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  5. KENT SURGICAL ASSOCIATES, INC.

KENT SURGICAL ASSOCIATES, INC.

Company Details

Name: KENT SURGICAL ASSOCIATES, INC.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Dissolved
Date of Organization in Rhode Island: 23 Jul 1970 (55 years ago)
Date of Dissolution: 06 Feb 2017 (8 years ago)
Date of Status Change: 06 Feb 2017 (8 years ago)
Identification Number: 000015137
ZIP code: 02886
County: Kent County
Principal Address: 227 CENTERVILLE ROAD, WARWICK, RI, 02886, USA
Purpose: GENERAL SURGEONS

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1457459943 2006-09-20 2011-02-24 227 CENTERVILLE RD, SUITE 2, WARWICK, RI, 028864394, US 227 CENTERVILLE RD, SUITE 2, WARWICK, RI, 028864394, US

Contacts
Phone +1 401-737-4828
Fax 4017328484

Authorized person
Name BERNARD ST.JEAN
Role PRESIDENT
Phone 4017374828

Taxonomy
Taxonomy Code 208600000X - Surgery Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number KS00507
State RI
Issuer RI BLUE SHIELD
Number 838-7
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KENT SURGICAL ASSOCIATES, INC. PENSION PLAN 2016 050342254 2017-08-23 KENT SURGICAL ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 4017374828
Plan sponsor’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886
KENT SURGICAL ASSOCIATES, INC. PENSION PLAN 2015 050342254 2016-06-16 KENT SURGICAL ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 4017374828
Plan sponsor’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886
KENT SURGICAL ASSOCIATES, INC. PENSION PLAN 2014 050342254 2015-05-12 KENT SURGICAL ASSOCIATES, INC. 10
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 4017374828
Plan sponsor’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050342254
Plan administrator’s name KENT SURGICAL ASSOCIATES, INC.
Plan administrator’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886
Administrator’s telephone number 4017374828

Signature of
Role Plan administrator
Date 2015-05-12
Name of individual signing BERNARD ST. JEAN
Valid signature Filed with authorized/valid electronic signature
KENT SURGICAL ASSOCIATES, INC. PENSION PLAN 2013 050342254 2014-04-25 KENT SURGICAL ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 4017374828
Plan sponsor’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050342254
Plan administrator’s name KENT SURGICAL ASSOCIATES, INC.
Plan administrator’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886
Administrator’s telephone number 4017374828

Signature of
Role Plan administrator
Date 2014-04-25
Name of individual signing BERNARD ST. JEAN
Valid signature Filed with authorized/valid electronic signature
KENT SURGICAL ASSOCIATES, INC. PENSION PLAN 2012 050342254 2013-05-21 KENT SURGICAL ASSOCIATES, INC. 9
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1989-01-01
Business code 621111
Sponsor’s telephone number 4017374828
Plan sponsor’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050342254
Plan administrator’s name KENT SURGICAL ASSOCIATES, INC.
Plan administrator’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886
Administrator’s telephone number 4017374828

Signature of
Role Plan administrator
Date 2013-05-21
Name of individual signing BERNARD ST. JEAN
Valid signature Filed with authorized/valid electronic signature
KENT SURGICAL ASSOCIATES, INC. PENSION PLAN 2011 050342254 2012-05-22 KENT SURGICAL ASSOCIATES, INC. 10
File View Page
Three-digit plan number (PN) 004
Effective date of plan 1989-01-01
Business code 621111
Plan sponsor’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 050342254
Plan administrator’s name KENT SURGICAL ASSOCIATES, INC.
Plan administrator’s address 227 CENTERVILLE ROAD, WARWICK, RI, 02886
Administrator’s telephone number 4017374828

Signature of
Role Plan administrator
Date 2012-05-22
Name of individual signing BERNARD ST. JEAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GUY LANCELOTTI Agent 227 CENTERVILLE ROAD, WARWICK, RI, 02886, USA

PRESIDENT

Name Role Address
BERNARD P. ST. JEAN, MD PRESIDENT 227 CENTERVILLE ROAD WARWICK, RI 02886 USA

Filings

Number Name File Date
201733604570 Articles of Dissolution 2017-02-06
201691151880 Annual Report 2016-01-22
201579724650 Annual Report 2015-09-18
201578247150 Revocation Notice For Failure to File An Annual Report 2015-09-08
201433110010 Annual Report 2014-01-16
201310682940 Annual Report 2013-02-01
201310682760 Statement of Change of Registered/Resident Agent Office 2013-02-01
201308018230 Revocation Notice For Failure to Maintain a Registered Office 2013-01-09
201308002310 Registered Office Not Maintained 2012-12-18
201289004770 Annual Report 2012-02-03

Related by officers

No related officers

Related by address

227 CENTERVILLE ROAD, WARWICK, RI, 02886, USA

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Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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