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  5. JOHNSON MEMORIAL HOSPITAL, INC.

JOHNSON MEMORIAL HOSPITAL, INC.

Company Details

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
Business ALEI: 1188474
Annual report due: 24 Nov 2025
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
County: Tolland
Place of Formation: CONNECTICUT
E-Mail: legaldepartment@trinityhealthofne.org

form 5500

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
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 2021-06-07
Name of individual signing STUART ROSENBERG
Valid signature Filed with authorized/valid electronic signature
JOHNSON MEMORIAL HOSPITAL 403(B) PLAN 2019 060646696 2020-04-18 JOHNSON MEMORIAL HOSPITAL 87
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
JOHNSON MEMORIAL HOSPITAL 403(B) PLAN 2018 060646696 2019-04-28 JOHNSON MEMORIAL HOSPITAL 99
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
JOHNSON MEMORIAL HOSPITAL 403(B) PLAN 2010 060646696 2011-05-20 JOHNSON MEMORIAL HOSPITAL 0
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

Agent

Name Role
C T CORPORATION SYSTEM Agent

Officer

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

Director

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

License

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

History

Type Old value New value Date of change
Name change JMH ACQUISITION CORP. JOHNSON MEMORIAL HOSPITAL, INC. 2016-01-04

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012413482 2024-11-18 No data Annual Report Annual Report No data
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

Related by officers

Arosha Jayawickrema

SAINT MARY'S HOSPITAL, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.

ROBERT J. ANTHONY ESQ.

SAINT MARY'S HOSPITAL, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC. ITIS, INC. NORTH STONINGTON HEALTH CENTER, INC. BROWN RUDNICK ESOLUTIONS, LLC DATANATION, LLC P&D REALTY, LLC DONALD ROSENTHAL MD, LLC PRIMARY CARE PARTNERS, P.C.

NANCY KROEBER

IMMEDIATE MEDICAL CARE CENTER, INC.

KARL J. KRAPEK

SAINT MARY'S HOSPITAL, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC. KRAPEK FAMILY, LLC WINDY CITY, LLC 86 BRONSON RD., LLC

David Montez Carter, FACHE

SAINT MARY'S HOSPITAL, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.

SHERI A. LEMIEUX

SAINT MARY'S HOSPITAL, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.

WALTER HARRISON PH.D.

SAINT MARY'S HOSPITAL, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.

Juan Miguel Betancourt

SAINT MARY'S HOSPITAL, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.

EMILY BROWER

SAINT MARY'S HOSPITAL, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC.

JAMES C. SMITH

SAINT MARY'S HOSPITAL, INC. HAROLD WEBSTER SMITH FOUNDATION, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC. J. A. JONES CONSTRUCTION COMPANY BRISTOL FINANCIAL SERVICES, INC. FIRST HEALTH GROUP CORP.

JOANN H. PRICE

FAIRVIEW CAPITAL PARTNERS, LLC SAINT MARY'S HOSPITAL, INC. FAIRVIEW CAPITAL PARTNERS, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC. FAIRVIEW CAPITAL EM PARTNERS, L.L.C. FAIRVIEW CONSTITUTION MANAGEMENT II LLC FAIRVIEW VENTURE MANAGEMENT III, L.L.C. FAIRVIEW CERES PARTNERS, LLC FAIRVIEW CONSTITUTION MANAGEMENT III, LLC

John Kinney, JD

SAINT MARY'S HOSPITAL, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC.

Sean M. Fitzpatrick

SAINT MARY'S HOSPITAL, INC. MOUNT SINAI REHABILITATION HOSPITAL, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.

Related by address

201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076, United States

JOHNSON MEMORIAL HOSPITAL AUXILIARY, INC.

114 WOODLAND STREET, HARTFORD, CT, United States, 06105

WOODLAND ANESTHESIOLOGY ASSOCIATES, P.C. WOMEN'S AUXILIARY OF SAINT FRANCIS HOSPITAL AND MEDICAL CENTER, INC. TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC. SAINT FRANCIS EMERGENCY MEDICAL GROUP, INC. CONNECTICUT INTERVENTIONAL PAIN CONSULTANTS, P.C. TRINITY HEALTH OF NEW ENGLAND EMERGENCY MEDICAL SERVICES, INC. HOME & COMMUNITY HEALTH SERVICES, INC.

Date of last update: 25 Nov 2024

Sources: Connecticut's Official State Website

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