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  5. ALPINE NURSING HOME, INC.

ALPINE NURSING HOME, INC.

Company Details

Name: ALPINE NURSING HOME, INC.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 05 Jul 1990 (35 years ago)
Identification Number: 000061014
ZIP code: 02816
County: Kent County
Principal Address: 557 WEAVER HILL ROAD P.O. BOX 557, COVENTRY, RI, 02816, USA
Purpose: BUSINESS OF A REST HOME
NAICS: 623110 - Nursing Care Facilities (Skilled Nursing Facilities)
Fictitious names: ALPINE REST HOME (trading name, 1995-06-14 - )
Historical names: ALPINE REST HOME, INC.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1316915580 2006-03-14 2024-10-07 557 WEAVER HILL RD, PO BOX 457, COVENTRY, RI, 028164654, US 557 WEAVER HILL RD, COVENTRY, RI, 028164654, US

Contacts
Phone +1 401-397-5001

Authorized person
Name MR. RODNEY GAUVIN
Role ADMINISTRATOR
Phone 4013975001

Taxonomy
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number 689
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 4105089
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ALPINE REST HOME 401(K) PROFIT SHARING PLAN AND TRUST 2023 050365908 2024-07-15 ALPINE REST HOME 71
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address 557 WEAVER HILL RD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2024-07-15
Name of individual signing RODNEY GAUVIN
Valid signature Filed with authorized/valid electronic signature
ALPINE REST HOME 401(K) PROFIT SHARING PLAN AND TRUST 2022 050365908 2023-07-18 ALPINE REST HOME 100
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address 557 WEAVER HILL RD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2023-07-18
Name of individual signing RODNEY GAUVIN
Valid signature Filed with authorized/valid electronic signature
ALPINE REST HOME 401(K) PROFIT SHARING PLAN AND TRUST 2021 050365908 2022-07-06 ALPINE REST HOME 100
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address 557 WEAVER HILL ROAD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2022-07-06
Name of individual signing KYLE GAUVIN
Valid signature Filed with authorized/valid electronic signature
ALPINE REST HOME 401(K) PROFIT SHARING PLAN AND TRUST 2020 050365908 2021-07-06 ALPINE REST HOME 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address 557 WEAVER HILL ROAD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2021-07-06
Name of individual signing RODNEY GAUVIN
Valid signature Filed with authorized/valid electronic signature
ALPINE REST HOME 401(K) PROFIT SHARING PLAN AND TRUST 2019 050365908 2020-06-16 ALPINE REST HOME 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address 557 WEAVER HILL ROAD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2020-06-16
Name of individual signing KYLE GAUVIN
Valid signature Filed with authorized/valid electronic signature
ALPINE REST HOME 401 K PROFIT SHARING PLAN TRUST 2018 050365908 2019-03-26 ALPINE REST HOME 75
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address 557 WEAVER HILL RD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2019-03-26
Name of individual signing RODNEY GAUVIN
Valid signature Filed with authorized/valid electronic signature
ALPINE REST HOME 401 K PROFIT SHARING PLAN TRUST 2017 050365908 2018-07-06 ALPINE REST HOME 90
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address 557 WEAVER HILL RD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2018-07-06
Name of individual signing RODNEY GAUVIN
Valid signature Filed with authorized/valid electronic signature
ALPINE REST HOME 401 K PROFIT SHARING PLAN TRUST 2016 050365908 2017-06-08 ALPINE REST HOME 97
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4014975001
Plan sponsor’s address 557 WEAVER HILL RD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2017-06-08
Name of individual signing RODNEY J. GAUVIN
Valid signature Filed with authorized/valid electronic signature
ALPINE NURSING HOME INC 401 K PROFIT SHARING PLAN TRUST 2015 050365908 2016-07-20 ALPINE REST HOME 86
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address 557 WEAVER HILL RD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2016-07-20
Name of individual signing RODNEY GAUVIN
Valid signature Filed with authorized/valid electronic signature
ALPINE NURSING HOME INC 401 K PROFIT SHARING PLAN TRUST 2014 050365908 2015-07-20 ALPINE REST HOME 80
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4014975001
Plan sponsor’s address 557 WEAVER HILL RD, PO BOX #457, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2015-07-20
Name of individual signing RODNEY GAUVIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/08/20141008102434P040014017679001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address 557 WEAVER HILL RD, COVENTRY, RI, 02816

Signature of
Role Plan administrator
Date 2014-10-08
Name of individual signing RODNEY GAUVIN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/26/20130726102457P040322358579001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address P.O. BOX 457, 557 WEAVER HILL ROAD, COVENTRY, RI, 02816

Plan administrator’s name and address
Administrator’s EIN 050365908
Plan administrator’s name ALPINE NURSING HOME, INC.
Plan administrator’s address P.O. BOX 457, 557 WEAVER HILL ROAD, COVENTRY, RI, 02816
Administrator’s telephone number 4013975001

Signature of
Role Plan administrator
Date 2013-07-26
Name of individual signing SUSAN WILKIE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/19/20120619150826P030003866406001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address P.O. BOX 457, 557 WEAVER HILL ROAD, COVENTRY, RI, 02816

Plan administrator’s name and address
Administrator’s EIN 050365908
Plan administrator’s name ALPINE NURSING HOME, INC.
Plan administrator’s address P.O. BOX 457, 557 WEAVER HILL ROAD, COVENTRY, RI, 02816
Administrator’s telephone number 4013975001

Signature of
Role Plan administrator
Date 2012-06-19
Name of individual signing SUSAN WILKIE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/10/20110610140431P040344491568001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address P.O. BOX 457, 557 WEAVER HILL ROAD, COVENTRY, RI, 02816

Plan administrator’s name and address
Administrator’s EIN 050365908
Plan administrator’s name ALPINE NURSING HOME, INC.
Plan administrator’s address P.O. BOX 457, 557 WEAVER HILL ROAD, COVENTRY, RI, 02816
Administrator’s telephone number 4013975001

Signature of
Role Plan administrator
Date 2011-06-10
Name of individual signing SUSAN WILKIE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/05/11/20100511162817P030250156241001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 623000
Sponsor’s telephone number 4013975001
Plan sponsor’s address P.O. BOX 457, 557 WEAVER HILL ROAD, COVENTRY, RI, 02816

Plan administrator’s name and address
Administrator’s EIN 050365908
Plan administrator’s name ALPINE NURSING HOME, INC.
Plan administrator’s address P.O. BOX 457, 557 WEAVER HILL ROAD, COVENTRY, RI, 02816
Administrator’s telephone number 4013975001

Signature of
Role Plan administrator
Date 2010-05-11
Name of individual signing SUSAN WILKIE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-05-11
Name of individual signing SUSAN WILKIE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
HASLAW, INC. Agent 100 WESTMINSTER STREET SUITE 1500 C/O HINCKLEY ALLEN & SNYDER LLP, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
RODNEY J GAUVIN PRESIDENT 38 UPLAND AVENUE EAST GREENWICH, RI 02818 USA

TREASURER

Name Role Address
RODNEY J GAUVIN TREASURER 38 UPLAND AVENUE EAST GREENWICH, RI 02818 USA

SECRETARY

Name Role Address
JANET MESSIER SECRETARY 11 PAULINE STREET WEST WARWICK, RI 02893 USA

VICE PRESIDENT

Name Role Address
SUSAN WILKIE VICE PRESIDENT 3 CONANICUS AVENUE JAMESTOWN, RI 02835 USA

DIRECTOR

Name Role Address
JANET MESSIER DIRECTOR 11 PAULINE STREET WEST WARWICK, RI 02893 USA
SUSAN WILKIE DIRECTOR 3 CONANICUS AVENUE JAMESTOWN, RI 02835 USA
RODNEY J GAUVIN DIRECTOR 38 UPLAND AVENUE EAST GREENWICH, RI 02818 USA

Events

Type Date Old Value New Value
Name Change 1995-06-14 ALPINE REST HOME, INC. ALPINE NURSING HOME, INC.

Filings

Number Name File Date
202455097400 Annual Report 2024-05-30
202327935520 Annual Report 2023-02-08
202327933850 Statement of Change of Registered/Resident Agent 2023-02-08
202221497070 Statement of Change of Registered/Resident Agent Office 2022-07-20
202213632850 Annual Report 2022-03-28
202189134970 Annual Report 2021-02-02
202036889770 Annual Report 2020-03-27
201989561500 Annual Report 2019-03-30
201861196310 Annual Report 2018-03-29
201738954490 Annual Report 2017-03-27

Related by officers

HASLAW, INC.

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RODNEY J GAUVIN

ALPINE HEALTH CARE, L.L.C.

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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