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  5. Blackstone Valley Community Health Care, Inc.

Blackstone Valley Community Health Care, Inc.

Company Details

Name: Blackstone Valley Community Health Care, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 14 Jan 1976 (49 years ago)
Identification Number: 000029376
ZIP code: 02860
County: Providence County
Principal Address: 39 EAST AVENUE, PAWTUCKET, RI, 02860, USA
Purpose: OPERATING A COMMUNITY BASED HEALTH CENTER WHICH IN 1999 HAD OVER 41,000 PATIENT VISITS.
NAICS: 621112 - Offices of Physicians, Mental Health Specialists
Fictitious names: Blackstone Valley Community Health Pharmacy (trading name, 2022-03-01 - )
HealthKey (trading name, 2010-05-26 - )
Historical names: Pawtucket Neighborhood Health Centers
Pawtucket Neighborhood Health Center, Incorporated

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1528716362 2022-03-11 2022-03-11 39 EAST AVE, PAWTUCKET, RI, 028604003, US 39 EAST AVE, PAWTUCKET, RI, 028604003, US

Contacts
Phone +1 401-722-0081
Fax 4013120318

Authorized person
Name RAYMOND J LAVOIE
Role EXECUTIVE DIRECTOR
Phone 4017290080

Taxonomy
Taxonomy Code 3336C0003X - Community/Retail Pharmacy
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DEFINED CONTRIBUTION PENSION PLAN FOR EMPLOYEES OF BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC. 2014 510183476 2015-10-07 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 198
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-07-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s mailing address 39 EAST AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 39 EAST AVEBNUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Active participants 107
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 104
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 206
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2015-10-07
Name of individual signing RAYMOND LAVOIE
Valid signature Filed with authorized/valid electronic signature
DEFINED CONTRIBUTION PENSION PLAN FOR EMPLOYEES OF BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC. 2013 510183476 2014-07-31 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 196
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-07-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s mailing address 39 EAST AVENUE, PAWTUCKET, RI, 02860
Plan sponsor’s address 39 EAST AVEBNUE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Active participants 91
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 107
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 194
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 4

Signature of
Role Plan administrator
Date 2014-07-31
Name of individual signing RAYMOND LAVOIE
Valid signature Filed with authorized/valid electronic signature
DEFINED CONTRIBUTION PENSION PLAN FOR EMPLOYEES OF BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC. 2012 510183476 2013-10-11 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 197
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-07-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s mailing address 42 PARK PLACE, PAWTUCKET, RI, 02860
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Number of participants as of the end of the plan year
Active participants 91
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 103
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 186

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing RAYMOND LAVOIE
Valid signature Filed with authorized/valid electronic signature
DEFINED CONTRIBUTION PENSION PLAN FOR EMPLOYEES OF BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC. 2011 510183476 2012-07-25 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 191
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-07-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s mailing address 42 PARK PLACE, PAWTUCKET, RI, 02860
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Number of participants as of the end of the plan year
Active participants 73
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 124
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 193
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 7

Signature of
Role Plan administrator
Date 2012-07-25
Name of individual signing RAYMOND LAVOIE
Valid signature Filed with authorized/valid electronic signature
DEFINED CONTRIBUTION PENSION PLAN FOR EMPLOYEES OF BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC. 2010 510183476 2011-09-28 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 143
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-07-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s mailing address 42 PARK PLACE, PAWTUCKET, RI, 02860
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Number of participants as of the end of the plan year
Active participants 74
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 116
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 188
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 7

Signature of
Role Plan administrator
Date 2011-09-28
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFITS PLAN OF BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 2009 510183476 2010-11-23 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 131
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-07-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s mailing address 42 PARK PLACE, PAWTUCKET, RI, 02860
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Number of participants as of the end of the plan year
Active participants 72
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 66
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 0

Signature of
Role Plan administrator
Date 2010-11-23
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFITS PLAN OF BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC. 2009 510183476 2010-11-23 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 140
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-07-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s mailing address 42 PARK PLACE, PAWTUCKET, RI, 02860
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Number of participants as of the end of the plan year
Active participants 63
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 80
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 1

Signature of
Role Plan administrator
Date 2010-11-23
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFITS PLAN OF BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. 2009 510183476 2010-11-23 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. 126
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1983-07-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s mailing address 42 PARK PLACE, PAWTUCKET, RI, 02860
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Number of participants as of the end of the plan year
Active participants 75
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 56
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 131
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-11-23
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature
EMPLOYEE BENEFITS PLAN OF BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC. 2009 510183476 2010-10-14 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 140
Three-digit plan number (PN) 001
Effective date of plan 1983-07-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s mailing address 42 PARK PLACE, PAWTUCKET, RI, 02860
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Number of participants as of the end of the plan year
Active participants 63
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 80
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 1

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature
TAX DEFERRED ANNUITY - BVCHC 2009 510183476 2011-07-27 BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC 49
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Signature of
Role Plan administrator
Date 2011-07-27
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-27
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Signature of
Role Plan administrator
Date 2010-10-08
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Signature of
Role Employer/plan sponsor
Date 2010-10-08
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 002
Effective date of plan 1983-01-01
Business code 621111
Sponsor’s telephone number 4017290080
Plan sponsor’s address 42 PARK PLACE, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 510183476
Plan administrator’s name BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC
Plan administrator’s address 42 PARK PLACE, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017290080

Signature of
Role Employer/plan sponsor
Date 2010-10-08
Name of individual signing WILLIAM RUSH
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DON E. WINEBERG Agent CHACE RUTTENBERG & FREEDMAN LLP ONE PARK ROW SUITE 300, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
JOHN LEFRANCOIS PRESIDENT 156 BEAR HILL ROAD CUMBERLAND, RI 02868 USA

TREASURER

Name Role Address
NORM DEGUILIO TREASURER 61 COTTAGE STREET CENTRAL FALLS, RI 02863 USA

VICE PRESIDENT

Name Role Address
RAUL FIGUERO VICE PRESIDENT 437 NEWPORT AVENUE, APT 212 QUINCY, MA 02170 USA

ACTING SECRETARY

Name Role Address
JOHN LEFRANCOIS ACTING SECRETARY 156 BEAR HILL ROAD CUMBERLAND, RI 02868 USA

DIRECTOR

Name Role Address
MELINDA GAUDREAU DIRECTOR 185 MAUREEN CIRCLE MAPLEVILLE, RI 02839 USA
JOHN T. GANNON ESQ. DIRECTOR 46 WILTON AVENUE PAWTUCKET, RI 02861 USA
GABRIEL MARTINEZ DIRECTOR 142 OAKLAND AVENUE PAWTUCKET, RI 02861 USA
MARIO BUENO DIRECTOR 98 FLETCHER AVENUE CRANSTON, RI 02920 USA
ALBA FIGUEROA DIRECTOR 81 METCALF STREET PROVIDENCE, RI 02904 USA
ANGELA PESARE DIRECTOR 20 STEPHEN STREET GREENVILLE, RI 02808 USA

Events

Type Date Old Value New Value
Merged 1993-06-18 CHAMBER OF COMMERCE REALTY, INC. on Blackstone Valley Community Health Care, Inc.
Name Change 1990-01-02 Pawtucket Neighborhood Health Center, Incorporated Blackstone Valley Community Health Care, Inc.
Name Change 1984-07-03 Pawtucket Neighborhood Health Centers Pawtucket Neighborhood Health Center, Incorporated

Filings

Number Name File Date
202446575900 Annual Report 2024-02-16
202328103450 Annual Report 2023-02-10
202211879400 Fictitious Business Name Statement 2022-03-01
202211848550 Annual Report - Amended 2022-03-01
202208764270 Annual Report 2022-01-27
202197814240 Annual Report 2021-06-04
202197803910 Annual Report - Amended 2021-06-04
202041315370 Annual Report 2020-06-02
202034254930 Statement of Change of Registered/Resident Agent 2020-02-12
202034110740 Annual Report 2020-02-10

Related by officers

DON E. WINEBERG

Rhode Island Medical Imaging, Inc. ROBERT J. WILSON HOUSE, INC. CASA FABRICS, INC. MELCOR, INC. Preferred Laboratories, Inc. CIVN, Inc. The Rhode Island Public Health Foundation SSHM Management Services Organization, Inc. MedSpan, Inc. MARILABS, INC.

JOHN LEFRANCOIS

Rhode Island State Championships at the City ofCentral Falls Antique & Custom Car Show BVCHC Support Corporation

GABRIEL MARTINEZ

The Columbian-American Cultural Society, Inc. Broad Market LLC

MARIO BUENO

R. I. INSTITUTE FOR LABOR STUDIES AND RESEARCH

ALBA FIGUEROA

RI Puerto Ricans: Empowered & United

Related by address

39 EAST AVENUE, PAWTUCKET, RI, 02860, USA

eCHC

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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