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  5. THE FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY

THE FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY

Company Details

Name: THE FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Merged Into An Entity Of Record
Date of Organization in Rhode Island: 02 Jan 1891 (134 years ago)
Date of Dissolution: 30 Jun 2013 (12 years ago)
Date of Status Change: 30 Jun 2013 (12 years ago)
Identification Number: 000027073
ZIP code: 02860
County: Providence County
Principal Address: C/O GATEWAY HEALTHCARE 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860, USA
Purpose: CLINICAL COUNSELING JANUARY SESSION 1891

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1629014865 2006-06-22 2020-08-22 33 SUMMER ST, PAWTUCKET, RI, 028602964, US 33 SUMMER ST, PAWTUCKET, RI, 028602964, US

Contacts
Phone +1 401-723-2124
Fax 4017230566

Authorized person
Name MR. JOHN J CARR
Role EXECUTIVE DIRECTOR
Phone 4017232124

Taxonomy
Taxonomy Code 1041C0700X - Clinical Social Worker
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TAX DEFERRED ANNUITY PLAN OF FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 2016 050258870 2017-07-24 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Active participants 0
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 1
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 2017-07-21
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-21
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 2015 050258870 2016-10-18 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Active participants 0
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 1
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 2016-10-18
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
403B THRIFT PLAN OF FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 2014 050258870 2015-09-11 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 4
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 2015-09-11
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-11
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 2014 050258870 2015-09-11 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Active participants 0
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 1
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 2015-09-11
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-11
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 2013 050258870 2014-07-17 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Active participants 0
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 1
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 2014-07-16
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-16
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 2013 050258870 2014-07-17 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Other retired or separated participants entitled to future benefits 4
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 2014-07-16
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-16
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF FAMILY SERVICE SOCIETY AND PAWTUCKET AND VICINITY 2012 050258870 2013-10-09 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Other retired or separated participants entitled to future benefits 5
Number of participants with account balances as of the end of the plan year 5

Signature of
Role Plan administrator
Date 2013-10-09
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 2012 050258870 2013-10-09 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Other retired or separated participants entitled to future benefits 3
Number of participants with account balances as of the end of the plan year 3

Signature of
Role Plan administrator
Date 2013-10-09
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
403(B) THRIFT PLAN OF FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 2011 050258870 2012-07-20 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050258870
Plan administrator’s name FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY
Plan administrator’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017248400

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 5
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 5
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 2012-07-17
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY PLAN OF FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 2011 050258870 2012-07-20 FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050258870
Plan administrator’s name FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY
Plan administrator’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017248400

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 3
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 3
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 2012-07-17
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/17/20111017135238P040154956385001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050258870
Plan administrator’s name FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY
Plan administrator’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017248400

Number of participants as of the end of the plan year
Other retired or separated participants entitled to future benefits 5

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/14/20101014161059P070027445137001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050258870
Plan administrator’s name FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY
Plan administrator’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017248400

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 6
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 6
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 2010-10-14
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/14/20101014161342P070003435685001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 624100
Sponsor’s telephone number 4017248400
Plan sponsor’s mailing address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Plan sponsor’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050258870
Plan administrator’s name FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY
Plan administrator’s address 249 ROOSEVELT AVENUE, SUITE 205, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017248400

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 4
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 2010-10-14
Name of individual signing SCOTT DICHRISTOFERO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ADLER POLLOCK & SHEEHAN P.C. Agent ONE CITIZENS PLAZA 8TH FLOOR, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
RICHARD H LECLERC PRESIDENT 28 WESTWOOD ROAD NORTH SMITHFIELD, RI 02896 USA

CFO

Name Role Address
SCOTT DICHRISTOFERO CFO 44 ROLLING ACRES DRIVE CUMBERLAND, RI 02864 USA

ASSISTANT SECRETARY

Name Role Address
HENRY SACHS MD ASSISTANT SECRETARY 4 BRAMEL CIRCLE WALPOLE, MA 02081 USA

IMMEDIATE PAST CHAIR

Name Role Address
J. THOMAS EAKIN IMMEDIATE PAST CHAIR 1150 DOUGLAS PIKE SMITHFIELD, RI 02917 USA

CHAIR

Name Role Address
LLOYD J. ROBERTSON CHAIR 50 SCOTT DRIVE RIVERSIDE, RI 02915 USA

TREASURER

Name Role Address
ROBERT P. ANDRADE TREASURER 1 ANCHOR WAY RIVERSIDE, RI 02915 USA

SECRETARY

Name Role Address
JOHN MICROULIS SECRETARY P.O. BOX 5309 WAKEFIELD, RI 02880 USA

VICE CHAIR

Name Role Address
DR. GOWRI ANANDARAJAH VICE CHAIR 60 GOVERNOR BRADFORD DRIVE BARRINGTON, RI 02806 USA

DIRECTOR

Name Role Address
DR. GOWRI ANANDARAJAH MD DIRECTOR 60 GOVERNOR BRADFORD DRIVE BARRINGTON, RI 02806 USA
JOHN MICROULIS DIRECTOR P.O. BOX 5309 WAKEFIELD, RI 02880 USA
RICHARD R BERETTA JR DIRECTOR 511 EAST MAIN ROAD JAMESTOWN, RI 02835 USA
CAROLYN TRAXLER DIRECTOR 109 SOUTHWINDS DRIVE WAKEFIELD, RI 02879 USA
J THOMAS EAKIN DIRECTOR 1150 DOUGLAS PIKE, BOX 64 SMITHFIELD, RI 02917 USA
LLOYD J ROBERTSON DIRECTOR 50 SCOTT DRIVE RIVERSIDE, RI 02915 USA
AL MARCIANO DIRECTOR 11 BROADVIEW AVENUE WARWICK, RI 02889 USA
HENRY SACHS MD DIRECTOR 4 BRAMEL CIRCLE WALPOLE, MA 02081 USA
ROBERT P ANDRADE DIRECTOR 1 ANCHOR WAY RIVERSIDE, RI 02916 USA
MARK FIELDS DIRECTOR RIVERVIEW TERRACE, APT. 506, 475 SCHOOL STREET PAWTUCKET, RI 02860 USA

Events

Type Date Old Value New Value
Merged 2013-06-30 THE FAMILY SERVICE SOCIETY OF PAWTUCKET AND VICINITY GATEWAY HEALTHCARE, INC. on

Filings

Number Name File Date
201322143950 Annual Report 2013-06-03
201293520840 Annual Report 2012-05-29
201180050740 Annual Report 2011-06-10
201063621700 Articles of Amendment 2010-06-18
201062834200 Annual Report 2010-06-07
200948001750 Statement of Change of Registered/Resident Agent 2009-07-01
200948001660 Articles of Amendment 2009-07-01
200945878300 Annual Report 2009-05-21
200812486760 Annual Report 2008-07-07
200703384870 Annual Report 2007-07-19

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Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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