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  5. ANNETTE L. HEADLEY, M.D., LLC

ANNETTE L. HEADLEY, M.D., LLC

Company Details

Entity Name: ANNETTE L. HEADLEY, M.D., LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 15 Sep 2000
Business ALEI: 0661309
Annual report due: 31 Mar 2025
NAICS code: 621111 - Offices of Physicians (except Mental Health Specialists)
Business address: 56 WHITEHALL AVENUE WHITEHALL AVENUE, MYSTIC, CT, 06355, United States
Mailing address: 56 WHITEHALL AVE., MYSTIC, CT, United States, 06355
ZIP code: 06355
County: New London
Place of Formation: CONNECTICUT
E-Mail: rheadley5@comcast.net

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ANNETTE L. HEADLEY, M.D. PROFIT SHARING PLAN 2023 061484616 2024-03-28 ANNETTE L. HEADLEY, M.D. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2024-03-28
Name of individual signing ANNETTE HEADLEY
Valid signature Filed with authorized/valid electronic signature
ANNETTE L. HEADLEY, M.D. CASH BALANCE PLAN 2023 061484616 2024-07-13 ANNETTE L. HEADLEY, M.D. 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2024-07-13
Name of individual signing ANNETTE HEADLEY
Valid signature Filed with authorized/valid electronic signature
ANNETTE L. HEADLEY, M.D. PROFIT SHARING PLAN 2022 061484616 2023-06-05 ANNETTE L. HEADLEY, M.D 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2023-06-05
Name of individual signing ANNETTE HEADLEY
Valid signature Filed with authorized/valid electronic signature
ANNETTE L. HEADLEY, M.D. CASH BALANCE PLAN 2022 061484616 2023-07-15 ANNETTE L. HEADLEY, M.D 4
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2023-07-15
Name of individual signing ANNETTE HEADLEY
Valid signature Filed with authorized/valid electronic signature
ANNETTE L. HEADLEY, M.D. PROFIT SHARING PLAN 2021 061484616 2022-06-11 ANNETTE L. HEADLEY, M.D 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2022-06-11
Name of individual signing ANNETTE L. HEADLEY, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-11
Name of individual signing ANNETTE HEADLEY
Valid signature Filed with authorized/valid electronic signature
ANNETTE L. HEADLEY, M.D. CASH BALANCE PLAN 2021 061484616 2022-07-05 ANNETTE L. HEADLEY, M.D 5
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2022-07-05
Name of individual signing ANNETTE L. HEADLEY, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-05
Name of individual signing ANNETTE HEADLEY
Valid signature Filed with authorized/valid electronic signature
ANNETTE L. HEADLEY, M.D. PROFIT SHARING PLAN 2020 061484616 2021-05-11 ANNETTE L. HEADLEY, M.D 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2021-05-11
Name of individual signing ANNETTE L. HEADLEY, M.D.
Valid signature Filed with authorized/valid electronic signature
ANNETTE L. HEADLEY, M.D. CASH BALANCE PLAN 2020 061484616 2021-05-11 ANNETTE L. HEADLEY, M.D 6
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2021-05-11
Name of individual signing ANNETTE L. HEADLEY, M.D.
Valid signature Filed with authorized/valid electronic signature
ANNETTE L. HEADLEY, M.D. CASH BALANCE PLAN 2019 061484616 2020-06-02 ANNETTE L. HEADLEY, M.D 6
File View Page
Three-digit plan number (PN) 003
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2020-06-02
Name of individual signing ANNETTE L. HEADLEY, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-02
Name of individual signing ANNETTE L. HEADLEY, M.D.
Valid signature Filed with authorized/valid electronic signature
ANNETTE L. HEADLEY, M.D. PROFIT SHARING PLAN 2019 061484616 2020-06-02 ANNETTE L. HEADLEY, M.D 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 8605361354
Plan sponsor’s address 56 WHITEHALL AVENUE, MYSTIC, CT, 06355

Signature of
Role Plan administrator
Date 2020-06-02
Name of individual signing ANNETTE L. HEADLEY, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-02
Name of individual signing ANNETTE L. HEADLEY, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
PALMER LATKO LEDAS PAGE LLC Agent

Officer

Name Role Business address Residence address
ANNETTE L. HEADLEY M.D. Officer 56 WHITEHALL AVE, MYSTIC, CT, 06355, United States 61 TIMBER RIDGE DR., PAWCATUCK, CT, 06379, United States

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012148734 2024-01-16 No data Annual Report Annual Report No data
BF-0011397877 2023-02-08 No data Annual Report Annual Report No data
BF-0010308146 2022-03-10 No data Annual Report Annual Report 2022
0007104013 2021-02-02 No data Annual Report Annual Report 2021
0006773432 2020-02-22 No data Annual Report Annual Report 2020
0006377661 2019-02-11 No data Annual Report Annual Report 2019
0006009404 2018-01-16 No data Annual Report Annual Report 2018
0005968982 2017-11-20 No data Annual Report Annual Report 2016
0005968978 2017-11-20 No data Annual Report Annual Report 2014
0005968984 2017-11-20 No data Annual Report Annual Report 2017

Related by officers

No related officers

Related by address

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Date of last update: 13 Jan 2025

Sources: Connecticut's Official State Website

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