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  5. Kent County Memorial Hospital

Kent County Memorial Hospital

Company Details

Name: Kent County Memorial Hospital
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 25 Apr 1946 (79 years ago)
Identification Number: 000031486
ZIP code: 02886
County: Kent County
Principal Address: 455 TOLL GATE ROAD, WARWICK, RI, 02886, USA
Purpose: ENACTED BY THE GENERAL ASSEMBLY DURING THE JANUARY SESSION OF 1946 EFFECTIVE 04/25/1946. NON PROFIT COMMUNITY HOSPITAL JANUARY SESSION 1946
NAICS: 622110 - General Medical and Surgical Hospitals
Fictitious names: Kent Hospital (trading name, 2015-08-26 - )
Kent Hospitalists (trading name, 1999-06-08 - )
Kent Primary Care Associates (trading name, 1999-06-08 - )
Historical names: KENT COUNTY MEMORIAL HOSPITAL

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1922621614 2020-05-28 2020-05-28 455 TOLL GATE RD, WARWICK, RI, 028862759, US 455 TOLL GATE RD, WARWICK, RI, 028862759, US

Contacts
Phone +1 401-737-7000

Authorized person
Name HEATHER-ROSE MATTIAS
Role DIRECTOR CONTRACT ADMINISTRATION
Phone 4019218535

Taxonomy
Taxonomy Code 291U00000X - Clinical Medical Laboratory
Is Primary Yes

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
549300YH7OVBZIIB8I51 000031486 US-RI GENERAL ACTIVE No data

Addresses
Legal C/O Joseph A. Dipietro, Esq, 455 Toll Gate Road, Warwick, US-RI, US, 02886
Headquarters C/O Joseph A. Dipietro, Esq, 455 Toll Gate Road, Warwick, US-RI, US, 02886

Registration details
Registration Date 2013-08-22
Last Update 2023-08-04
Status LAPSED
Next Renewal 2014-08-22
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 000031486

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KENT COUNTY MEMORIAL HOSPITAL 401(K) PROFIT SHARING PLAN & TRUST 2020 056013557 2022-06-08 KENT COUNTY MEMORIAL HOSPITAL 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 522130
Sponsor’s telephone number 4017377010
Plan sponsor’s address 455 TOLL GATE RD., WARWICK, RI, 028862759

Plan administrator’s name and address
Administrator’s EIN 050125860
Plan administrator’s name NAVIGANT CREDIT UNION C/O JEFF LEMOS
Plan administrator’s address 1005 DOUGLAS PIKE, SMITHFIELD, RI, 029171206
Administrator’s telephone number 4012334304

Signature of
Role Plan administrator
Date 2022-06-08
Name of individual signing JEFFREY P. LEMOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-08
Name of individual signing JEFFREY P LEMOS
Valid signature Filed with authorized/valid electronic signature
KENT COUNTY MEMORIAL HOSPITAL 401(K) PROFIT SHARING PLAN & TRUST 2019 056013557 2020-10-15 KENT COUNTY MEMORIAL HOSPITAL 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 522130
Sponsor’s telephone number 4017377010
Plan sponsor’s address KENT HOSPITAL CREDIT UNION, 455 TOLL GATE RD, WARWICK, RI, 028862759

Signature of
Role Plan administrator
Date 2020-10-15
Name of individual signing JEFFREY LEMOS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-10-15
Name of individual signing JEFFREY LEMOS
Valid signature Filed with authorized/valid electronic signature
KENT COUNTY MEMORIAL HOSPITAL 401 K PROFIT SHARING PLAN TRUST 2018 056013557 2019-07-31 KENT COUNTY MEMORIAL HOSPITAL 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 522130
Sponsor’s telephone number 4017377010
Plan sponsor’s address KENT HOSPITAL CREDIT UNION, ATT GENE LECO 455 TOLL GATE RD, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2019-07-31
Name of individual signing EUGENE LECO
Valid signature Filed with authorized/valid electronic signature
KENT COUNTY MEMORIAL HOSPITAL 401 K PROFIT SHARING PLAN TRUST 2017 056013557 2018-08-15 KENT COUNTY MEMORIAL HOSPITAL 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 522130
Sponsor’s telephone number 4017377010
Plan sponsor’s address KENT HOSPITAL CREDIT UNION, ATT GENE LECO 455 TOLL GATE RD, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2018-08-15
Name of individual signing EUGENE LECO
Valid signature Filed with authorized/valid electronic signature
KENT COUNTY MEMORIAL HOSPITAL 401 K PROFIT SHARING PLAN TRUST 2015 056013557 2016-07-28 KENT COUNTY MEMORIAL HOSPITAL 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 522130
Sponsor’s telephone number 4017377010
Plan sponsor’s address KENT HOSPITAL CREDIT UNION, ATT GENE LECO 455 TOLL GATE RD, WARWICK, RI, 028862770

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing EUGENE LECO
Valid signature Filed with authorized/valid electronic signature
KENT COUNTY MEMORIAL HOSPITAL 401 K PROFIT SHARING PLAN TRUST 2014 056013557 2015-07-27 KENT COUNTY MEMORIAL HOSPITAL 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 522130
Sponsor’s telephone number 4017377010
Plan sponsor’s address KENT HOSPITAL CREDIT UNION, ATT GENE LECO 455 TOLL GATE RD, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2015-07-27
Name of individual signing EUGENE LECO
Valid signature Filed with authorized/valid electronic signature
KENT COUNTY MEMORIAL HOSPITAL 401 K PROFIT SHARING PLAN TRUST 2013 056013557 2014-08-07 KENT COUNTY MEMORIAL HOSPITAL 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 522130
Sponsor’s telephone number 4017377010
Plan sponsor’s address KENT HOSPITAL CREDIT UNION, ATT GENE LECO 455 TOLL GATE RD, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2014-08-07
Name of individual signing EUGENE LECO
Valid signature Filed with authorized/valid electronic signature
KENT COUNTY MEMORIAL HOSPITAL 401 K PROFIT SHARING PLAN TRUST 2012 056013557 2013-07-15 KENT COUNTY MEMORIAL HOSPITAL 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 522130
Sponsor’s telephone number 4017377010
Plan sponsor’s address KENT HOSPITAL CREDIT UNION, ATT GENE LECO 455 TOLL GATE RD, WARWICK, RI, 02886

Signature of
Role Plan administrator
Date 2013-07-15
Name of individual signing KENT COUNTY MEMORIAL HOSPITAL
Valid signature Filed with authorized/valid electronic signature
KENT COUNTY MEMORIAL HOSPITAL 401 K PROFIT SHARING PLAN TRUST 2011 056013557 2012-07-31 KENT COUNTY MEMORIAL HOSPITAL 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 522130
Sponsor’s telephone number 4017377010
Plan sponsor’s address KENT HOSPITAL CREDIT UNION, ATT GENE LECO 455 TOLL GATE RD, WARWICK, RI, 02886

Plan administrator’s name and address
Administrator’s EIN 056013557
Plan administrator’s name KENT COUNTY MEMORIAL HOSPITAL
Plan administrator’s address KENT HOSPITAL CREDIT UNION, ATT GENE LECO 455 TOLL GATE RD, WARWICK, RI, 02886
Administrator’s telephone number 4017377010

Signature of
Role Plan administrator
Date 2012-07-31
Name of individual signing KENT COUNTY MEMORIAL HOSPITAL
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
SUZANNE DUNI BRIGGS, JD,RN,BSN Agent 455 TOLL GATE ROAD RISK MANAGEMENT DEPT., WARWICK, RI, 02886, USA

SECRETARY

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

DIRECTOR

Name Role Address
R. STEPHEN MANTY DIRECTOR 110 ROYAL LITTLE DRIVE PROVIDENCE, RI 02904 USA
JUDITH REMONDI DIRECTOR 258 BRIDLE TRAIL ROAD NEEDHAM, MA 02492 USA
KEVIN BAILL MD DIRECTOR 345 BLACKSTONE BLVD PROVIDENCE, RI 02906 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
CHARLES R REPPUCCI DIRECTOR 215 SUNNYBROOK FARM ROAD NARRAGANSETT, RI 02882 USA
ANA TUYA FULTON MD DIRECTOR 4 RICHMOND SQUARE PROVIDENCE, RI 02906 USA
PATRICK J. MURRAY, JR. DIRECTOR 255 BOXWOOD LANE BRIDGEWATER, MA 02324 USA
MARIBETH WILLIAMSON DIRECTOR 450 WAKEFIELD STREET WEST WARWICK, RI 02893 USA
JOSEPH J. MCGAIR, ESQ. DIRECTOR 92 SANDY LANE WARWICK, RI 02889 USA

ASSISTANT SECRETARY

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

PRESIDENT

Name Role Address
PAARI GOPALAKRISHNAN MD PRESIDENT 455 TOLL GATE ROAD WARWICK, RI 02886 USA

TREASURER

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

EX OFFICIO DIRECTOR

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

ASSISTANT TREASURER

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

CHAIRPERSON

Name Role Address
GARY E. FURTADO CHAIRPERSON 15 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
Name Change 1974-11-01 KENT COUNTY MEMORIAL HOSPITAL Kent County Memorial Hospital
Merged 1974-11-01 Providence Floating Hospital Association Kent County Memorial Hospital

Filings

Number Name File Date
202450605510 Annual Report 2024-04-10
202330163530 Annual Report 2023-03-08
202213264150 Annual Report 2022-03-22
202198180560 Annual Report 2021-06-11
202078361290 Annual Report 2020-12-03
201921926710 Statement of Change of Registered/Resident Agent 2019-10-01
201996116700 Annual Report 2019-06-10
201995476670 Statement of Change of Registered/Resident Agent 2019-06-05
201870270450 Annual Report 2018-06-22
201863120340 Statement of Change of Registered/Resident Agent 2018-04-30

Related by officers

JAMES BOTVIN

COLONIAL LEASING INC. COLONIAL MOTOR SALES, INC. Cove Condominium Association, Inc. KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital The Providence Center, Inc. Women & Infants Hospital of Rhode Island Butler Hospital Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM

R. STEPHEN MANTY

KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island Butler Hospital Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. HealthTouch, Inc. AAA Auto Glass, Inc. Auto Glass TPA, Inc.

JUDITH REMONDI

KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island Butler Hospital Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. HealthTouch, Inc. Tikkun Mobile Healthcare Care New England Ambulatory Surgery Center

KEVIN BAILL MD

KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island Butler Hospital Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. HealthTouch, Inc. Butler Hospital Foundation INTEGRA COMMUNITY CARE NETWORK, LLC

ASHLEY TAYLOR ESQ.

The Memorial Hospital HealthTouch, Inc. Care New England Ambulatory Surgery Center

PAARI GOPALAKRISHNAN MD

Kent Hospital Foundation KENT ANCILLARY SERVICES, LLC

CAROLYNN MASTERS PH.D., RN

KENT COUNTY VISITING NURSE ASSOCIATION Women & Infants Hospital of Rhode Island Butler Hospital Women & Infants Corporation Southeastern Healthcare System, Inc. Care New England Ambulatory Surgery Center

PETER R. PHILLIPS

KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island Butler Hospital Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. HealthTouch, Inc. Care New England Ambulatory Surgery Center

CHARLES R REPPUCCI

Rhode Island Academic Health Care System, Inc.

MICHAEL WAGNER MD

HOSPITAL ASSOCIATION OF RHODE ISLAND HOSPITAL RESEARCH AND EDUCATION FOUNDATION OF RHODE ISLAND KENT COUNTY VISITING NURSE ASSOCIATION Grandview Realty Corporation The Memorial Hospital The Providence Center, Inc. STANDARD REALTY, INC. Women & Infants Hospital of Rhode Island Butler Hospital Primary Care Centers of New England, Inc.

TODD CONKLIN

KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island Butler Hospital Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. HealthTouch, Inc. SURFSIDE THAI FOOD LLC Care New England Ambulatory Surgery Center

ANA TUYA FULTON MD

HOSPITAL ASSOCIATION OF RHODE ISLAND KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island Butler Hospital Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. HealthTouch, Inc. Care New England Ambulatory Surgery Center

GARY E. FURTADO

KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. The Memorial Hospital Foundation Navigant Credit Union Charitable Foundation, Inc. Care New England Ambulatory Surgery Center Pine Theater Parking, Inc.

PATRICK J. MURRAY, JR.

KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. HealthTouch, Inc.

MARIBETH WILLIAMSON

KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island RHODE ISLAND ZOOLOGICAL SOCIETY Butler Hospital Women & Infants Corporation CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. HealthTouch, Inc. RIZS Properties, Inc.

JOSEPH J. MCGAIR, ESQ.

HARRINGTON FOOTWEAR, INC. KENT COUNTY VISITING NURSE ASSOCIATION The Memorial Hospital Women & Infants Hospital of Rhode Island Women & Infants Corporation Haines Park Improvement Ass'n., Inc. CARE NEW ENGLAND HEALTH SYSTEM Southeastern Healthcare System, Inc. HealthTouch, Inc. GLENWOOD PARK CONDOMINIUM, INC.

SHARON CONARD- WELLS

KENT COUNTY VISITING NURSE ASSOCIATION CARE NEW ENGLAND HEALTH SYSTEM HealthTouch, Inc. Care New England Ambulatory Surgery Center

Related by address

455 TOLL GATE ROAD, WARWICK, RI, 02886, USA

The Kent County Medical Society Kent County Health Services, Inc. Kent Hospital Foundation KENT ANCILLARY SERVICES, LLC Anesthesia Associates of Kent County, LLC CARE NEW ENGLAND PHARMACY, LLC

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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