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  5. Bethany Home of Rhode Island

Bethany Home of Rhode Island

Company Details

Name: Bethany Home of Rhode Island
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 26 Apr 1892 (133 years ago)
Identification Number: 000027249
ZIP code: 02906
County: Providence County
Principal Address: 111 SOUTH ANGELL STREET, PROVIDENCE, RI, 02906, USA
Purpose: ENACTED BY THE GENERAL ASSEMBLY DURING THE JANUARY SESSION DURING THE JANUARY SESSION OF 1892 A SKILLED NURSING FACILITY
NAICS: 624120 - Services for the Elderly and Persons with Disabilities

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1356338248 2005-10-05 2022-07-01 111 SOUTH ANGELL STREET, PROVIDENCE, RI, 029065397, US 111 SOUTH ANGELL STREET, PROVIDENCE, RI, 029065397, US

Contacts
Phone +1 401-831-2870
Fax 4013319570

Authorized person
Name LINDA CHRISTIAN WILSON
Role CFO
Phone 4018312870

Taxonomy
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number LTC00531
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 4105096
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2023 050258941 2024-06-03 BETHANY HOME OF RHODE ISLAND 83
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2022 050258941 2023-06-07 BETHANY HOME OF RHODE ISLAND 83
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2021 050258941 2022-08-01 BETHANY HOME OF RHODE ISLAND 90
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2020 050258941 2021-07-12 BETHANY HOME OF RHODE ISLAND 100
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2019 050258941 2020-07-21 BETHANY HOME OF RHODE ISLAND 99
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2018 050258941 2019-04-15 BETHANY HOME OF RHODE ISLAND 90
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2017 050258941 2018-07-02 BETHANY HOME OF RHODE ISLAND 93
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2016 050258941 2017-06-12 BETHANY HOME OF RHODE ISLAND 74
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2015 050258941 2016-06-07 BETHANY HOME OF RHODE ISLAND 67
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870
BETHANY HOME OF RI THRIFT 401K PLAN AND TRUST 2014 050258941 2015-07-15 BETHANY HOME OF RHODE ISLAND 67
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870

Signature of
Role Plan administrator
Date 2015-07-15
Name of individual signing ELIZABETH SARRO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/25/20140725130107P030021638269001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870

Signature of
Role Plan administrator
Date 2014-07-25
Name of individual signing ELIZABETH SARRO
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/06/06/20130606145012P040316987137001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870

Signature of
Role Plan administrator
Date 2013-06-06
Name of individual signing MICHELLE GEREZ
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/04/18/20120418141922P040010259522001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1997-01-01
Business code 623000
Sponsor’s telephone number 4018312870
Plan sponsor’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309

Plan administrator’s name and address
Administrator’s EIN 050258941
Plan administrator’s name BETHANY HOME OF RHODE ISLAND
Plan administrator’s address 111 S ANGELL ST, PROVIDENCE, RI, 029065309
Administrator’s telephone number 4018312870

Signature of
Role Plan administrator
Date 2012-04-18
Name of individual signing MICHELLE GEREZ
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
W. THOMAS HUMPHREYS, ESQ. Agent CAMERON & MITTLEMAN LLP 301 PROMENADE STREET, PROVIDENCE, RI, 02908, USA

PRESIDENT

Name Role Address
STEPHANIE IGOE PRESIDENT 111 S. ANGELL STREET PROVIDENCE, RI 02906 USA

TREASURER

Name Role Address
MARK CHAFEE TREASURER 31 PATTEN DRIVE LITTLE COMPTON, RI 02837 USA

DIRECTOR

Name Role Address
LUCY HANNA DIRECTOR 111 S. ANGELL STREET PROVIDENCE, RI 02906 USA
BELINDA JOHNSON DIRECTOR 111 S. ANGELL STREET PROVIDENCE, RI 02906 USA
JUD SAVISKAS DIRECTOR 111 SOUTH ANGELL STREET PROVIDENCE, RI 02906 USA
ELAINE HILL DIRECTOR 111 S. ANGELL STREET PROVIDENCE, RI 02906 USA
MARK CHAFEE DIRECTOR 31 PATTEN DRIVE LITTLE COMPTON, RI 02837 USA
SR. JANE MCGARRAHAN DIRECTOR 111 S. ANGELL STREET PROVIDENCE, RI 02906 USA
ANDREW SCHUPACK DIRECTOR 59 SAGE DRIVE WARWICK, RI 02886 USA
SR. DONNA CONROY DIRECTOR 15 HIGHLAND VIEW ROAD CUMBERLAND, RI 02864 USA
STEPHANIE IGOE DIRECTOR 111 SOUTH ANGELL STREET PROVIDENCE, RI 02906 USA

BOARD CHAIR

Name Role Address
SR. JANE MCGARRAHAN BOARD CHAIR 111 S. ANGELL STREET PROVIDENCE, RI 02906 USA

SECRETARY AND DIRECTOR

Name Role Address
DEBORAH KELLY SECRETARY AND DIRECTOR 111 S. ANGELL STREET PROVIDENCE, RI 02906 USA

Filings

Number Name File Date
202450126150 Annual Report 2024-04-04
202335503430 Annual Report - Amended 2023-05-10
202335487280 Annual Report 2023-05-10
202217706610 Annual Report 2022-05-23
202217702540 Statement of Change of Registered/Resident Agent 2022-05-23
202198060880 Annual Report 2021-06-09
202044273730 Annual Report 2020-07-07
201926514020 Statement of Change of Registered/Resident Agent Office 2019-10-31
201908199140 Annual Report 2019-07-29
201870076980 Annual Report 2018-06-20

Related by officers

W. THOMAS HUMPHREYS, ESQ.

THE ALMON COMPANY Claflin Service Company VALLEY APPLIANCE AND MERCHANDISING COMPANY Bethany Home Foundation, Inc. Furnace & Duct Supply Co., Inc. HENRY A. EVERS CORP. HAAS REALTY, LLC VNA Foundation WEST SHORE DENTAL ASSOCIATES, INC. Val D, LLC

STEPHANIE IGOE

Bethany Home Foundation, Inc. Rhode Island Association of Facilities and Services for the Aging Rhode Island Association of Facilities and Services for the Aging Education Corporation Rhode Island Nursing Home Group, Inc.

MARK CHAFEE

The Mary Dexter Chafee Fund Bethany Home Foundation, Inc. The Sakonnet Point Marina Association, Inc.

LUCY HANNA

Bethany Home Foundation, Inc.

BELINDA JOHNSON

Bethany Home Foundation, Inc.

JUD SAVISKAS

Bethany Home Foundation, Inc.

SR. JANE MCGARRAHAN

Bethany Home Foundation, Inc.

DEBORAH KELLY

Bethany Home Foundation, Inc. Crown Castle USA Inc. Fibertech Facilities Corp. Crown Castle Fiber Holdings Corp.

ELAINE HILL

Bethany Home Foundation, Inc. Harbor House

ANDREW SCHUPACK

Bethany Home Foundation, Inc.

SR. DONNA CONROY

Bethany Home Foundation, Inc.

Related by address

111 SOUTH ANGELL STREET, PROVIDENCE, RI, 02906, USA

Bethany Home Foundation, Inc.

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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