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  5. LIFESPAN PHYSICIAN GROUP, INC.

LIFESPAN PHYSICIAN GROUP, INC.

Headquarter

Company Details

Name: LIFESPAN PHYSICIAN GROUP, INC.
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 22 Jan 1981 (44 years ago)
Identification Number: 000028426
ZIP code: 02903
County: Providence County
Principal Address: 167 POINT STREET, PROVIDENCE, RI, 02903, USA
Purpose: RESEARCH, EDUCATION AND DIRECT PATIENT CARE
Fictitious names: Brown University Health Urgent Care (trading name, 2024-08-19 - )
Brown Health Medical Group (trading name, 2024-08-19 - )
Brown Health Medical Group Specialty Care (trading name, 2024-08-19 - )
Lifespan Urgent Care (trading name, 2019-07-22 - )
OB-GYN Associates, a Lifespan Physcian Group Practice (trading name, 2013-08-05 - 2024-08-21)
Historical names: RIH Cardiology Foundation, Inc.
University Cardiology Foundation, Inc.

Industry & Business Activity

NAICS

622110 General Medical and Surgical Hospitals

This industry comprises establishments known and licensed as general medical and surgical hospitals primarily engaged in providing diagnostic and medical treatment (both surgical and nonsurgical) to inpatients with any of a wide variety of medical conditions. These establishments maintain inpatient beds and provide patients with food services that meet their nutritional requirements. These hospitals have an organized staff of physicians and other medical staff to provide patient care services. These establishments usually provide other services, such as outpatient services, anatomical pathology services, diagnostic X-ray services, clinical laboratory services, operating room services for a variety of procedures, and pharmacy services. Learn more at the U.S. Census Bureau

Companies doing General medical and surgical hospitals

Links between entities

Type Company Name Company Number State
Headquarter of LIFESPAN PHYSICIAN GROUP, INC., CONNECTICUT 1082039 CONNECTICUT

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1285191163 2019-02-27 2024-09-18 117 ELLENFIELD ST STE 101, PROVIDENCE, RI, 029054513, US 17 AIRPORT RD, WARWICK, RI, 028891001, US

Contacts
Phone +1 401-444-6779
Fax 4014446912
Phone +1 401-606-2520
Fax 4013847190

Authorized person
Name MR. PETER K MARKELL
Role EVP & CFO
Phone 4014447914

Taxonomy
Taxonomy Code 208D00000X - General Practice Physician
Is Primary No
Taxonomy Code 261QU0200X - Urgent Care Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
UNIVERSITY CARDIOLOGY FOUNDATION, INC. DEFINED CONTRIBUTION RETIREMENT PLAN 2012 050389801 2013-08-30 UNIVERSITY CARDIOLOGY FOUNDATION, INC. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 621111
Sponsor’s telephone number 4012280205
Plan sponsor’s address 60 AMARAL STREET, RIVERSIDE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050389801
Plan administrator’s name UNIVERSITY CARDIOLOGY FOUNDATION, INC.
Plan administrator’s address 60 AMARAL STREET, RIVERSIDE, RI, 02915
Administrator’s telephone number 4012280205

Signature of
Role Plan administrator
Date 2013-08-30
Name of individual signing WILLIAM E. KIRKWOOD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY CARDIOLOGY FOUNDATION, INC. DEFINED CONTRIBUTION RETIREMENT PLAN 2011 050389801 2012-06-22 UNIVERSITY CARDIOLOGY FOUNDATION, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 621111
Sponsor’s telephone number 4012280205
Plan sponsor’s address 60 AMARAL STREET, RIVERSIDE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050389801
Plan administrator’s name UNIVERSITY CARDIOLOGY FOUNDATION, INC.
Plan administrator’s address 60 AMARAL STREET, RIVERSIDE, RI, 02915
Administrator’s telephone number 4012280205

Signature of
Role Plan administrator
Date 2012-06-22
Name of individual signing MIRIAM KATZ
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY CARDIOLOGY FOUNDATION, INC. DEFINED CONTRIBUTION RETIREMENT PLAN 2010 050389801 2011-06-22 UNIVERSITY CARDIOLOGY FOUNDATION, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 621111
Sponsor’s telephone number 4012280205
Plan sponsor’s address 60 AMARAL STREET, RIVERSIDE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050389801
Plan administrator’s name UNIVERSITY CARDIOLOGY FOUNDATION, INC.
Plan administrator’s address 60 AMARAL STREET, RIVERSIDE, RI, 02915
Administrator’s telephone number 4012280205

Signature of
Role Plan administrator
Date 2011-06-22
Name of individual signing MIRIAM KATZ
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY CARDIOLOGY FOUNDATION, INC. DEFINED CONTRIBUTION RETIREMENT PLAN 2009 050389801 2010-07-12 UNIVERSITY CARDIOLOGY FOUNDATION, INC. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 621111
Sponsor’s telephone number 4012280205
Plan sponsor’s address 60 AMARAL STREET, RIVERSIDE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050389801
Plan administrator’s name UNIVERSITY CARDIOLOGY FOUNDATION, INC.
Plan administrator’s address 60 AMARAL STREET, RIVERSIDE, RI, 02915
Administrator’s telephone number 4012280205

Signature of
Role Plan administrator
Date 2010-07-12
Name of individual signing ROCHELLE M. FORTIN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PAUL J. ADLER Agent 245 CHAPMAN STREET SUITE 200, PROVIDENCE, RI, 02905, USA

DIRECTOR

Name Role Address
HENRY SACHS, M.D. DIRECTOR 1011 VETERANS MEMORIAL PKWY EAST PROVIDENCE, RI 02915 USA

PRESIDENT

Name Role Address
BABAR KHOKHAR MD PRESIDENT 167 POINT STREET PROVIDENCE, RI 02903 USA

Events

Type Date Old Value New Value
Name Change 2012-05-25 University Cardiology Foundation, Inc. LIFESPAN PHYSICIAN GROUP, INC.
Name Change 1998-12-15 RIH Cardiology Foundation, Inc. University Cardiology Foundation, Inc.

Filings

Number Name File Date
202458973260 Statement of Abandonment of Use of Fictitious Business Name 2024-08-21
202458913220 Fictitious Business Name Statement 2024-08-19
202458913040 Fictitious Business Name Statement 2024-08-19
202458912890 Fictitious Business Name Statement 2024-08-19
202449067240 Annual Report 2024-03-14
202334044880 Annual Report 2023-04-26
202213203320 Annual Report 2022-03-21
202199504950 Annual Report 2021-07-23
202042559610 Annual Report 2020-06-19
201914608760 Annual Report 2019-08-22

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
05-0389801 Corporation Unconditional Exemption 167 POINT STREET, PROVIDENCE, RI, 02903-4771 1982-09
In Care of Name % MARY A WAKEFIELD EVP & CFO
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Organization that normally receives no more than one-third of its support from gross investment income and unrelated business income and at the same time more than one-third of its support from contributions, fees, and gross receipts related to exempt purposes 509(a)(2)
Tax Period 2023-09
Asset 50,000,000 to greater
Income 50,000,000 to greater
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Sep
Asset Amount 58072603
Income Amount 260257653
Form 990 Revenue Amount 260023583
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
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 LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 202209
Filing Type E
Return Type 990
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 202109
Filing Type E
Return Type 990
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 201909
Filing Type E
Return Type 990
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 201909
Filing Type P
Return Type 990T
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 201809
Filing Type E
Return Type 990
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 201809
Filing Type P
Return Type 990T
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 201709
Filing Type E
Return Type 990
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 201709
Filing Type E
Return Type 990T
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 201609
Filing Type E
Return Type 990
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 201609
Filing Type P
Return Type 990T
File View File
Organization Name LIFESPAN PHYSICIAN GROUP INC
EIN 05-0389801
Tax Period 201509
Filing Type E
Return Type 990
File View File

Related by officers

PAUL J. ADLER

HOSPITAL PROPERTIES, INC. HUMAN SERVICES REALTY, INC. NEWPORT HOSPITAL FOUNDATION, INC. NEWPORT HEALTH PROPERTY MANAGEMENT, INC. THE MIRIAM HOSPITAL THE MIRIAM HOSPITAL FOUNDATION Lifespan Diversified Services, Inc. RHODE ISLAND HOSPITAL LIFESPAN CORPORATION RIH VENTURES

BABAR KHOKHAR MD

LIFESPAN MSO, INC.

Related by address

167 POINT STREET, PROVIDENCE, RI, 02903, USA

NEWPORT HEALTH PROPERTY MANAGEMENT, INC. Lifespan Diversified Services, Inc. DOWNING REALTY CORP. DOWNING/INDIAN LAKE, INC. LIFESPAN CORPORATION DOWNING/INDIAN LAKE ASSOCIATES, INC. Royal Oak Trust, Inc. Downing Seaport, Inc. LIFESPAN FOUNDATION

Date of last update: 06 Apr 2025

Sources: Rhode Island Department of State

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