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  5. GRIFFIN FACULTY PHYSICIANS, INC.

GRIFFIN FACULTY PHYSICIANS, INC.

Company Details

Entity Name: GRIFFIN FACULTY PHYSICIANS, INC.
Jurisdiction: Connecticut
Legal type: Non-Stock
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 05 Sep 1996
Business ALEI: 0543658
Annual report due: 05 Sep 2025
NAICS code: 621111 - Offices of Physicians (except Mental Health Specialists)
Business address: 130 DIVISON STREET, DERBY, CT, 06418, United States
Mailing address: 130 DIVISON STREET, DERBY, CT, United States, 06418
ZIP code: 06418
County: New Haven
Place of Formation: CONNECTICUT
E-Mail: admininfo@griffinhealth.org

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GRIFFIN FACULTY PRACTICE PLAN, INC. 401(K) RETIREMENT PLAN 2021 061463147 2022-10-12 GRIFFIN FACULTY PRACTICE PLAN, INC. 118
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION STREET, DERBY, CT, 064181326

Signature of
Role Plan administrator
Date 2022-10-12
Name of individual signing STEPHEN MORDECAI
Valid signature Filed with authorized/valid electronic signature
GRIFFIN FACULTY PRACTICE PLAN, INC. 401(K) RETIREMENT PLAN 2020 061463147 2021-10-13 GRIFFIN FACULTY PRACTICE PLAN, INC. 104
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION STREET, DERBY, CT, 064181326

Signature of
Role Plan administrator
Date 2021-10-13
Name of individual signing STEPHEN MORDECAI
Valid signature Filed with authorized/valid electronic signature
GRIFFIN FACULTY PRACTICE PLAN, INC. 401(K) RETIREMENT PLAN 2019 061463147 2020-09-30 GRIFFIN FACULTY PRACTICE PLAN, INC. 98
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION STREET, DERBY, CT, 064181326

Signature of
Role Plan administrator
Date 2020-09-30
Name of individual signing STEPHEN MORDECAI
Valid signature Filed with authorized/valid electronic signature
GRIFFIN FACULTY PRACTICE PLAN, INC. 401(K) RETIREMENT PLAN 2018 061463147 2019-10-01 GRIFFIN FACULTY PRACTICE PLAN, INC. 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION STREET, DERBY, CT, 064181326
GRIFFIN FACULTY PRACTICE PLAN, INC. 401(K) RETIREMENT PLAN 2017 061463147 2018-10-01 GRIFFIN FACULTY PRACTICE PLAN, INC. 75
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION STREET, DERBY, CT, 064181326
GRIFFIN FACULTY PRACTICE PLAN, INC. 401K RETIREMENT PLAN 2016 061463147 2017-06-19 GRIFFIN FACULTY PRACTICE PLAN, INC. 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION ST, DERBY, CT, 064181326
GRIFFIN FACULTY PRACTICE PLAN, INC. 401K RETIREMENT PLAN 2015 061463147 2016-07-14 GRIFFIN FACULTY PRACTICE PLAN, INC. 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION ST, DERBY, CT, 064181326
GRIFFIN FACULTY PRACTICE PLAN, INC. 401K RETIREMENT PLAN 2014 061463147 2015-07-06 GRIFFIN FACULTY PRACTICE PLAN, INC. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION ST, DERBY, CT, 064181326

Plan administrator’s name and address
Administrator’s EIN 061463147
Plan administrator’s name GRIFFIN FACULTY PRACTICE PLAN, INC.
Plan administrator’s address 130 DIVISION ST, DERBY, CT, 064181326
Administrator’s telephone number 2037327240

Signature of
Role Plan administrator
Date 2015-07-06
Name of individual signing PATRICK CHARMEL
Valid signature Filed with authorized/valid electronic signature
GRIFFIN FACULTY PRACTICE PLAN, INC. 401K RETIREMENT PLAN 2013 061463147 2014-07-10 GRIFFIN FACULTY PRACTICE PLAN, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION ST, DERBY, CT, 064181326

Plan administrator’s name and address
Administrator’s EIN 061463147
Plan administrator’s name GRIFFIN FACULTY PRACTICE PLAN, INC.
Plan administrator’s address 130 DIVISION ST, DERBY, CT, 064181326
Administrator’s telephone number 2037327240

Signature of
Role Plan administrator
Date 2014-07-10
Name of individual signing PATRICK CHARMEL
Valid signature Filed with authorized/valid electronic signature
GRIFFIN FACULTY PRACTICE PLAN, INC. 401K RETIREMENT PLAN 2012 061463147 2013-07-17 GRIFFIN FACULTY PRACTICE PLAN, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-07-01
Business code 622000
Sponsor’s telephone number 2037327240
Plan sponsor’s address 130 DIVISION ST, DERBY, CT, 064181326

Plan administrator’s name and address
Administrator’s EIN 061463147
Plan administrator’s name GRIFFIN FACULTY PRACTICE PLAN, INC.
Plan administrator’s address 130 DIVISION ST, DERBY, CT, 064181326
Administrator’s telephone number 2037327240

Signature of
Role Plan administrator
Date 2013-07-17
Name of individual signing PATRICK CHARMEL
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Business address Phone E-Mail Residence address
Patrick Charmel Agent 130 Division St, Derby, CT, 06418-1326, United States +1 203-732-7500 admininfo@griffinhealth.org 100 West Meadow Road, Hamden, CT, 06518, United States

Officer

Name Role Business address Residence address
PATRICK CHARMEL Officer 130 DIVISON STREET, DERBY, CT, 06418, United States 100 WEST MEADOW STREET, HAMDEN, CT, 06518, United States
Alexander Balko Officer 130 Division St, Derby, CT, 06418-1326, United States 6 Snowberry Ln, Shelton, CT, 06484-3700, United States
Frederick Browne Officer 130 Division St, Derby, CT, 06418-1326, United States 35 Fiddlehead Rd, Oxford, CT, 06478-2708, United States
Denise Barajas Officer 130 Division St, Derby, CT, 06418-1326, United States 40 Bethmour Rd, Bethany, CT, 06524-3336, United States

History

Type Old value New value Date of change
Name change GRIFFIN FACULTY PRACTICE PLAN, INC. GRIFFIN FACULTY PHYSICIANS, INC. 2018-01-10

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012179328 2024-09-04 No data Annual Report Annual Report No data
BF-0011258442 2023-09-05 No data Annual Report Annual Report No data
BF-0011020652 2022-09-28 2022-09-28 Change of Email Address Business Email Address Change No data
BF-0010414432 2022-09-28 No data Annual Report Annual Report 2022
BF-0008290954 2021-09-21 No data Annual Report Annual Report 2020
BF-0009889671 2021-09-21 No data Annual Report Annual Report No data
0006689402 2019-12-03 No data Annual Report Annual Report 2019
0006689398 2019-12-03 No data Annual Report Annual Report 2018
0006689395 2019-12-03 No data Annual Report Annual Report 2017
0006001490 2018-01-10 2018-01-10 Amendment Amend Name No data

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CONNECTICUT HOSPITAL ASSOCIATION, INCORPORATED, THE GRIFFIN HEALTHCARE, INC. CONNECTICUT HEALTH FOUNDATION, INC. PLANETREE INTERNATIONAL, INC. VALUE CARE ALLIANCE, LLC GRIFFIN PHO, INC. SUBURBAN HEALTH PLAN, INC. HOSPITAL LABORATORY ALLIANCE OF CONNECTICUT LLC

Related by address

No related companies by address

Date of last update: 06 Jan 2025

Sources: Connecticut's Official State Website

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