |
| Name of individual signing | STUART ROSENBERG |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2006-01-01 |
| Business code | 622000 |
| Sponsor’s telephone number | 8606848203 |
| Plan sponsor’s address | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076 |
Signature of
| Role | Plan administrator |
| Date | 2020-04-18 |
| Name of individual signing | STUART ROSENBERG |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2006-01-01 |
| Business code | 622000 |
| Sponsor’s telephone number | 8606848203 |
| Plan sponsor’s address | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076 |
Signature of
| Role | Plan administrator |
| Date | 2019-04-28 |
| Name of individual signing | STUART ROSENBERG |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2007-01-01 |
| Business code | 622000 |
| Sponsor’s telephone number | 8606844251 |
| Plan sponsor’s mailing address | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076 |
| Plan sponsor’s address | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076 |
Plan administrator’s name and address
| Administrator’s EIN | 060646696 |
| Plan administrator’s name | JOHNSON MEMORIAL HOSPITAL |
| Plan administrator’s address | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076 |
| Administrator’s telephone number | 8606844251 |
Number of participants as of the end of the plan year
| Active participants | 0 |
Signature of
| Role | Plan administrator |
| Date | 2011-05-20 |
| Name of individual signing | DIANA ROSE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| ROBERT ROOSE, M.D., M.P.H. | Officer | 271 Carew St, Springfield, MA, 01104-2377, United States | 271 Carew St, Springfield, MA, 01104-2377, United States |
| ROBERT C. GUMBARDO, M.D. | Officer | 385 Main St S, Southbury, CT, 06488-4240, United States | 385 Main St S, Southbury, CT, 06488-4240, United States |
| ROBERT J. ANTHONY ESQ. | Officer | 114 WOODLAND STREET, HARTFORD, CT, 06105, United States | 1277 DEER RUN CIRCLE, CHESHIRE, CT, 06410, United States |
| David Montez Carter, FACHE | Officer | 1000 Asylum Ave, Hartford, CT, 06105-1770, United States | 1000 Asylum Ave, Hartford, CT, 06105, United States |
| SHERI A. LEMIEUX | Officer | 1000 ASYLUM AVENUE, 5TH FLOOR, HARTFORD, CT, 06105, United States | 243 STEELE ROAD, #331, WEST HARTFORD, CT, 06117, United States |
| WALTER HARRISON PH.D. | Officer | 200 BLOOMFIELD AVENUE, WEST HARTFORD, CT, 06117, United States | 130 BLUE HERON ROAD, WELLFLEET, MA, 02667, United States |
| Catherine M. Spath MD | Officer | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076, United States | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076, United States |
| EMILY BROWER | Officer | 20555 Victor Pkwy, Livonia, MI, 48152-7031, United States | 1319 WELLS STREET, ANN ARBOR, MI, 48104, United States |
| JAMES C. SMITH | Officer | 123 BANK STREET, 2ND FLOOR, WATERBURY, CT, 06702, United States | 290 TRANQUILITY ROAD, MIDDLEBURY, CT, 06762, United States |
| JOANN H. PRICE | Officer | 75 ISHAM ROAD, SUITE 200, WEST HARTFORD, CT, 06107, United States | 45 HERITAGE LANE, AVON, CT, 06001, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| Arosha Jayawickrema | Director | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076, United States | 56 Franklin Street, Waterbury, CT, 06706-1253, United States |
| NANCY KROEBER | Director | 222 Old Mountain Rd, Marion, CT, 06444-0049, United States | 222 Old Mountain Rd, Marion, CT, 06444-0049, United States |
| KARL J. KRAPEK | Director | 11 Pembroke Dr, Avon, CT, 06001-3970, United States | 11 PEMBROKE DRIVE, AVON, CT, 06001, United States |
| Barbara A. Mullen, CSJ | Director | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076, United States | 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076, United States |
| Juan Miguel Betancourt | Director | 134 Farmington Ave, Hartford, CT, 06105-3723, United States | 134 Farmington Avenue, Hartford, CT, 06105, United States |
| JAMES C. SMITH | Director | 123 BANK STREET, 2ND FLOOR, WATERBURY, CT, 06702, United States | 290 TRANQUILITY ROAD, MIDDLEBURY, CT, 06762, United States |
| JOANN H. PRICE | Director | 75 ISHAM ROAD, SUITE 200, WEST HARTFORD, CT, 06107, United States | 45 HERITAGE LANE, AVON, CT, 06001, United States |
| Credential | Credential type | Status | Status reason | Issue date | Effective date | Expiration date |
|---|---|---|---|---|---|---|
| FDR.0000654 | FROZEN DESSERT RETAILER | INACTIVE | EXPIRED MORE THAN 3 YEARS - MUST REAPPLY | No data | 2020-01-24 | 2020-12-31 |
| BAK.0002649 | BAKERY | INACTIVE | EXPIRED MORE THAN 3 YEARS - MUST REAPPLY | No data | 2016-07-01 | 2017-06-30 |
| CHR.0003617-EXEMPT | PUBLIC CHARITY-EXEMPT FROM FINANCIAL REQUIREMENTS | ACTIVE | No data | No data | No data | No data |
| GH.0000072 | General Hospital | ACTIVE | CURRENT | 2015-12-22 | 2024-01-01 | 2025-12-31 |
| RAFF.00078-CL 1 | RAFFLE PERMIT CLASS 1 | CLOSED | VERIFICATION STATEMENT COMPLETE | 2012-04-02 | 2012-04-02 | 2012-04-21 |
| GH.0000033 | General Hospital | INACTIVE | INACTIVE | 2010-01-01 | 2014-01-01 | 2015-12-31 |
| Type | Old value | New value | Date of change |
|---|---|---|---|
| Name change | JMH ACQUISITION CORP. | JOHNSON MEMORIAL HOSPITAL, INC. | 2016-01-04 |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0011442414 | 2024-06-10 | No data | Annual Report | Annual Report | No data |
| BF-0010297327 | 2022-10-31 | No data | Annual Report | Annual Report | 2022 |
| BF-0009822558 | 2021-11-18 | No data | Annual Report | Annual Report | No data |
| 0006998249 | 2020-10-09 | No data | Annual Report | Annual Report | 2020 |
| 0006882416 | 2020-04-13 | No data | Annual Report | Annual Report | 2019 |
| 0006472515 | 2019-03-18 | No data | Interim Notice | Interim Notice | No data |
| 0006383885 | 2019-02-14 | No data | Annual Report | Annual Report | 2018 |
| 0006297644 | 2018-12-21 | 2019-01-01 | Amendment | Restated | No data |
| 0006126537 | 2018-03-16 | No data | Annual Report | Annual Report | 2017 |
| 0005746229 | 2017-01-19 | 2017-01-23 | Merger | Certificate of Merger | No data |
Date of last update: 04 Nov 2024
Sources: Connecticut's Official State Website
