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  5. Northwest Community Health Care

Northwest Community Health Care

Company Details

Name: Northwest Community Health Care
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 23 Sep 1929 (95 years ago)
Identification Number: 000028216
ZIP code: 02859
County: Providence County
Principal Address: 36 BRIDGEWAY P.O. BOX 312, PASCOAG, RI, 02859, USA
Purpose: CHARITABLE, SCIENTIFIC, LITERARY AND EDUCATIONAL
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)
Fictitious names: WellOne Behavioral Health Services (trading name, 2009-07-30 - )
WellOne Primary Medical and Dental Care (trading name, 2009-07-30 - )
WellOne (trading name, 2009-07-30 - )
Bayside Family Healthcare (trading name, 2008-06-30 - )
Northwest Health Center (trading name, 2002-05-30 - )
Northwest Mental Health (trading name, 2000-04-26 - )
Northwest Dental Associates (trading name, 2000-04-26 - )
Historical names: NORTHWEST COMMUNITY NURSING AND HEALTH SERVICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1003362864 2016-08-31 2016-08-31 35 VILLAGE PLAZA WAY, 1-53 VILLAGE PLAZA WAY, UNITS 12 & 13, SCITUATE, RI, 028571849, US 35 VILLAGE PLAZA WAY, 1-53 VILLAGE PLAZA WAY, UNITS 12 & 13, SCITUATE, RI, 028571849, US

Contacts
Phone +1 401-567-0800
Fax 4015670900

Authorized person
Name PETER BANCROFT
Role PRESIDENT/CEO
Phone 4012855119

Taxonomy
Taxonomy Code 261QF0400X - Federally Qualified Health Center (FQHC)
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2022 050258811 2024-01-29 NORTHWEST COMMUNITY HEALTH CARE 205
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s mailing address P.O. BOX 312, PASCOAG, RI, 028590312
Plan sponsor’s address 36 BRIDGE WAY, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Number of participants as of the end of the plan year
Active participants 161
Retired or separated participants receiving benefits 12
Other retired or separated participants entitled to future benefits 0
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 156
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 15
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2021 050258811 2023-01-20 NORTHWEST COMMUNITY HEALTH CARE 211
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s mailing address P.O. BOX 312, PASCOAG, RI, 028590312
Plan sponsor’s address 36 BRIDGE WAY, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Number of participants as of the end of the plan year
Active participants 152
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 53
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 197
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 17
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2020 050258811 2022-01-21 NORTHWEST COMMUNITY HEALTH CARE 153
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s mailing address P.O. BOX 312, PASCOAG, RI, 028590312
Plan sponsor’s address 36 BRIDGE WAY, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Number of participants as of the end of the plan year
Active participants 174
Retired or separated participants receiving benefits 37
Other retired or separated participants entitled to future benefits 0
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 169
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 10
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2019 050258811 2021-01-29 NORTHWEST COMMUNITY HEALTH CARE 156
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s mailing address P.O. BOX 312, PASCOAG, RI, 028590312
Plan sponsor’s address 36 BRIDGE WAY, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Number of participants as of the end of the plan year
Active participants 129
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 24
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 148
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 15
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2018 050258811 2020-01-29 NORTHWEST COMMUNITY HEALTH CARE 146
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s mailing address P.O. BOX 312, PASCOAG, RI, 028590312
Plan sponsor’s address 36 BRIDGE WAY, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Number of participants as of the end of the plan year
Active participants 135
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 21
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 143
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 9
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2017 050258811 2019-01-30 NORTHWEST COMMUNITY HEALTH CARE 145
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s mailing address P.O. BOX 312, PASCOAG, RI, 028590312
Plan sponsor’s address 36 BRIDGE WAY, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Number of participants as of the end of the plan year
Active participants 130
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 16
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 139
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 13
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2016 050258811 2018-01-09 NORTHWEST COMMUNITY HEALTH CARE 134
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s mailing address P.O. BOX 312, PASCOAG, RI, 028590312
Plan sponsor’s address 36 BRIDGE WAY, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Number of participants as of the end of the plan year
Active participants 127
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 18
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 138
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 12
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2015 050258811 2016-08-31 NORTHWEST COMMUNITY HEALTH CARE 118
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s address P.O. BOX 312, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2014 050258811 2015-11-09 NORTHWEST COMMUNITY HEALTH CARE 111
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s address P.O. BOX 312, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Signature of
Role Plan administrator
Date 2015-11-09
Name of individual signing DIANE HOPPER
Valid signature Filed with authorized/valid electronic signature
NORTHWEST COMMUNITY HEALTH CARE RETIREMENT PLAN 2013 050258811 2014-11-10 NORTHWEST COMMUNITY HEALTH CARE 105
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s address P.O. BOX 312, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Signature of
Role Plan administrator
Date 2014-11-10
Name of individual signing DIANE HOPPER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/11/12/20131112140028P030031266421001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s address P.O. BOX 312, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Signature of
Role Plan administrator
Date 2013-11-12
Name of individual signing DIANE HOPPER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/12/12/20121212142039P040008014771001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s address P.O. BOX 312, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Signature of
Role Plan administrator
Date 2012-12-12
Name of individual signing PETER BANCROFT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/11/14/20111114151710P030025054736001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s address P.O. BOX 312, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Signature of
Role Plan administrator
Date 2011-11-14
Name of individual signing PETER BANCROFT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/03/28/20110328140058P040001016803001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621900
Sponsor’s telephone number 4015670800
Plan sponsor’s address P.O. BOX 312, PASCOAG, RI, 028590312

Plan administrator’s name and address
Administrator’s EIN 050258811
Plan administrator’s name NORTHWEST COMMUNITY HEALTH CARE
Plan administrator’s address P.O. BOX 312, PASCOAG, RI, 028590312
Administrator’s telephone number 4015670800

Signature of
Role Plan administrator
Date 2011-03-28
Name of individual signing PETER BANCROFT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PETER BANCROFT Agent 36 BRIDGEWAY P.O. BOX 312, PASCOAG, RI, 02859, USA

TREASURER

Name Role Address
SARAH NOTTAGE TREASURER 21 DAVID ST. CRANSTON, RI 02920 USA

SECRETARY

Name Role Address
DAVID FERRARA SECRETARY 21 GARDEN CITY DRIVE CRANSTON, RI 02920 USA

ASSISTANT SECRETARY

Name Role Address
JOSEPH CASEY ASSISTANT SECRETARY 11 PARTRIDGE TRAIL BELLINGHAM, MA 02019 USA

VICE PRESIDENT

Name Role Address
DIANE HOPPER VICE PRESIDENT 50 STEAMBOAT ST. JAMESTOWN, RI 02835 USA
DEIRDRE NORTON VICE PRESIDENT 45 HOOD AVENUE RUMFORD, RI 02916 USA
ANDREA MARCOTTE VICE PRESIDENT 37 MORTIN AVENUE JOHNSTON, RI 02919 USA

PRESIDENT

Name Role Address
PETER BANCROFT PRESIDENT 81 SEAWARD LANE FALL RIVER, MA 02720-

DIRECTOR

Name Role Address
CHRISTINE VALLEE DIRECTOR 1180 DOUGLAS PIKE HARRISVILLE, RI 02830 USA
GERARD GOULET DIRECTOR 215 CRESTWOOD ROAD WARWICK, RI 02886 USA
JOAN HILTON DIRECTOR 11 BLUEBERRY LANE JOHNSTON, RI 02919 USA
DARYA KRAVITZ DIRECTOR 211 KNIBB ROAD PASCOAG, RI 02859 USA
MARGARET DUDLEY DIRECTOR 10 MILL POND RD. HARRISVILLE, RI 02830 USA
DENNIS ANDERSON DIRECTOR 593 WHIPPLE ROAD PASCOAG, RI 02859 USA
DAVID DEJESUS JR. DIRECTOR 222 EDMOND DR. NO. KINGSTOWN, RI 02852 USA
ROBERTA LACEY DIRECTOR 80 SPRING ST. PASCOAG, RI 02859 USA
CRYSTAL LEDDY DIRECTOR 98 ORCHARD MEADOWS DR. SMITHFIELD, RI 02917 USA
SUZANNE ESTEN DIRECTOR 108 BLACK HUT ROAD HARRISVILLE, RI 02830 USA

Events

Type Date Old Value New Value
Merged 2008-07-01 Bayside Family Healthcare, Inc. on Northwest Community Health Care
Merged 2003-01-01 NW HEALTH CENTER on Northwest Community Health Care
Name Change 2002-05-30 NORTHWEST COMMUNITY NURSING AND HEALTH SERVICE Northwest Community Health Care

Filings

Number Name File Date
202449275500 Annual Report 2024-03-25
202332110460 Annual Report 2023-03-31
202213916220 Annual Report 2022-04-04
202198417530 Annual Report 2021-06-18
202043803280 Annual Report 2020-06-30
201997527640 Annual Report 2019-06-18
201870020820 Annual Report 2018-06-19
201745607440 Annual Report 2017-06-16
201600954010 Annual Report 2016-06-22
201563402700 Annual Report 2015-06-16

Related by officers

PETER BANCROFT

RHODE ISLAND HEALTH CENTER ASSOCIATION WellOne Foundation Neighborhood Health Plan of Rhode Island, Inc. Neighborhood Health Plan of Rhode Island

SARAH NOTTAGE

WellOne Foundation

DAVID FERRARA

DEENA ETHRIDGE

JOSEPH CASEY

HARBORONE MORTGAGE, LLC Rhode Island Passive Investment Corp.

CHRISTINE VALLEE

NORTHERN RHODE ISLAND ASSOCIATION OF HUMAN SERVICEPROVIDERS

GERARD GOULET

HERITAGE HILLS CONSTRUCTION CO. HERITAGE HILLS NURSING CENTRE, INC.

DENNIS ANDERSON

ANDERSON AUTOMOTIVE, INC. T W COMMUNICATIONS, INC.

ROBERTA LACEY

Burrillville Land Trust

CRYSTAL LEDDY

WellOne Foundation

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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