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  5. NEW CANAAN INTERNAL MEDICINE LLC

NEW CANAAN INTERNAL MEDICINE LLC

Company Details

Entity Name: NEW CANAAN INTERNAL MEDICINE LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Dissolved
Date Formed: 26 Mar 2003
Date of dissolution: 17 Feb 2016
Business ALEI: 0743986
Business address: 173 EAST AVE., NEW CANAAN, CT, 06840
ZIP code: 06840
County: Fairfield
Place of Formation: CONNECTICUT

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NEW CANAAN INTERNAL MEDICINE LLC PROFIT SHARING PLAN 2016 043749818 2017-08-17 NEW CANAAN INTERNAL MEDICINE LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-01
Business code 621111
Sponsor’s telephone number 2039724236
Plan sponsor’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840

Signature of
Role Plan administrator
Date 2017-08-17
Name of individual signing JAMES SLATER, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-08-17
Name of individual signing JAMES SLATER, TRUSTEE
Valid signature Filed with authorized/valid electronic signature
NEW CANAAN INTERNAL MEDICINE LLC PROFIT SHARING PLAN 2015 043749818 2016-09-13 NEW CANAAN INTERNAL MEDICINE LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-01
Business code 621111
Sponsor’s telephone number 2039724236
Plan sponsor’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840

Signature of
Role Plan administrator
Date 2016-09-13
Name of individual signing JAMES SLATER, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-13
Name of individual signing JAMES SLATER, TRUSTEE
Valid signature Filed with authorized/valid electronic signature
NEW CANAAN INTERNAL MEDICINE LLC PROFIT SHARING PLAN 2014 043749818 2015-10-13 NEW CANAAN INTERNAL MEDICINE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-01
Business code 621111
Sponsor’s telephone number 2039724236
Plan sponsor’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing JAMES SLATER, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-10-13
Name of individual signing JAMES SLATER, TRUSTEE
Valid signature Filed with authorized/valid electronic signature
NEW CANAAN INTERNAL MEDICINE LLC PROFIT SHARING PLAN 2013 043749818 2014-05-02 NEW CANAAN INTERNAL MEDICINE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-01
Business code 621111
Sponsor’s telephone number 2039724236
Plan sponsor’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840

Signature of
Role Plan administrator
Date 2014-05-02
Name of individual signing JAMES SLATER, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-05-02
Name of individual signing JAMES SLATER, TRUSTEE
Valid signature Filed with authorized/valid electronic signature
NEW CANAAN INTERNAL MEDICINE LLC PROFIT SHARING PLAN 2012 043749818 2013-08-14 NEW CANAAN INTERNAL MEDICINE LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-01
Business code 621111
Sponsor’s telephone number 2039724236
Plan sponsor’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840

Signature of
Role Plan administrator
Date 2013-08-14
Name of individual signing JAMES SLATER, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-08-14
Name of individual signing JAMES SLATER, TRUSTEE
Valid signature Filed with authorized/valid electronic signature
NEW CANAAN INTERNAL MEDICINE LLC PROFIT SHARING PLAN 2011 043749818 2012-07-05 NEW CANAAN INTERNAL MEDICINE LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-01
Business code 621111
Sponsor’s telephone number 2039724236
Plan sponsor’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840

Plan administrator’s name and address
Administrator’s EIN 043749818
Plan administrator’s name NEW CANAAN INTERNAL MEDICINE LLC
Plan administrator’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840
Administrator’s telephone number 2039724236

Signature of
Role Plan administrator
Date 2012-07-05
Name of individual signing JAMES SLATER, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-07-05
Name of individual signing JAMES SLATER, TRUSTEE
Valid signature Filed with authorized/valid electronic signature
NEW CANAAN INTERNAL MEDICINE LLC PROFIT SHARING PLAN 2010 043749818 2011-10-03 NEW CANAAN INTERNAL MEDICINE LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-01
Business code 621111
Sponsor’s telephone number 2039724236
Plan sponsor’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840

Plan administrator’s name and address
Administrator’s EIN 043749818
Plan administrator’s name NEW CANAAN INTERNAL MEDICINE LLC
Plan administrator’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840
Administrator’s telephone number 2039724236

Signature of
Role Plan administrator
Date 2011-10-03
Name of individual signing JAMES SLATER, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-10-03
Name of individual signing JAMES SLATER, TRUSTEE
Valid signature Filed with authorized/valid electronic signature
NEW CANAAN INTERNAL MEDICINE LLC PROFIT SHARING PLAN 2009 043749818 2010-10-01 NEW CANAAN INTERNAL MEDICINE LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-05-01
Business code 621111
Sponsor’s telephone number 2039724236
Plan sponsor’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840

Plan administrator’s name and address
Administrator’s EIN 043749818
Plan administrator’s name NEW CANAAN INTERNAL MEDICINE LLC
Plan administrator’s address 173 EAST AVENUE, NEW CANAAN, CT, 06840
Administrator’s telephone number 2039724236

Signature of
Role Plan administrator
Date 2010-10-01
Name of individual signing JAMES SLATER, MD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-10-01
Name of individual signing JAMES SLATER, TRUSTEE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
REID AND RIEGE, P.C. Agent

Officer

Name Role Business address Residence address
PETER M. SHUTKIN MD Officer NEW CANAAN INTERNAL MEDICINE LLC, 173 EAST AVE., NEW CANAAN, CT, 06840, United States 86 PARTRIDGE ROAD, STAMFORD, NY, 06903, United States

Filing

Filing number Filing date Effective date Filing category Filing type Report year
0005488526 2016-02-17 2016-02-17 Dissolution Certificate of Dissolution No data
0004624500 2012-05-12 No data Annual Report Annual Report 2012
0004458402 2011-03-30 No data Annual Report Annual Report 2011
0004159610 2010-03-22 No data Annual Report Annual Report 2010
0003910527 2009-03-16 No data Annual Report Annual Report 2009
0003674409 2008-03-31 No data Annual Report Annual Report 2008
0003416241 2007-03-20 No data Annual Report Annual Report 2007
0003258515 2006-06-29 No data Annual Report Annual Report 2005
0003258516 2006-06-29 No data Annual Report Annual Report 2006
0003258514 2006-06-29 No data Annual Report Annual Report 2004

Related by officers

No related officers

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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