| Entity Name: | HARBOR HEALTH SERVICES, INC. |
| Jurisdiction: | Connecticut |
| Legal type: | Non-Stock |
| Citizenship: | Foreign |
| Status: | Withdrawn |
| Date Formed: | 25 Jan 2021 |
| Business ALEI: | 1376014 |
| Annual report due: | 25 Jan 2023 |
| NAICS code: | 621498 - All Other Outpatient Care Centers |
| Business address: | 44 BUCKINGHAM STREET, PAWCATUCK, CT, 06379 |
| Mailing address: | 1135 Morton St, Mattapan, MA, United States, 02126-2834 |
| ZIP code: | 06379 |
| County: | New London |
| Place of Formation: | MASSACHUSETTS |
| E-Mail: | MLAPOINTE@HHSI.US |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HARBOR HEALTH SERVICES, INC. 401(K) PLAN | 2010 | 061030073 | 2012-01-25 | HARBOR HEALTH SERVICES, INC. | 120 | |||||||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 061030073 |
| Plan administrator’s name | HARBOR HEALTH SERVICES, INC. |
| Plan administrator’s address | 14 SYCAMORE WAY, BRANFORD, CT, 064056551 |
| Administrator’s telephone number | 2034832630 |
Number of participants as of the end of the plan year
| Active participants | 90 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 26 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 3 |
| Number of participants with account balances as of the end of the plan year | 85 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 3 |
Signature of
| Role | Plan administrator |
| Date | 2012-01-25 |
| Name of individual signing | ROBERTA COOK |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 1993-07-01 |
| Business code | 621498 |
| Sponsor’s telephone number | 2034832630 |
| Plan sponsor’s mailing address | 14 SYCAMORE WAY, BRANFORD, CT, 064056551 |
| Plan sponsor’s address | 14 SYCAMORE WAY, BRANFORD, CT, 064056551 |
Plan administrator’s name and address
| Administrator’s EIN | 061030073 |
| Plan administrator’s name | HARBOR HEALTH SERVICES, INC. |
| Plan administrator’s address | 14 SYCAMORE WAY, BRANFORD, CT, 064056551 |
| Administrator’s telephone number | 2034832630 |
Number of participants as of the end of the plan year
| Active participants | 88 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 31 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 1 |
| Number of participants with account balances as of the end of the plan year | 89 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 1 |
Signature of
| Role | Plan administrator |
| Date | 2011-01-03 |
| Name of individual signing | ROBERTA COOK |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Business address |
|---|---|---|
| Secretary of State | Agent | 165 Capitol Ave., P.O. BOX 150470, Hartford, CT, 06115-0470, United States |
| Name | Role | Residence address |
|---|---|---|
| Jan Mattimoe | Officer | 240 Pearl Street, 415, Somerville, MA, 02145, United States |
| MARY LOU O'CONNOR | Officer | 60 BOUTWELL STREET, DORCHESTER, MA, 02122, United States |
| KATHRYN AUDETTE | Officer | 12 MOULTRIE STREET, #1, DORCHESTER, MA, 02124, United States |
| Credential | Credential type | Status | Status reason | Issue date | Effective date | Expiration date |
|---|---|---|---|---|---|---|
| SA.0000319 | Substance Abuse | CLOSED | CLOSED | 2009-10-01 | 2009-10-01 | 2011-09-30 |
| MHCR.0CR0011 | Mental Health Community Residence | CLOSED | CLOSED | 2009-10-01 | 2009-10-01 | 2011-09-30 |
| POCA.00C0193 | Psychiatric Outpatient Clinic | CLOSED | CLOSED | 2007-10-01 | 2007-10-01 | 2011-09-30 |
| MHDT.HDT0014 | Mental Health Day Treatment | INACTIVE | No data | 2005-10-01 | 2005-10-01 | 2007-09-30 |
| CHR.0011470 | PUBLIC CHARITY | INACTIVE | No data | 2003-04-21 | 2011-12-01 | 2012-11-30 |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0011011381 | 2022-09-20 | 2022-09-20 | Withdrawal | Certificate of Withdrawal | No data |
| BF-0010174698 | 2021-12-29 | No data | Annual Report | Annual Report | 2022 |
| 0007094001 | 2021-01-25 | 2021-01-25 | Business Registration | Certificate of Authority | No data |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
