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The Memorial Hospital

Company Details

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 - )

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1548696941 2013-09-18 2014-02-19 PO BOX 418999, BOSTON, MA, 022418999, US 111 BREWSTER ST, PAWTUCKET, RI, 028604474, US

Contacts

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

form 5500

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
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 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
THE MEMORIAL HOSPITAL DEFINED BENEFIT PENSION PLAN AND TRUST 2013 050259004 2014-10-15 MEMORIAL HOSPITAL OF RHODE ISLAND 2606
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
THE MEMORIAL HOSPITAL DEFINED BENEFIT PENSION PLAN AND TRUST 2012 050259004 2013-10-09 MEMORIAL HOSPITAL OF RHODE ISLAND 2034
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
THE MEMORIAL HOSPITAL DEFINED BENEFIT PENSION PLAN AND TRUST 2011 050259004 2012-08-17 MEMORIAL HOSPITAL OF RHODE ISLAND 2070
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
THE MEMORIAL HOSPITAL DEFINED BENEFIT PENSION PLAN AND TRUST 2010 050259004 2011-10-17 MEMORIAL HOSPITAL OF RHODE ISLAND 2108
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

Agent

Name Role Address
ASHLEY TAYLOR Agent 4 RICHMOND SQUARE, PROVIDENCE, RI, 02906, USA

SECRETARY

Name Role Address
JAMES BOTVIN SECRETARY 12 BAGY WRINKLE COVER WARREN, RI 02885 USA

DIRECTOR

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
JOSEPH J. MCGAIR, ESQ. DIRECTOR 92 SANDY LANE WARWICK, RI 02889 USA
GARY E. FURTADO DIRECTOR 15 BETH AVENUE WARREN, RI 02885 USA
JAMES BOTVIN DIRECTOR 12 BAGY WRINKLE COVE WARREN, RI 02885 USA

TREASURER

Name Role Address
R. STEPHEN MANTY TREASURER 110 ROYAL LITTLE DRIVE PROVIDENCE, RI 02904 USA

ASSISTANT TREASURER

Name Role Address
TODD CONKLIN ASSISTANT TREASURER 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA

ASSISTANT SECRETARY

Name Role Address
ASHLEY TAYLOR ESQ. ASSISTANT SECRETARY 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA

EX OFFICIO DIRECTOR

Name Role Address
MICHAEL WAGNER MD EX OFFICIO DIRECTOR 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA

CHAIRPERSON

Name Role Address
GARY E. FURTADO CHAIRPERSON 5 BETH AVENUE WARREN, RI 02885 USA

VICE CHAIRPERSON

Name Role Address
R. STEPHEN MANTY VICE CHAIRPERSON 110 ROYAL LITTLE DRIVE PROVIDENCE, RI 02904 USA

Events

Type Date Old Value New Value
Merged 1989-09-29 Notre Dame Hospital on The Memorial Hospital

Filings

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

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State