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  5. AMBULANCE SERVICE OF MANCHESTER, LLC

AMBULANCE SERVICE OF MANCHESTER, LLC

Company Details

Entity Name: AMBULANCE SERVICE OF MANCHESTER, LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 27 Jul 1999
Business ALEI: 0626535
Annual report due: 31 Mar 2026
NAICS code: 621910 - Ambulance Services
Business address: 275 NEW STATE RD, MANCHESTER, CT, 06042, United States
Mailing address: P O BOX 300, MANCHESTER, CT, United States, 06045
ZIP code: 06042
County: Hartford
Place of Formation: CONNECTICUT
E-Mail: karoh@asm-aetna.com

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
M1Z1G5QBZL77 2023-01-05 275 NEW STATE RD, MANCHESTER, CT, 06040, 1810, USA PO BOX 300, MANCHESTER, CT, 06045, USA

Business Information
Doing Business As AMBULANCE SERVICE OF MANCHESTER
Division Name ASM/AETNA
Congressional District 01
State/Country of Incorporation CT, USA
Activation Date 2021-12-08
Initial Registration Date 2021-12-06
Entity Start Date 2000-07-21
Fiscal Year End Close Date Apr 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name HEATHER ZIMMERMAN
Address PO BOX 300, MANCHESTER, CT, 06045, USA
Government Business
Title PRIMARY POC
Name HEATHER ZIMMERMAN
Address PO BOX 300, MANCHESTER, CT, 06045, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AMBULANCE SERVICE OF MANCHESTER DENTAL PLAN 2011 061557358 2013-03-29 AMBULANCE SERVICE OF MANCHESTER LLC 198
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1989-09-01
Business code 621900
Sponsor’s telephone number 8606479798
Plan sponsor’s mailing address PO BOX 300, MANCHESTER, CT, 06045
Plan sponsor’s address PO BOX 300, MANCHESTER, CT, 06045

Plan administrator’s name and address
Administrator’s EIN 061557358
Plan administrator’s name AMBULANCE SERVICE OF MANCHESTER LLC
Plan administrator’s address PO BOX 300, MANCHESTER, CT, 06045

Number of participants as of the end of the plan year
Active participants 230

Signature of
Role Plan administrator
Date 2013-03-01
Name of individual signing WAYNE WRIGHT
Valid signature Filed with authorized/valid electronic signature
AMBULANCE SERVICE OF MANCHESTER MEDICAL PLAN 2011 061557358 2013-03-29 AMBULANCE SERVICE OF MANCHESTER LLC 156
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1989-09-01
Business code 621900
Sponsor’s telephone number 0008606479
Plan sponsor’s mailing address PO BOX 300, MANCHESTER, CT, 06045
Plan sponsor’s address PO BOX 300, MANCHESTER, CT, 06045

Plan administrator’s name and address
Administrator’s EIN 061557358
Plan administrator’s name AMBULANCE SERVICE OF MANCHESTER LLC
Plan administrator’s address PO BOX 300, MANCHESTER, CT, 06045
Administrator’s telephone number 0008606479

Number of participants as of the end of the plan year
Active participants 139

Signature of
Role Plan administrator
Date 2013-03-01
Name of individual signing WAYNE WRIGHT
Valid signature Filed with authorized/valid electronic signature
AMBULANCE SERVICE OF MANCHESTER MEDICAL PLAN 2011 061557358 2013-03-29 AMBULANCE SERVICE OF MANCHESTER LLC 147
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1989-09-01
Business code 621900
Sponsor’s telephone number 8606479798
Plan sponsor’s mailing address PO BOX 300, MANCHESTER, CT, 06045
Plan sponsor’s address PO BOX 300, MANCHESTER, CT, 06045

Plan administrator’s name and address
Administrator’s EIN 061557358
Plan administrator’s name AMBULANCE SERVICE OF MANCHESTER LLC
Plan administrator’s address PO BOX 300, MANCHESTER, CT, 06045

Number of participants as of the end of the plan year
Active participants 156

Signature of
Role Plan administrator
Date 2013-03-01
Name of individual signing WAYNE WRIGHT
Valid signature Filed with authorized/valid electronic signature
AMBULANCE SERVICE OF MANCHESTER MEDICAL PLAN 2011 061557358 2013-03-29 AMBULANCE SERVICE OF MANCHESTER LLC 167
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1989-09-01
Business code 621900
Sponsor’s telephone number 8606479798
Plan sponsor’s mailing address PO BOX 300, MANCHESTER, CT, 06045
Plan sponsor’s address PO BOX 300, MANCHESTER, CT, 06045

Plan administrator’s name and address
Administrator’s EIN 061557358
Plan administrator’s name AMBULANCE SERVICE OF MANCHESTER LLC
Plan administrator’s address PO BOX 300, MANCHESTER, CT, 06045

Number of participants as of the end of the plan year
Active participants 172

Signature of
Role Plan administrator
Date 2013-03-01
Name of individual signing WAYNE WRIGHT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
CORPORATION SERVICE COMPANY Agent

Officer

Name Role Business address Residence address
HARTFORD HEALTHCARE CORPORATION Officer 100 Pearl St., 2nd Floor, CLO, HARTFORD, CT, 06103, United States No data
PROSPECT ECHN, INC. Officer 3415 S. SEPULVEDA BLVD, 9TH FLOOR, LOS ANGELES, CA, 90034, United States No data
Kimberly Aroh Officer 275 New State Rd, Manchester, CT, 06042-1810, United States 34 Crosby Rd, Glastonbury, CT, 06033-3431, United States

License

Credential Credential type Status Status reason Issue date Effective date Expiration date
L.0L077P2 Licensed EMS Organization ACTIVE CURRENT 2017-01-03 2024-01-01 2024-12-31

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012936644 2025-02-27 No data Annual Report Annual Report No data
BF-0012352752 2024-03-07 No data Annual Report Annual Report No data
BF-0011152191 2023-03-01 No data Annual Report Annual Report No data
BF-0010237345 2022-03-31 No data Annual Report Annual Report 2022
BF-0010460111 2022-01-14 2022-01-14 Mass Agent Change � Address Agent Address Change No data
0007266335 2021-03-29 No data Annual Report Annual Report 2021
0006950703 2020-07-06 2020-07-06 Change of Agent Address Agent Address Change No data
0006943532 2020-07-06 2020-07-06 Change of Agent Address Agent Address Change No data
0006931132 2020-06-24 No data Annual Report Annual Report 2020
0006853269 2020-03-27 2020-03-27 Change of Agent Agent Change No data

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
123333924 0112000 1999-10-27 275 NEW STATE ROAD, MANCHESTER, CT, 06040
Inspection Type Complaint
Scope Partial
Safety/Health Health
Close Conference 1999-10-27
Emphasis N: BLOOD
Case Closed 2000-02-08

Related Activity
Type Complaint
Activity Nr 200083475
Health Yes

Violation Items
Citation ID 01001A
Citaton Type Serious
Standard Cited 19101030 G02 IIC
Issuance Date 1999-12-13
Abatement Due Date 2000-01-30
Current Penalty 487.5
Initial Penalty 975.0
Nr Instances 38
Nr Exposed 38
Gravity 01
Citation ID 01001B
Citaton Type Serious
Standard Cited 19101030 D03 IV
Issuance Date 1999-12-13
Abatement Due Date 1999-12-31
Nr Instances 38
Nr Exposed 38
Gravity 01
Citation ID 01002
Citaton Type Serious
Standard Cited 19101200 E01
Issuance Date 1999-12-13
Abatement Due Date 1999-12-21
Current Penalty 487.5
Initial Penalty 975.0
Nr Instances 1
Nr Exposed 38
Gravity 01

Related by officers

HARTFORD HEALTHCARE CORPORATION

HARTFORD HEALTHCARE LABORATORIES, LLC LITCHFIELD HILLS SURGERY CENTER, LLC HARTFORD HEALTHCARE INSTITUTES, LLC HARTFORD HEALTHCARE ENDOWMENT, LLC INTEGRATED CARE PARTNERS, LLC NEW ENGLAND HEALTH ALLIANCE, LLC HHC SURGERY CENTER HOLDINGS, LLC HHC IMAGING CENTER HOLDINGS, LLC HHC EMS HOLDINGS, LLC ASM REALTY EAST HARTFORD, LLC

Related by address

275 NEW STATE RD, MANCHESTER, CT, 06042, United States

ASSOCIATION OF CONNECTICUT AMBULANCE PROVIDERS, INC.

P O BOX 300, MANCHESTER, CT, United States, 06045

AETNA AMBULANCE SERVICE REALTY, LLC

Date of last update: 10 Mar 2025

Sources: Connecticut's Official State Website

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