Name: | The Memorial Hospital |
Jurisdiction: | Rhode Island |
Entity type: | Domestic Non-Profit Corporation |
Status: | Activ |
Date of Organization in Rhode Island: | 25 May 1901 (124 years ago) |
Identification Number: | 000028357 |
ZIP code: | 02860 |
County: | Providence County |
Principal Address: | 111 BREWSTER STREET, PAWTUCKET, RI, 02860, USA |
Purpose: | TO ERECT ESTABLISH AND MAINTAIN A HOSPITAL FOR THE MEDICAL AND SURGICAL TREATMENT OF THE SICK 176 |
Fictitious names: |
Memorial Hospital of Rhode Island (trading name, 2003-12-10 - ) |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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1548696941 | 2013-09-18 | 2014-02-19 | PO BOX 418999, BOSTON, MA, 022418999, US | 111 BREWSTER ST, PAWTUCKET, RI, 028604474, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Phone | +1 401-273-0641 |
Fax | 4012732919 |
Phone | +1 401-729-2250 |
Fax | 4017292721 |
Authorized person
Name | MR. CHRISTOPHER DACEY |
Role | DIRECTOR PHO |
Phone | 4012730641 |
Taxonomy
Taxonomy Code | 207N00000X - Dermatology Physician |
Is Primary | No |
Taxonomy Code | 207P00000X - Emergency Medicine Physician |
Is Primary | No |
Taxonomy Code | 207Q00000X - Family Medicine Physician |
Is Primary | No |
Taxonomy Code | 207R00000X - Internal Medicine Physician |
Is Primary | No |
Taxonomy Code | 207RC0000X - Cardiovascular Disease Physician |
Is Primary | No |
Taxonomy Code | 207RE0101X - Endocrinology, Diabetes & Metabolism Physician |
Is Primary | No |
Taxonomy Code | 207RG0300X - Geriatric Medicine (Internal Medicine) Physician |
Is Primary | No |
Taxonomy Code | 207RH0003X - Hematology & Oncology Physician |
Is Primary | No |
Taxonomy Code | 207RI0200X - Infectious Disease Physician |
Is Primary | No |
Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
Is Primary | No |
Taxonomy Code | 207RR0500X - Rheumatology Physician |
Is Primary | No |
Taxonomy Code | 207RS0012X - Sleep Medicine (Internal Medicine) Physician |
Is Primary | No |
Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
Is Primary | No |
Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
Is Primary | No |
Taxonomy Code | 282N00000X - General Acute Care Hospital |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | MH11562 |
State | RI |
Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
THE MEMORIAL HOSPITAL DEFINED BENEFIT PENSION PLAN AND TRUST | 2014 | 050259004 | 2015-10-15 | MEMORIAL HOSPITAL OF RHODE ISLAND | 2489 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Active participants | 730 |
Retired or separated participants receiving benefits | 671 |
Other retired or separated participants entitled to future benefits | 1020 |
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 69 |
Signature of
Role | Plan administrator |
Date | 2015-10-15 |
Name of individual signing | LISA PRATT |
Valid signature | Filed with authorized/valid electronic signature |
File | View Page |
Three-digit plan number (PN) | 001 |
Effective date of plan | 1966-04-01 |
Business code | 622000 |
Sponsor’s telephone number | 4017292198 |
Plan sponsor’s mailing address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Plan sponsor’s address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Number of participants as of the end of the plan year
Active participants | 860 |
Retired or separated participants receiving benefits | 636 |
Other retired or separated participants entitled to future benefits | 925 |
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 68 |
Signature of
Role | Plan administrator |
Date | 2014-10-15 |
Name of individual signing | LISA PRATT |
Valid signature | Filed with authorized/valid electronic signature |
Role | Employer/plan sponsor |
Date | 2014-10-15 |
Name of individual signing | LISA PRATT |
Valid signature | Filed with authorized/valid electronic signature |
File | View Page |
Three-digit plan number (PN) | 001 |
Effective date of plan | 1966-04-01 |
Business code | 622000 |
Sponsor’s telephone number | 4017292198 |
Plan sponsor’s mailing address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Plan sponsor’s address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Number of participants as of the end of the plan year
Active participants | 1109 |
Retired or separated participants receiving benefits | 0 |
Other retired or separated participants entitled to future benefits | 816 |
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 6 |
Number of participants with account balances as of the end of the plan year | 0 |
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 31 |
Signature of
Role | Plan administrator |
Date | 2013-10-09 |
Name of individual signing | ARTHUR DEBLOIS |
Valid signature | Filed with authorized/valid electronic signature |
Role | Employer/plan sponsor |
Date | 2013-10-09 |
Name of individual signing | ARTHUR DEBLOIS |
Valid signature | Filed with authorized/valid electronic signature |
File | View Page |
Three-digit plan number (PN) | 001 |
Effective date of plan | 1966-04-01 |
Business code | 622000 |
Sponsor’s telephone number | 4017292198 |
Plan sponsor’s mailing address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Plan sponsor’s address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Plan administrator’s name and address
Administrator’s EIN | 050259004 |
Plan administrator’s name | MEMORIAL HOSPITAL OF RHODE ISLAND |
Plan administrator’s address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Administrator’s telephone number | 4017292198 |
Number of participants as of the end of the plan year
Active participants | 1201 |
Retired or separated participants receiving benefits | 0 |
Other retired or separated participants entitled to future benefits | 812 |
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2 |
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 38 |
Signature of
Role | Plan administrator |
Date | 2012-08-17 |
Name of individual signing | ARTHUR DEBLOIS |
Valid signature | Filed with authorized/valid electronic signature |
Role | Employer/plan sponsor |
Date | 2012-08-17 |
Name of individual signing | ARTHUR DEBLOIS |
Valid signature | Filed with authorized/valid electronic signature |
File | View Page |
Three-digit plan number (PN) | 001 |
Effective date of plan | 1966-04-01 |
Business code | 622000 |
Sponsor’s telephone number | 4017292198 |
Plan sponsor’s mailing address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Plan sponsor’s address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Plan administrator’s name and address
Administrator’s EIN | 050259004 |
Plan administrator’s name | MEMORIAL HOSPITAL OF RHODE ISLAND |
Plan administrator’s address | 111 BREWSTER STREET, PAWTUCKET, RI, 02860 |
Administrator’s telephone number | 4017292198 |
Number of participants as of the end of the plan year
Active participants | 1267 |
Retired or separated participants receiving benefits | 0 |
Other retired or separated participants entitled to future benefits | 760 |
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 3 |
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 48 |
Signature of
Role | Plan administrator |
Date | 2011-10-17 |
Name of individual signing | MARTIN TURSKY |
Valid signature | Filed with authorized/valid electronic signature |
Role | Employer/plan sponsor |
Date | 2011-10-17 |
Name of individual signing | MARTIN TURSKY |
Valid signature | Filed with authorized/valid electronic signature |
Name | Role | Address |
---|---|---|
ASHLEY TAYLOR | Agent | 4 RICHMOND SQUARE, PROVIDENCE, RI, 02906, USA |
Name | Role | Address |
---|---|---|
JAMES BOTVIN | SECRETARY | 12 BAGY WRINKLE COVER WARREN, RI 02885 USA |
Name | Role | Address |
---|---|---|
CHARLES R. REPPUCCI | DIRECTOR | 215 SUNNYBROOK FARM ROAD NARRAGANSETT, RI 02882 USA |
R. STEPHEN MANTY | DIRECTOR | 110 ROYAL LITTLE DRIVE PROVIDENCE, RI 02904 USA |
JUDITH REMONDI | DIRECTOR | 258 BRIDLE TRAIL ROAD NEEDHAM, MA 02492 USA |
CAROLYNN MASTERS PH.D, RN | DIRECTOR | RHODE ISLAND COLLEGE, FLS 158-600 MOUNT PLEASANT AVENUE PROVIDENCE, RI 02908 USA |
PETER R. PHILLIPS | DIRECTOR | 156 WESTMINSTER STREET PROVIDENCE, RI 02903 USA |
KEVIN BAILL MD | DIRECTOR | 345 BLACKSTONE BLVD PROVIDENCE, RI 02906 USA |
ANA TUYA FULTON MD | DIRECTOR | 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA |
GARY E. FURTADO | DIRECTOR | 15 BETH AVENUE WARREN, RI 02885 USA |
JAMES BOTVIN | DIRECTOR | 12 BAGY WRINKLE COVE WARREN, RI 02885 USA |
MARIBETH WILLIAMSON | DIRECTOR | 450 WAKEFIELD STREET WEST WARWICK, RI 02893 USA |
Name | Role | Address |
---|---|---|
R. STEPHEN MANTY | TREASURER | 110 ROYAL LITTLE DRIVE PROVIDENCE, RI 02904 USA |
Name | Role | Address |
---|---|---|
TODD CONKLIN | ASSISTANT TREASURER | 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA |
Name | Role | Address |
---|---|---|
ASHLEY TAYLOR ESQ. | ASSISTANT SECRETARY | 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA |
Name | Role | Address |
---|---|---|
MICHAEL WAGNER MD | EX OFFICIO DIRECTOR | 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA |
Name | Role | Address |
---|---|---|
GARY E. FURTADO | CHAIRPERSON | 5 BETH AVENUE WARREN, RI 02885 USA |
Name | Role | Address |
---|---|---|
R. STEPHEN MANTY | VICE CHAIRPERSON | 110 ROYAL LITTLE DRIVE PROVIDENCE, RI 02904 USA |
Type | Date | Old Value | New Value |
---|---|---|---|
Merged | 1989-09-29 | Notre Dame Hospital on | The Memorial Hospital |
Number | Name | File Date |
---|---|---|
202450610190 | Annual Report | 2024-04-10 |
202330871390 | Annual Report | 2023-03-15 |
202213666710 | Annual Report | 2022-03-29 |
202104492240 | Statement of Change of Registered/Resident Agent Office | 2021-11-02 |
202104492150 | Statement of Change of Registered/Resident Agent Office | 2021-11-02 |
202198181260 | Annual Report | 2021-06-11 |
202078442700 | Annual Report | 2020-12-03 |
201997189910 | Annual Report | 2019-06-17 |
201870755100 | Annual Report | 2018-06-27 |
201870649940 | Statement of Change of Registered/Resident Agent | 2018-06-26 |
Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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312347925 | 0112300 | 2010-09-15 | 174 ARMISTICE BLVD, PAWTUCKET, RI, 02860 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Type | Complaint |
Activity Nr | 207788076 |
Safety | Yes |
Inspection Type | Complaint |
Scope | Partial |
Safety/Health | Health |
Close Conference | 1999-04-26 |
Case Closed | 1999-05-24 |
Related Activity
Type | Complaint |
Activity Nr | 202461794 |
Health | Yes |
Violation Items
Citation ID | 01001 |
Citaton Type | Other |
Standard Cited | 19101030 G02 VIII |
Issuance Date | 1999-05-05 |
Abatement Due Date | 1999-11-03 |
Nr Instances | 1 |
Nr Exposed | 30 |
Gravity | 01 |
Citation ID | 01002 |
Citaton Type | Other |
Standard Cited | 19101030 H02 IB |
Issuance Date | 1999-05-05 |
Abatement Due Date | 1999-05-22 |
Nr Instances | 1 |
Nr Exposed | 2 |
Gravity | 01 |
Citation ID | 01003 |
Citaton Type | Other |
Standard Cited | 19101030 H02 IC |
Issuance Date | 1999-05-05 |
Abatement Due Date | 1999-05-22 |
Nr Instances | 1 |
Nr Exposed | 1 |
Gravity | 01 |
Inspection Type | Complaint |
Scope | Partial |
Safety/Health | Health |
Close Conference | 1993-01-13 |
Case Closed | 1993-03-05 |
Related Activity
Type | Complaint |
Activity Nr | 74812132 |
Health | Yes |
Violation Items
Citation ID | 01001 |
Citaton Type | Serious |
Standard Cited | 19101200 H02 I |
Issuance Date | 1993-02-22 |
Abatement Due Date | 1993-03-27 |
Current Penalty | 1875.0 |
Initial Penalty | 1875.0 |
Nr Instances | 1 |
Nr Exposed | 1 |
Related Event Code (REC) | Complaint |
Gravity | 03 |
Citation ID | 01002 |
Citaton Type | Serious |
Standard Cited | 19260058 E06 IV |
Issuance Date | 1993-02-22 |
Abatement Due Date | 1993-03-27 |
Current Penalty | 1875.0 |
Initial Penalty | 1875.0 |
Nr Instances | 1 |
Nr Exposed | 1 |
Related Event Code (REC) | Complaint |
Gravity | 03 |
Citation ID | 01003 |
Citaton Type | Serious |
Standard Cited | 19260058 F01 I |
Issuance Date | 1993-02-22 |
Abatement Due Date | 1993-02-26 |
Current Penalty | 1875.0 |
Initial Penalty | 1875.0 |
Nr Instances | 1 |
Nr Exposed | 1 |
Related Event Code (REC) | Complaint |
Gravity | 03 |
Citation ID | 01004 |
Citaton Type | Serious |
Standard Cited | 19260058 L02 |
Issuance Date | 1993-02-22 |
Abatement Due Date | 1993-02-26 |
Current Penalty | 1875.0 |
Initial Penalty | 1875.0 |
Nr Instances | 1 |
Nr Exposed | 1 |
Related Event Code (REC) | Complaint |
Gravity | 03 |
Citation ID | 02001A |
Citaton Type | Other |
Standard Cited | 19260058 H03 I |
Issuance Date | 1993-02-22 |
Abatement Due Date | 1993-03-27 |
Current Penalty | 750.0 |
Initial Penalty | 750.0 |
Nr Instances | 1 |
Nr Exposed | 1 |
Gravity | 00 |
Citation ID | 02001B |
Citaton Type | Other |
Standard Cited | 19260058 H04 I |
Issuance Date | 1993-02-22 |
Abatement Due Date | 1993-03-27 |
Nr Instances | 1 |
Nr Exposed | 1 |
Gravity | 00 |
EIN | Type of Organization | Exempt Organization Status | Address | Ruling Date | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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05-0259004 | Corporation | Unconditional Exemption | 4 RICHMOND SQUARE 4TH FLOOR, PROVIDENCE, RI, 02906-5117 | 1932-05 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Description | Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. |
On Publication 78 Data List | Yes |
Deductibility | Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions) |
Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name | MEMORIAL HOSPITAL |
EIN | 05-0259004 |
Tax Period | 202109 |
Filing Type | E |
Return Type | 990 |
File | View File |
Organization Name | MEMORIAL HOSPITAL |
EIN | 05-0259004 |
Tax Period | 201909 |
Filing Type | E |
Return Type | 990 |
File | View File |
Organization Name | MEMORIAL HOSPITAL |
EIN | 05-0259004 |
Tax Period | 201809 |
Filing Type | E |
Return Type | 990 |
File | View File |
Organization Name | MEMORIAL HOSPITAL |
EIN | 05-0259004 |
Tax Period | 201709 |
Filing Type | E |
Return Type | 990 |
File | View File |
Organization Name | MEMORIAL HOSPITAL |
EIN | 05-0259004 |
Tax Period | 201609 |
Filing Type | E |
Return Type | 990 |
File | View File |
Date of last update: 06 Apr 2025
Sources: Rhode Island Department of State