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TIC, LLC

Company Details

Entity Name: TIC, LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Active
Date Formed: 28 Mar 2016 (Companies founded in March 2016)
Business ALEI: 1201623
Annual report due: 31 Mar 2025
NAICS code: 621512 - Diagnostic Imaging Centers
Business address: 6 Fieldstone Cmns, Tolland, CT, 06084-3419, United States
Mailing address: 6 Fieldstone Cmns, Suite E, Tolland, CT, United States, 06084-3419
ZIP code: 06084 (Companies in Tolland, 06084)
County: Tolland
Place of Formation: CONNECTICUT
E-Mail: jmenzel@echn.org

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TIC, LLC. TRADITIONAL 401K PLAN 2023 812022269 2024-06-04 TIC, LLC. 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621498
Sponsor’s telephone number 8608964847
Plan sponsor’s address 6 FIELDSTONE COMMONS, SUITE E, TOLLAND, CT, 06084

Signature of

Role Plan administrator
Date 2024-06-04
Name of individual signing LAURIE KINGSBURY
Valid signature Filed with authorized/valid electronic signature
TIC, LLC. TRADITIONAL 401K PLAN 2022 812022269 2023-06-02 TIC, LLC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621498
Sponsor’s telephone number 8608964847
Plan sponsor’s address 6 FIELDSTONE COMMONS, SUITE E, TOLLAND, CT, 06084

Signature of

Role Plan administrator
Date 2023-06-02
Name of individual signing LAURIE KINGSBURY
Valid signature Filed with authorized/valid electronic signature
TIC, LLC. TRADITIONAL 401K PLAN 2021 812022269 2022-05-20 TIC, LLC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621498
Sponsor’s telephone number 8608964847
Plan sponsor’s address 6 FIELDSTONE COMMONS, SUITE E, TOLLAND, CT, 06084

Signature of

Role Plan administrator
Date 2022-05-20
Name of individual signing LAURIE KINGSBURY
Valid signature Filed with authorized/valid electronic signature
TIC, LLC. TRADITIONAL 401K PLAN 2020 812022269 2021-07-01 TIC, LLC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621498
Sponsor’s telephone number 8608964847
Plan sponsor’s address 6 FIELDSTONE COMMONS, SUITE E, TOLLAND, CT, 06084

Signature of

Role Plan administrator
Date 2021-07-01
Name of individual signing LAURIE KINGSBURY
Valid signature Filed with authorized/valid electronic signature
TIC, LLC. TRADITIONAL 401K PLAN 2019 812022269 2020-07-20 TIC, LLC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621498
Sponsor’s telephone number 8608964847
Plan sponsor’s address 6 FIELDSTONE COMMONS, SUITE E, TOLLAND, CT, 06084

Signature of

Role Plan administrator
Date 2020-07-20
Name of individual signing LAURIE KINGSBURY
Valid signature Filed with authorized/valid electronic signature
TIC, LLC. TRADITIONAL 401K PLAN 2018 812022269 2019-07-23 TIC, LLC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621498
Sponsor’s telephone number 8608964847
Plan sponsor’s address 6 FIELDSTONE COMMONS, SUITE E, TOLLAND, CT, 06084

Signature of

Role Plan administrator
Date 2019-07-23
Name of individual signing LAURIE KINGSBURY
Valid signature Filed with authorized/valid electronic signature
TIC, LLC. TRADITIONAL 401K PLAN 2017 812022269 2018-06-14 TIC, LLC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621498
Sponsor’s telephone number 8608964847
Plan sponsor’s address 6 FIELDSTONE COMMONS, SUITE E, TOLLAND, CT, 06084

Signature of

Role Plan administrator
Date 2018-06-14
Name of individual signing LAURIE KINGSBURY
Valid signature Filed with authorized/valid electronic signature
TIC, LLC. TRADITIONAL 401K PLAN 2016 812022269 2017-07-16 TIC, LLC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621498
Sponsor’s telephone number 8608964847
Plan sponsor’s address 6 FIELDSTONE COMMONS, SUITE E, TOLLAND, CT, 06084

Signature of

Role Plan administrator
Date 2017-07-16
Name of individual signing LAURIE KINGSBURY
Valid signature Filed with authorized/valid electronic signature

Officer

Name Role Business address Residence address
Jillian Menzel Officer No data 464 Dunn Rd, Coventry, CT, 06238-1198, United States
PROSPECT ROCKVILLE HOSPITAL Officer 31 Union Street, Vernon, CT, 06066, United States 31 Union Street, Vernon, CT, 06066, United States
PROSPECT MANCHESTER HOSPITAL, INC. Officer 71 HAYNES STREET, MANCHESTER, CT, 06040, United States No data
JOHNSON MEMORIAL HOSPITAL Officer 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076, United States 201 CHESTNUT HILL ROAD, STAFFORD SPRINGS, CT, 06076, United States
WINDHAM HOSPITAL Officer 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226, United States 112 MANSFIELD AVENUE, WILLIMANTIC, CT, 06226, United States

Agent

Name Role Mailing address Phone E-Mail Residence address
Agnieszka Dziubinski Agent 750 Wrights Mill Rd, Coventry, CT, 06238-1558, United States +1 860-463-0860 adziubinski@echn.org 750 Wrights Mill Rd, Coventry, CT, 06238-1558, United States

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012425315 2024-01-25 No data Annual Report Annual Report No data
BF-0011448841 2023-01-27 No data Annual Report Annual Report No data
BF-0010389802 2022-02-07 No data Annual Report Annual Report 2022
0007328017 2021-05-10 No data Annual Report Annual Report 2021
0006941041 2020-07-06 2020-07-06 Change of Agent Agent Change No data
0006941052 2020-07-06 No data Annual Report Annual Report 2020
0006466319 2019-03-14 No data Annual Report Annual Report 2019
0006363126 2019-02-05 No data Annual Report Annual Report 2018
0005781311 2017-03-03 No data Annual Report Annual Report 2017
0005523460 2016-03-28 2016-03-28 Business Formation Certificate of Organization No data

Date of last update: 04 Nov 2024

Sources: Connecticut's Official State Website