| Name: | OBSIDIAN INSURANCE HOLDINGS, INC. |
| Jurisdiction: | New York |
| Legal type: | FOREIGN BUSINESS CORPORATION |
| Status: | Active |
| Date of registration: | 24 Dec 2019 (5 years ago) |
| Entity Number: | 5676997 |
| ZIP code: | 10005 |
| County: | New York |
| Place of Formation: | Delaware |
| Address: | 28 LIBERTY STREET, NEW YORK, NY, United States, 10005 |
| Principal Address: | 515 Centerpoint Drive, Suite 2207, Middletown, CT, United States, 06457 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OBSIDIAN INSURANCE HOLDINGS, INC. 401(K) PLAN | 2021 | 842685941 | 2022-03-26 | OBSIDIAN INSURANCE HOLDINGS, INC. | 11 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-03-26 |
| Name of individual signing | CRAIG RAPPAPORT |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 524210 |
| Sponsor’s telephone number | 8603253202 |
| Plan sponsor’s address | SUITE 23A, NEW YORK, NY, 10019 |
Signature of
| Role | Plan administrator |
| Date | 2021-03-27 |
| Name of individual signing | CRAIG RAPPAPORT |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | DOS Process Agent | 28 LIBERTY STREET, NEW YORK, NY, United States, 10005 |
| Name | Role | Address |
|---|---|---|
| WILLIAM MANNING JEWETT | Chief Executive Officer | 515 CENTERPOINT DRIVE, SUITE 2207, MIDDLETOWN, CT, United States, 06457 |
| Start date | End date | Type | Value |
|---|---|---|---|
| 2023-12-13 | 2023-12-13 | Address | 515 CENTERPOINT DRIVE, SUITE 2207, MIDDLETOWN, CT, 06457, USA (Type of address: Chief Executive Officer) |
| 2023-12-13 | 2023-12-13 | Address | 1330 AVENUE OF THE AMERICAS, SUITE 23A, NEW YORK, NY, 10019, USA (Type of address: Chief Executive Officer) |
| 2019-12-24 | 2023-12-13 | Address | 28 LIBERTY STREET, NEW YORK, NY, 10005, USA (Type of address: Service of Process) |
| Filing Number | Date Filed | Type | Effective Date |
|---|---|---|---|
| 231213022464 | 2023-12-13 | BIENNIAL STATEMENT | 2023-12-13 |
| 211220002548 | 2021-12-20 | BIENNIAL STATEMENT | 2021-12-20 |
| 191224000346 | 2019-12-24 | APPLICATION OF AUTHORITY | 2019-12-24 |
Date of last update: 12 Jan 2025
Sources: New York Secretary of State
