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  5. Marc A. Jaffe, M.D., Inc.

Marc A. Jaffe, M.D., Inc.

Company Details

Name: Marc A. Jaffe, M.D., Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 08 Aug 1989 (35 years ago)
Date of Dissolution: 31 Dec 2021 (3 years ago)
Date of Status Change: 31 Dec 2021 (3 years ago)
Identification Number: 000056989
ZIP code: 02806
County: Bristol County
Principal Address: 36 MALLARD COVE WAY, BARRINGTON, RI, 02806, USA
Purpose: MEDICAL PRACTICE
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2020 050447910 2021-01-09 MARC A. JAFFE, M.D., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address PO BOX 53, BARRINGTON, RI, 02806

Signature of
Role Plan administrator
Date 2021-01-09
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2019 050447910 2020-06-20 MARC A. JAFFE, M.D., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2020-06-20
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2018 050447910 2019-09-20 MARC A. JAFFE, M.D., INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2019-09-20
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2017 050447910 2018-06-11 MARC A. JAFFE, M.D., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2018-06-11
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2016 050447910 2017-09-19 MARC A. JAFFE, M.D., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2017-09-19
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2015 050447910 2016-09-15 MARC A. JAFFE, M.D., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2016-09-15
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2014 050447910 2015-10-01 MARC A. JAFFE, M.D., INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2015-10-01
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2013 050447910 2014-09-26 MARC A. JAFFE, M.D., INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2014-09-26
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2012 050447910 2013-09-12 MARC A. JAFFE, M.D., INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2013-09-12
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
MARC A. JAFFE, M.D., INC. PROFIT SHARING PLAN 2011 050447910 2012-10-03 MARC A. JAFFE, M.D., INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2012-10-03
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/05/12/20110512154207P030009621094001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2011-05-12
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-05-12
Name of individual signing MARC A. JAFFE, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/08/06/20100806145305P040020938308001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 621111
Sponsor’s telephone number 4014383300
Plan sponsor’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915

Plan administrator’s name and address
Administrator’s EIN 050447910
Plan administrator’s name MARC A. JAFFE, M.D., INC.
Plan administrator’s address 38 AMARAL STREET, EAST PROVIDENCE, RI, 02915
Administrator’s telephone number 4014383300

Signature of
Role Plan administrator
Date 2010-08-06
Name of individual signing MARC A. JAFFE, MD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
STEPHEN M. LITWIN, ESQ. Agent 116 ORANGE STREET, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
MARC A JAFFE MD PRESIDENT 36 MALLARD COVE WAY BARRINGTON, RI 02806 USA

Filings

Number Name File Date
202107537470 Articles of Dissolution 2021-12-31
202197121500 Annual Report 2021-05-21
202196751230 Revocation Notice For Failure to File An Annual Report 2021-05-19
202063985610 Annual Report - Amended 2020-10-13
202034006610 Annual Report 2020-02-07
201985177390 Annual Report 2019-01-24
201857032480 Annual Report 2018-01-25
201740124140 Statement of Change of Registered Office by the Registered Agent 2017-04-06
201730683280 Annual Report 2017-01-23
201691634680 Annual Report 2016-02-01

Related by officers

STEPHEN M. LITWIN, ESQ.

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Related by address

No related companies by address

Date of last update: 07 Oct 2024

Sources: Rhode Island Department of State

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