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  5. Ronald McDonald House of Providence, Inc.

Ronald McDonald House of Providence, Inc.

Company Details

Name: Ronald McDonald House of Providence, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Merged Into An Entity Of Record
Date of Organization in Rhode Island: 22 Jul 1987 (38 years ago)
Date of Dissolution: 15 Mar 2019 (6 years ago)
Date of Status Change: 15 Mar 2019 (6 years ago)
Identification Number: 000007083
ZIP code: 02903
County: Providence County
Principal Address: 50 KENNEDY PLAZA SUITE 1500, PROVIDENCE, RI, 02903, USA
Purpose: TP PROVIDE TEMPORARY HOUSING FOR FAMILIES OF HOSPITALIZED CHILDREN
NAICS: 624190 - Other Individual and Family Services
Historical names: Family House Interest Group, Incorporated

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FORUS 401(K) 2023 222760752 2024-09-15 RONALD MCDONALD HOUSE OF PROVIDENCE INC. 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 461803145
Plan administrator’s name FORUSALL, INC
Plan administrator’s address 809 LAUREL ST., #1328, SAN CARLOS, CA, 94070
Administrator’s telephone number 8444012253

Signature of
Role Plan administrator
Date 2024-09-15
Name of individual signing JUSTIN RAMIREZ
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2022 222760752 2023-07-28 RONALD MCDONALD HOUSE OF PROVIDENCE INC. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 461803145
Plan administrator’s name FORUSALL, INC
Plan administrator’s address 809 LAUREL ST., #1328, SAN CARLOS, CA, 94070
Administrator’s telephone number 8444012253

Signature of
Role Plan administrator
Date 2023-07-28
Name of individual signing ALEXANDER JACOBSEN
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2021 050434218 2022-09-23 RONALD MCDONALD HOUSE OF PROVIDENCE INC. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 461803145
Plan administrator’s name FORUSALL, INC
Plan administrator’s address 809 LAUREL ST., #1328, SAN CARLOS, CA, 94070
Administrator’s telephone number 8444012253

Signature of
Role Plan administrator
Date 2022-09-23
Name of individual signing ALEXANDER JACOBSEN
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2020 050434218 2021-10-10 RONALD MCDONALD HOUSE OF PROVIDENCE INC. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 461803145
Plan administrator’s name FORUSALL, INC.
Plan administrator’s address 809 LAUREL ST., #1328, SAN CARLOS, CA, 94070
Administrator’s telephone number 8444012253

Signature of
Role Plan administrator
Date 2021-10-10
Name of individual signing CINDY BLOCH
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2019 050434218 2020-09-03 RONALD MCDONALD HOUSE OF PROVIDENCE INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 464315488
Plan administrator’s name 3(16) FIDUCIARY SOLUTIONS, INC.
Plan administrator’s address 878 W AIRPORT ROAD, MENASHA, WI, 54952
Administrator’s telephone number 9205605698

Signature of
Role Plan administrator
Date 2020-09-03
Name of individual signing CHRISTOPHER DIERINGER
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2018 050434218 2019-07-19 RONALD MCDONALD HOUSE OF PROVIDENCE INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 464315488
Plan administrator’s name 3(16) FIDUCIARY SOLUTIONS, INC.
Plan administrator’s address 878 W AIRPORT ROAD, MENASHA, WI, 54952
Administrator’s telephone number 9205605698

Signature of
Role Plan administrator
Date 2019-07-19
Name of individual signing CHRISTOPHER DIERINGER
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2017 050434218 2018-07-11 RONALD MCDONALD HOUSE OF PROVIDENCE INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 464315488
Plan administrator’s name 3(16) FIDUCIARY SOLUTIONS, INC.
Plan administrator’s address 878 W AIRPORT ROAD, MENASHA, WI, 54952
Administrator’s telephone number 9205605698

Signature of
Role Plan administrator
Date 2018-07-11
Name of individual signing CHRISTOPHER DIERINGER
Valid signature Filed with authorized/valid electronic signature
RONALD MCDONALD HOUSE OF PROVIDENCE, INC. RETIREMENT PLAN 2016 050434218 2017-09-19 RONALD MCDONALD HOUSE OF PROVIDENCE, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2017-09-19
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-19
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
RONALD MCDONALD HOUSE OF PROVIDENCE, INC. RETIREMENT PLAN 2016 050434218 2017-09-19 RONALD MCDONALD HOUSE OF PROVIDENCE, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2017-09-19
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-19
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
RONALD MCDONALD HOUSE OF PROVIDENCE, INC. RETIREMENT PLAN 2015 050434218 2016-05-03 RONALD MCDONALD HOUSE OF PROVIDENCE, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2016-05-03
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-03
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/06/11/20150611104421P030040477063001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2015-06-11
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-11
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/12/20140612090821P040390233219001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2014-06-12
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-12
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/09/20130709102053P040037662471001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2013-07-09
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-09
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/26/20120626085608P040006132356001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050434218
Plan administrator’s name RONALD MCDONALD HOUSE OF PROVIDENCE, INC.
Plan administrator’s address 45 GAY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012744447

Signature of
Role Plan administrator
Date 2012-06-26
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-26
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/18/20110718134924P030095835857001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050434218
Plan administrator’s name RONALD MCDONALD HOUSE OF PROVIDENCE, INC.
Plan administrator’s address 45 GAY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012744447

Signature of
Role Plan administrator
Date 2011-07-18
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-18
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/08/13/20100813082127P030041132455001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4012744447
Plan sponsor’s address 45 GAY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050434218
Plan administrator’s name RONALD MCDONALD HOUSE OF PROVIDENCE, INC.
Plan administrator’s address 45 GAY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012744447

Signature of
Role Plan administrator
Date 2010-08-13
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-13
Name of individual signing MICHAEL FANTOM
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PAUL A. SILVER, ESQ. Agent HINCKLEY ALLEN & SNYDER LLP 100 WESTMINSTER STREET SUITE 1500, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
JAY MARSHALL PRESIDENT 44 CASTLE ROCKS ROAD WARWICK, RI 02886 USA

DIRECTOR

Name Role Address
PETER S CRISAFI DIRECTOR 54 GLENSIDE DRIVE BLACKSTONE, MA 01504 USA

Events

Type Date Old Value New Value
Merged 2019-03-15 Ronald McDonald House of Providence, Inc. RONALD MCDONALD HOUSE CHARITIES OF EASTERN NEW ENGLAND, INC. (Note: Entity is not registered in Rhode Island)
Name Change 1996-05-16 Family House Interest Group, Incorporated Ronald McDonald House of Providence, Inc.

Filings

Number Name File Date
201988706290 Merge out of Existence 2019-03-15
201873714050 Annual Report 2018-08-01
201746798750 Annual Report 2017-06-28
201601326140 Annual Report 2016-07-06
201563815050 Statement of Change of Registered/Resident Agent Office 2015-06-25
201563647200 Annual Report 2015-06-22
201440635450 Annual Report 2014-06-05
201324057390 Annual Report 2013-06-18
201294496810 Annual Report 2012-07-02
201180888910 Annual Report 2011-07-01

Related by officers

PAUL A. SILVER, ESQ.

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Related by address

50 KENNEDY PLAZA SUITE 1500, PROVIDENCE, RI, 02903, USA

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Date of last update: 05 Oct 2024

Sources: Rhode Island Department of State

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