| Entity Name: | COLLABORATIVE LABORATORY SERVICES, LLC |
| Jurisdiction: | Connecticut |
| Legal type: | LLC |
| Citizenship: | Domestic |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 02 Jul 1998 |
| Business ALEI: | 0596836 |
| Annual report due: | 31 Mar 2025 |
| NAICS code: | 621511 - Medical Laboratories |
| Business address: | 1000 ASYLUM AVENUE, HARTFORD, CT, 06105, United States |
| Mailing address: | 1000 ASYLUM AVENUE, HARTFORD, CT, United States, 06105 |
| ZIP code: | 06105 |
| County: | Hartford |
| Place of Formation: | CONNECTICUT |
| E-Mail: | LEGALDEPARTMENT@TRINITYHEALTHOFNE.ORG |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COLLABORATIVE LABORATORY SERVICE DEFINED CONTRIBUTION PLAN | 2009 | 061520109 | 2010-08-09 | COLLABORATIVE LABORATORY SERVICES, LLC. | 163 | |||||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 061520109 |
| Plan administrator’s name | COLLABORATIVE LABORATORY SERVICES, LLC. |
| Plan administrator’s address | 114 WOODLAND STREET, HARTFORD, CT, 06105 |
| Administrator’s telephone number | 8607144812 |
Number of participants as of the end of the plan year
| Active participants | 181 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 11 |
| Number of participants with account balances as of the end of the plan year | 156 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
Signature of
| Role | Plan administrator |
| Date | 2010-08-09 |
| Name of individual signing | STEVEN ROSENBERG |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| Valerie L. Powell-Stafford, MHSA, FACHE | Officer | 114 Woodland St, Hartford, CT, 06105-1299, United States | 114 Woodland St, Hartford, CT, 06105-1299, United States |
| JAMES HARRIS | Officer | 114 WOODLAND STREET, HARTFORD, CT, 06105, United States | 61 TIMBER TRAIL, TOLLAND, CT, 06084, United States |
| Mike Ryan | Officer | 114 Woodland St, Hartford, CT, 06105, United States | 114 Woodland St, Hartford, CT, 06105, United States |
| Credential | Credential type | Status | Status reason | Issue date | Effective date | Expiration date |
|---|---|---|---|---|---|---|
| CLAB.0000949 | Clinical Laboratory | ACTIVE | CURRENT | 2018-07-23 | 2024-10-01 | 2026-09-30 |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0013274443 | 2024-12-02 | No data | Mass Agent Change � Address | Agent Address Change | No data |
| BF-0012170126 | 2024-06-10 | No data | Annual Report | Annual Report | No data |
| BF-0011146740 | 2023-01-17 | No data | Annual Report | Annual Report | No data |
| BF-0010382263 | 2022-03-09 | No data | Annual Report | Annual Report | 2022 |
| 0007200502 | 2021-03-03 | No data | Annual Report | Annual Report | 2021 |
| 0007000052 | 2020-10-13 | No data | Annual Report | Annual Report | 2020 |
| 0006517872 | 2019-03-21 | 2019-03-21 | Statement of Correction | Statement of Correction | No data |
| 0006333182 | 2019-01-23 | No data | Annual Report | Annual Report | 2019 |
| 0006158717 | 2018-04-10 | 2018-04-10 | Statement of Correction | Statement of Correction | No data |
| 0006158714 | 2018-04-10 | 2018-04-10 | Statement of Correction | Statement of Correction | No data |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 300089778 | 0112000 | 2002-06-14 | 1 ABRAHMS BOULEVARD, WEST HARTFORD, CT, 06117 | |||||||||||||||||||||||||||||||||||
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| Citation ID | 01001 |
| Citaton Type | Serious |
| Standard Cited | 19101030 D02 VIIA |
| Issuance Date | 2002-07-09 |
| Abatement Due Date | 2002-08-02 |
| Current Penalty | 687.5 |
| Initial Penalty | 1375.0 |
| Nr Instances | 4 |
| Nr Exposed | 140 |
| Gravity | 03 |
Date of last update: 10 Mar 2025
Sources: Connecticut's Official State Website
