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  5. Aquidneck Medical Associates, Inc.

Aquidneck Medical Associates, Inc.

Company Details

Name: Aquidneck Medical Associates, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Dissolved
Date of Organization in Rhode Island: 01 Jul 1969 (56 years ago)
Date of Dissolution: 31 Mar 2015 (10 years ago)
Date of Status Change: 31 Mar 2015 (10 years ago)
Identification Number: 000001221
ZIP code: 02840
County: Newport County
Principal Address: 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840, USA
Purpose: GROUP MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1891831764 2007-01-29 2020-08-22 50 MEMORIAL BLVD, NEWPORT, RI, 02840, US 50 MEMORIAL BLVD, NEWPORT, RI, 02840, US

Contacts
Phone +1 401-847-2290
Fax 4018498446

Authorized person
Name PAMELA MARSHALL
Role CREDENTIALLING
Phone 4018472290

Taxonomy
Taxonomy Code 261QM1300X - Multi-Specialty Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AQUIDNECK MEDICAL ASSOCIATES, INC. SUPPLEMENTAL INCOME PLAN 2013 050340000 2014-10-07 AQUIDNECK MEDICAL ASSOCIATES, INC. 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 621111
Sponsor’s telephone number 4018472290
Plan sponsor’s address 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840

Signature of
Role Plan administrator
Date 2014-10-07
Name of individual signing JEAN SANDERS
Valid signature Filed with authorized/valid electronic signature
AQUIDNECK MEDICAL ASSOCIATES, INC. SUPPLEMENTAL INCOME PLAN 2013 050340000 2014-05-13 AQUIDNECK MEDICAL ASSOCIATES, INC. 62
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 621111
Sponsor’s telephone number 4018472290
Plan sponsor’s address 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840

Signature of
Role Plan administrator
Date 2014-05-13
Name of individual signing JEAN SANDERS
Valid signature Filed with authorized/valid electronic signature
AQUIDNECK MEDICAL ASSOCIATES, INC. SUPPLEMENTAL INCOME PLAN 2012 050340000 2013-05-28 AQUIDNECK MEDICAL ASSOCIATES, INC. 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 621111
Sponsor’s telephone number 4018472290
Plan sponsor’s address 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840

Signature of
Role Plan administrator
Date 2013-05-28
Name of individual signing JEAN SANDERS
Valid signature Filed with authorized/valid electronic signature
AQUIDNECK MEDICAL ASSOCIATES, INC. SUPPLEMENTAL INCOME PLAN 2011 050340000 2012-05-23 AQUIDNECK MEDICAL ASSOCIATES, INC. 53
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 621111
Sponsor’s telephone number 4018472290
Plan sponsor’s address 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840

Plan administrator’s name and address
Administrator’s EIN 050340000
Plan administrator’s name AQUIDNECK MEDICAL ASSOCIATES, INC.
Plan administrator’s address 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840
Administrator’s telephone number 4018472290

Signature of
Role Plan administrator
Date 2012-05-23
Name of individual signing ERNEST A. BALASCO
Valid signature Filed with authorized/valid electronic signature
AQUIDNECK MEDICAL ASSOCIATES, INC. SUPPLEMENTAL INCOME PLAN 2010 050340000 2011-05-19 AQUIDNECK MEDICAL ASSOCIATES, INC. 51
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 621111
Sponsor’s telephone number 4018472290
Plan sponsor’s address 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840

Plan administrator’s name and address
Administrator’s EIN 050340000
Plan administrator’s name AQUIDNECK MEDICAL ASSOCIATES, INC.
Plan administrator’s address 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840
Administrator’s telephone number 4018472290

Signature of
Role Plan administrator
Date 2011-05-19
Name of individual signing DANIEL LABRADOR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-19
Name of individual signing DANIEL LABRADOR
Valid signature Filed with authorized/valid electronic signature
AQUIDNECK MEDICAL ASSOCIATES, INC. SUPPLEMENTAL INCOME PLAN 2009 050340000 2010-08-03 AQUIDNECK MEDICAL ASSOCIATES, INC. 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1984-07-01
Business code 621111
Sponsor’s telephone number 4018472290
Plan sponsor’s address 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840

Plan administrator’s name and address
Administrator’s EIN 050340000
Plan administrator’s name AQUIDNECK MEDICAL ASSOCIATES, INC.
Plan administrator’s address 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840
Administrator’s telephone number 4018472290

Signature of
Role Plan administrator
Date 2010-08-03
Name of individual signing JEAN SANDERS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JEAN SANDERS Agent 50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840, USA

PRESIDENT

Name Role Address
KEIVAN ETTEFAGH MD PRESIDENT 22 HARVEST STREET PORTSMOUTH, RI 02871 USA

TREASURER

Name Role Address
DAVID S GORELICK MD TREASURER 20 BARK AVE JAMESTOWN, RI 02835 USA

SECRETARY

Name Role Address
CHRISTINA DIEROLF MD SECRETARY 333 CARRIAGE DR PORTSMOUTH, RI 02871 USA

VICE PRESIDENT

Name Role Address
DAVID S GORELICK MD VICE PRESIDENT 20 BARK AVE JAMESTOWN, RI 02835 USA
RALPH T EARP MD VICE PRESIDENT 128 BELMONT DR PORTSMOUTH, RI 02871 USA
JAYANTHI PARAMESWARAN MD VICE PRESIDENT 59 DANIEL CHURCH RD TIVERTON, RI 02878 USA
MARTHA A ULLMAN MD VICE PRESIDENT 9 SAKONNET TER MIDDLETOWN, RI 02842 USA
HAROLD A SANDERS VICE PRESIDENT 75 TAYLOR RD PORTSMOUTH, RI 02871 USA
JENNIFER M SALM MD VICE PRESIDENT 138 ELLERY AVE MIDDLETOWN, RI 02842 USA

Filings

Number Name File Date
201558266670 Articles of Dissolution 2015-03-31
201558137880 Annual Report 2015-03-27
201440300790 Annual Report 2014-06-03
201439361650 Revocation Notice For Failure to File An Annual Report 2014-05-20
201315295910 Statement of Change of Registered/Resident Agent 2013-04-17
201315295640 Annual Report - Amended 2013-04-17
201206684870 Annual Report 2012-12-28
201287450650 Annual Report 2012-01-03
201184561260 Statement of Change of Registered/Resident Agent 2011-10-27
201173808620 Annual Report 2011-01-21

Related by officers

JEAN SANDERS

Oakland Farms Condominiums Association II, Inc.

MARTHA A ULLMAN MD

Aquidneck, Inc.

Related by address

50 MEMORIAL BOULEVARD, NEWPORT, RI, 02840, USA

Aquidneck, Inc.

Date of last update: 05 Apr 2025

Sources: Rhode Island Department of State

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