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  5. DAVID L. KITZES M.D., INC.

DAVID L. KITZES M.D., INC.

Company Details

Name: DAVID L. KITZES M.D., INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 01 Dec 1975 (49 years ago)
Date of Dissolution: 18 Aug 2020 (4 years ago)
Date of Status Change: 18 Aug 2020 (4 years ago)
Identification Number: 000015947
ZIP code: 02906
County: Providence County
Principal Address: 219 BLACKSTONE BOULEVARD, PROVIDENCE, RI, 02906, USA
Purpose: PHYSICIAN SERVICE
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DAVID L. KITZES, M.D., INC. PROFIT SHARING PLAN 2013 050365755 2014-10-08 DAVID L. KITZES, M.D., INC. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4013318877
Plan sponsor’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709

Signature of
Role Plan administrator
Date 2014-10-08
Name of individual signing DAVID L. KITZES, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID L. KITZES, M.D., INC. PROFIT SHARING PLAN 2012 050365755 2014-05-01 DAVID L. KITZES, M.D., INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4013318877
Plan sponsor’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709

Signature of
Role Plan administrator
Date 2014-05-01
Name of individual signing DAVID L. KITZES, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID L. KITZES, M.D., INC. PROFIT SHARING PLAN 2011 050365755 2013-06-27 DAVID L. KITZES, M.D., INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4013318877
Plan sponsor’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709

Plan administrator’s name and address
Administrator’s EIN 050365755
Plan administrator’s name DAVID L. KITZES, M.D., INC.
Plan administrator’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709
Administrator’s telephone number 4013318877

Signature of
Role Plan administrator
Date 2013-06-27
Name of individual signing DAVID L. KITZES, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID L. KITZES, M.D., INC. PROFIT SHARING PLAN 2010 050365755 2012-09-05 DAVID L. KITZES, M.D., INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4013318877
Plan sponsor’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709

Plan administrator’s name and address
Administrator’s EIN 050365755
Plan administrator’s name DAVID L. KITZES, M.D., INC.
Plan administrator’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709
Administrator’s telephone number 4013318877

Signature of
Role Plan administrator
Date 2012-09-05
Name of individual signing DAVID L. KITZES, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID L. KITZES, M.D., INC. PROFIT SHARING PLAN 2010 050365755 2012-04-18 DAVID L. KITZES, M.D., INC. 4
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4013318877
Plan sponsor’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709

Plan administrator’s name and address
Administrator’s EIN 050365755
Plan administrator’s name DAVID L. KITZES, M.D., INC.
Plan administrator’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709
Administrator’s telephone number 4013318877

Signature of
Role Plan administrator
Date 2012-04-18
Name of individual signing DAVID L. KITZES, M.D.
Valid signature Filed with authorized/valid electronic signature
DAVID L. KITZES, M.D., INC. PROFIT SHARING PLAN 2009 050365755 2010-03-04 DAVID L. KITZES, M.D., INC. 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4013318877
Plan sponsor’s mailing address ONE RANDALL SQUARE, PROVIDENCE, RI, 02906
Plan sponsor’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 02906

Plan administrator’s name and address
Administrator’s EIN 050365755
Plan administrator’s name DAVID L. KITZES, M.D., INC.
Plan administrator’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 02906
Administrator’s telephone number 4013318877

Number of participants as of the end of the plan year
Active participants 3
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 1
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 4
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-03-04
Name of individual signing PAUL MERLINO
Valid signature Filed with authorized/valid electronic signature
DAVID L. KITZES, M.D., INC. PROFIT SHARING PLAN 2009 050365755 2011-08-24 DAVID L. KITZES, M.D., INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1999-01-01
Business code 621111
Sponsor’s telephone number 4013318877
Plan sponsor’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709

Plan administrator’s name and address
Administrator’s EIN 050365755
Plan administrator’s name DAVID L. KITZES, M.D., INC.
Plan administrator’s address ONE RANDALL SQUARE, PROVIDENCE, RI, 029042709
Administrator’s telephone number 4013318877

Signature of
Role Plan administrator
Date 2011-08-24
Name of individual signing DAVID L. KITZES, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DAVID L. KITZES Agent 219 BLACKSTONE BOULEVARD, PROVIDENCE, RI, 02906, USA

PRESIDENT

Name Role Address
DAVID L. KITZES PRESIDENT 219 BLACKSTONE BOULEVARD PROVIDENCE, RI 02906 USA

Filings

Number Name File Date
202048592440 Articles of Dissolution 2020-08-18
202048589800 Annual Report 2020-08-18
202048590310 Statement of Change of Registered Office by the Registered Agent 2020-08-18
202048591100 Annual Report 2020-08-18
202048589260 Reinstatement 2020-08-18
201989721030 Revocation Certificate For Failure to Maintain a Registered Office 2019-04-03
201983616170 Revocation Notice For Failure to Maintain a Registered Office 2019-01-03
201883282240 Registered Office Not Maintained 2018-12-19
201856253570 Annual Report 2018-01-17
201731140160 Annual Report 2017-01-31

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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