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  5. CONNECTICUT PAIN CARE, P.C.

CONNECTICUT PAIN CARE, P.C.

Company Details

Entity Name: CONNECTICUT PAIN CARE, P.C.
Jurisdiction: Connecticut
Legal type: Stock
Citizenship: Domestic
Status: Dissolved
Date Formed: 28 Mar 1995
Date of dissolution: 01 Feb 2013
Business ALEI: 0510533
Annual report due: 25 Mar 2009
Business address: 109 NEWTOWN ROAD, DANBURY, CT, 06810
ZIP code: 06810
County: Fairfield
Place of Formation: CONNECTICUT
Total authorized shares: 20000

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CONNECTICUT PAIN CARE, P.C. 401(K) PLAN 2014 061420621 2015-05-28 CONNECTICUT PAIN CARE, P.C. 15
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 2037927246
Plan sponsor’s address 109 NEWTOWN RD, DANBURY, CT, 068104180
CONNECTICUT PAIN CARE, P.C. 401(K) PLAN 2013 061420621 2014-07-11 CONNECTICUT PAIN CARE, P.C. 20
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 2037927246
Plan sponsor’s address 109 NEWTOWN RD, DANBURY, CT, 068104180
CONNECTICUT PAIN CARE, P.C. 401(K) PLAN 2012 061420621 2013-09-11 CONNECTICUT PAIN CARE, P.C. 0
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 2037927246
Plan sponsor’s address 109 NEWTOWN RD, DANBURY, CT, 068104180

Signature of
Role Plan administrator
Date 2013-09-11
Name of individual signing DAVID S. KLOTH, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-11
Name of individual signing DAVID S. KLOTH, M.D.
Valid signature Filed with authorized/valid electronic signature
CONNECTICUT PAIN CARE, P.C. 401(K) PLAN 2011 061420621 2012-10-08 CONNECTICUT PAIN CARE, P.C. 32
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 2037927246
Plan sponsor’s address 109 NEWTOWN RD, DANBURY, CT, 068104180

Plan administrator’s name and address
Administrator’s EIN 061420621
Plan administrator’s name CONNECTICUT PAIN CARE, P.C.
Plan administrator’s address 109 NEWTOWN RD, DANBURY, CT, 068104180
Administrator’s telephone number 2037927246

Signature of
Role Plan administrator
Date 2012-10-08
Name of individual signing DAVID S. KLOTH, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-10-08
Name of individual signing DAVID S. KLOTH, M.D.
Valid signature Filed with authorized/valid electronic signature
CONNECTICUT PAIN CARE, P.C. 401(K) PLAN 2010 061420621 2011-09-08 CONNECTICUT PAIN CARE, P.C. 34
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 2037927246
Plan sponsor’s address 109 NEWTOWN RD, DANBURY, CT, 068104180

Plan administrator’s name and address
Administrator’s EIN 061420621
Plan administrator’s name CONNECTICUT PAIN CARE, P.C.
Plan administrator’s address 109 NEWTOWN RD, DANBURY, CT, 068104180
Administrator’s telephone number 2037927246

Signature of
Role Plan administrator
Date 2011-09-08
Name of individual signing DAVID KLOTH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-08
Name of individual signing DAVID KLOTH
Valid signature Filed with authorized/valid electronic signature
CONNECTICUT PAIN CARE, P.C. 401(K) PLAN 2009 061420621 2010-07-23 CONNECTICUT PAIN CARE, P.C. 31
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 2037927246
Plan sponsor’s address 109 NEWTOWN RD, DANBURY, CT, 068104180

Plan administrator’s name and address
Administrator’s EIN 061420621
Plan administrator’s name CONNECTICUT PAIN CARE, P.C.
Plan administrator’s address 109 NEWTOWN RD, DANBURY, CT, 068104180
Administrator’s telephone number 2037927246

Signature of
Role Plan administrator
Date 2010-07-23
Name of individual signing DAVID KLOTH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-23
Name of individual signing DAVID KLOTH
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Business address Residence address
DAVID M. LEVINE ESQ. Agent COHEN AND WOLF, P.C., 1115 BROAD ST., BRIDGEPORT, CT, 06604, United States 180 STONELEIGH SQUARE, FAIRFIELD, CT, 06432, United States

Officer

Name Role Business address Residence address
ROBERT J. BOOLBOL M.D. Officer 109 NEWTOWN ROAD, DANBURY, CT, 06810, United States 44 HUNTING RIDGE ROAD, GREENWICH, CT, 06831, United States
PARDEEP SOOD MD Officer 109 NEWTOWN ROAD, DANBURY, CT, 06810, United States 15 EVERGREEN DRIVE, WOODBRIDGE, CT, 06525, United States
DAVID KLOTH Officer 109 NEWTOWN ROAD, DANBURY, CT, 06810, United States 4 OLD BARLOW MOUNTAIN RD, RIDGEFIELD, CT, 06877, United States

License

Credential Credential type Status Status reason Issue date Effective date Expiration date
CSP.0024435 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER INACTIVE No data No data 1999-03-01 2000-02-28

Filing

Filing number Filing date Effective date Filing category Filing type Report year
0004805082 2013-02-01 2013-02-01 Dissolution Certificate of Dissolution No data
0004480224 2011-12-06 2011-12-06 Change of Agent Agent Change No data
0003687602 2008-04-14 No data Annual Report Annual Report 2008
0003450576 2007-05-01 No data Annual Report Annual Report 2007
0003425346 2007-03-29 No data Interim Notice Interim Notice No data
0003204220 2006-04-07 No data Annual Report Annual Report 2006
0002968939 2005-08-01 2005-08-01 Change of Agent Agent Change No data
0002967638 2005-04-19 No data Annual Report Annual Report 2005
0002857797 2005-01-06 No data Interim Notice Interim Notice No data
0002722055 2004-04-27 No data Interim Notice Interim Notice No data

Related by officers

DAVID M. LEVINE ESQ.

BRIDGEPORT ORTHOPEDIC GROUP, P.C. ORAL & MAXILLOFACIAL SURGEONS OF MILFORD & DERBY, P.C. WILTON MEDICAL ASSOCIATES, P.C. ASSOCIATED NEUROLOGISTS OF SOUTHERN CONNECTICUT, P.C. CHILDREN'S DENTAL ASSOCIATES OF NEW LONDON COUNTY, P.C. NEUROLOGICAL SPECIALISTS, P.C. FAIRFIELD COUNTY HEALTHCARE ASSOCIATES, P.C. OB-GYN PHYSICIANS, P.C. HUNTINGTON VILLAGE ASSOCIATES, LLC UROLOGICAL ASSOCIATES OF BRIDGEPORT, P.C.

Related by address

109 NEWTOWN ROAD, DANBURY, CT, 06810

DAVID KLOTH, M.D., P.C. DANBURY PHYSICAL MEDICINE AND REHABILITATION, P.C.

Date of last update: 06 Jan 2025

Sources: Connecticut's Official State Website

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