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  5. Westerly Medical Center, Inc.

Westerly Medical Center, Inc.

Company Details

Name: Westerly Medical Center, Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Revoked Entity
Date of Organization in Rhode Island: 08 Dec 1971 (53 years ago)
Date of Dissolution: 06 Nov 2014 (10 years ago)
Date of Status Change: 06 Nov 2014 (10 years ago)
Identification Number: 000017325
ZIP code: 02891
County: Washington County
Principal Address: 46 WELLS STREET, WESTERLY, RI, 02891, USA
Purpose: MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1588777957 2006-08-17 2011-02-14 46 WELLS ST, WESTERLY, RI, 028912924, US 46 WELLS ST, WESTERLY, RI, 028912924, US

Contacts
Phone +1 401-596-0174
Fax 4015962266

Authorized person
Name DR. JAMES G STUART
Role PRESIDENT
Phone 4015960174

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number WMO4875
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WESTERLY MEDICAL CENTER, INC. PROFIT SHARING PLAN 2014 060859288 2015-04-21 WESTERLY MEDICAL CENTER, INC. 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1970-01-08
Business code 621111
Sponsor’s telephone number 4015960174
Plan sponsor’s address 46 WELLS STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2015-04-21
Name of individual signing JAMES STUART
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-21
Name of individual signing JAMES STUART
Valid signature Filed with authorized/valid electronic signature
WESTERLY MEDICAL CENTER, INC. PROFIT SHARING PLAN 2013 060859288 2014-08-04 WESTERLY MEDICAL CENTER, INC. 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1970-01-08
Business code 621111
Sponsor’s telephone number 4015960174
Plan sponsor’s address 46 WELLS STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2014-08-04
Name of individual signing JAMES STUART
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-08-04
Name of individual signing JAMES STUART
Valid signature Filed with authorized/valid electronic signature
WESTERLY MEDICAL CENTER, INC. PROFIT SHARING PLAN 2012 060859288 2013-06-07 WESTERLY MEDICAL CENTER, INC. 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1970-01-08
Business code 621111
Sponsor’s telephone number 4015960174
Plan sponsor’s address 46 WELLS STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2013-06-07
Name of individual signing ANGELA SMITH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-07
Name of individual signing ANGELA SMITH
Valid signature Filed with authorized/valid electronic signature
WESTERLY MEDICAL CENTER, INC. PROFIT SHARING PLAN 2011 060859288 2012-09-25 WESTERLY MEDICAL CENTER, INC. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1970-01-08
Business code 621111
Sponsor’s telephone number 4015960174
Plan sponsor’s address 46 WELLS STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 060859288
Plan administrator’s name WESTERLY MEDICAL CENTER, INC.
Plan administrator’s address 46 WELLS STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015960174

Signature of
Role Plan administrator
Date 2012-09-25
Name of individual signing JAMES G. STUART
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-09-25
Name of individual signing JAMES G. STUART
Valid signature Filed with authorized/valid electronic signature
WESTERLY MEDICAL CENTER, INC. PROFIT SHARING PLAN 2010 060859288 2011-04-22 WESTERLY MEDICAL CENTER, INC. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1970-01-08
Business code 621111
Sponsor’s telephone number 4015960174
Plan sponsor’s address 46 WELLS STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 060859288
Plan administrator’s name WESTERLY MEDICAL CENTER, INC.
Plan administrator’s address 46 WELLS STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015960174

Signature of
Role Plan administrator
Date 2011-04-22
Name of individual signing JAMES G. STUART
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-04-22
Name of individual signing JAMES G. STUART
Valid signature Filed with authorized/valid electronic signature
WESTERLY MEDICAL CENTER, INC. PROFIT SHARING PLAN 2009 060859288 2010-09-22 WESTERLY MEDICAL CENTER, INC. 15
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1970-01-08
Business code 621111
Sponsor’s telephone number 4015960174
Plan sponsor’s address 46 WELLS STREET, WESTERLY, RI, 02891

Plan administrator’s name and address
Administrator’s EIN 060859288
Plan administrator’s name WESTERLY MEDICAL CENTER, INC.
Plan administrator’s address 46 WELLS STREET, WESTERLY, RI, 02891
Administrator’s telephone number 4015960174

Signature of
Role Plan administrator
Date 2010-09-22
Name of individual signing JAMES STUART
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-22
Name of individual signing JAMES STUART
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
THOMAS J. GRADY, ESQ. Agent 6 CANAL STREET, WESTERLY, RI, 02891, USA

PRESIDENT

Name Role Address
JAMES G. STUART PRESIDENT 46 WELLS STREET WESTERLY, RI 02891 USA

Filings

Number Name File Date
201450412760 Registered Office Not Maintained 2014-11-24
201449463270 Revocation Certificate For Failure to File the Annual Report for the Year 2014-11-06
201439382790 Revocation Notice For Failure to File An Annual Report 2014-05-20
201311128870 Annual Report 2013-02-07
201289707860 Annual Report 2012-02-15
201174703230 Annual Report 2011-02-09
201057975550 Annual Report 2010-02-03
200943710260 Statement of Change of Registered/Resident Agent 2009-03-09
200942104330 Annual Report 2009-02-09
200833729130 Annual Report 2008-08-15

Related by officers

No related officers

Related by address

46 WELLS STREET, WESTERLY, RI, 02891, USA

LLCS HOLDINGS, LLC James G. Stuart, DO, LLC Rhode Island Vascular Center, LLC Susan Stuart, DO, LLC Rhode Island Vascular Management Group, LLC

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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