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BLUE BACK DENTAL, LLC

Company Details

Entity Name: BLUE BACK DENTAL, LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Active
Sub status: Annual report due
Date Formed: 21 Mar 2011
Business ALEI: 1032262
Annual report due: 31 Mar 2025
NAICS code: 621210 - Offices of Dentists
Business address: 65 MEMORIAL DRIVE SUITE 400, WEST HARTFORD, CT, 06107, United States
Mailing address: 65 MEMORIAL DRIVE - SUITE 400, WEST HARTFORD, CT, United States, 06107
ZIP code: 06107
County: Hartford
Place of Formation: CONNECTICUT
E-Mail: kelsey@bluebackdental.com

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST 2023 451623829 2024-05-21 BLUE BACK DENTAL, LLC 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2024-05-21
Name of individual signing THEODORE WU
Valid signature Filed with authorized/valid electronic signature
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST 2022 451623829 2023-08-23 BLUE BACK DENTAL, LLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2023-08-23
Name of individual signing THEODORE WU
Valid signature Filed with authorized/valid electronic signature
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST 2021 451623829 2022-04-27 BLUE BACK DENTAL, LLC 31
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2022-04-27
Name of individual signing THEODORE WU
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-04-27
Name of individual signing THEODORE WU
Valid signature Filed with authorized/valid electronic signature
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST 2020 451623829 2021-07-27 BLUE BACK DENTAL, LLC 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2021-07-27
Name of individual signing THEODORE WU
Valid signature Filed with authorized/valid electronic signature
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST 2019 451623829 2020-06-30 BLUE BACK DENTAL, LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2020-06-30
Name of individual signing THEODORE WU
Valid signature Filed with authorized/valid electronic signature
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2018 451623829 2019-06-12 BLUE BACK DENTAL, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2019-06-12
Name of individual signing TED WU
Valid signature Filed with authorized/valid electronic signature
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2017 451623829 2018-07-02 BLUE BACK DENTAL, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2018-07-02
Name of individual signing TED WU
Valid signature Filed with authorized/valid electronic signature
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2016 451623829 2017-05-31 BLUE BACK DENTAL, LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2017-05-31
Name of individual signing TED WU
Valid signature Filed with authorized/valid electronic signature
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2015 451623829 2016-07-01 BLUE BACK DENTAL, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2016-07-01
Name of individual signing TED WU
Valid signature Filed with authorized/valid electronic signature
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2014 451623829 2015-05-12 BLUE BACK DENTAL, LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 621210
Sponsor’s telephone number 8602339300
Plan sponsor’s address 65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107

Signature of

Role Plan administrator
Date 2015-05-12
Name of individual signing KIRSTEN ZETTERGREN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-05-12
Name of individual signing KIRSTEN ZETTERGREN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Business address Mailing address Phone E-Mail Residence address
SCOTT B FRANKLIN Agent 68 SOUTH MAIN ST, WEST HARTFORD, CT, 06107, United States 68 SOUTH MAIN ST, WEST HARTFORD, CT, 06107, United States +1 860-798-0901 kelsey@bluebackdental.com BURR STREET, WEST HARTFORD, CT, 06107, United States

Officer

Name Role Business address Residence address
THEODORE WU D.M.D. Officer 65 MEMORIAL DR, STE. 400, WEST HARTFORD, CT, 06107, United States 35 HASTINGS TURN, AVON, CT, 06001, United States
TIMOTHY R. HOLZHAUER DMD Officer 65 MEMORIAL DRIVE, SUITE 400, WEST HARTFORD, CT, 06107, United States 2 KENSINGTON PLACE, FARMINGTON, CT, 06032, United States
ELIZABETH D. HOLZHAUER DMD Officer 65 MEMORIAL DRIVE, SUITE 400, WEST HARTFORD, CT, 06107, United States 2 KENSINGTON PLACE, FARMINGTON, CT, 06032, United States

Filing

Filing number Filing date Effective date Filing category Filing type Report year
BF-0012144056 2024-04-16 No data Annual Report Annual Report No data
BF-0011188596 2023-02-01 No data Annual Report Annual Report No data
BF-0009901844 2022-12-20 No data Annual Report Annual Report No data
BF-0010747422 2022-12-20 No data Annual Report Annual Report No data
BF-0008961712 2022-12-20 No data Annual Report Annual Report 2020
0006383292 2019-02-14 No data Annual Report Annual Report 2019
0006108530 2018-03-06 No data Annual Report Annual Report 2018
0006084888 2018-02-19 No data Annual Report Annual Report 2017
0005784065 2017-03-06 No data Annual Report Annual Report 2015
0005784074 2017-03-06 No data Annual Report Annual Report 2016

Date of last update: 06 Jan 2025

Sources: Connecticut's Official State Website