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  5. SOUTH COUNTY INTERNAL MEDICINE, INC.

SOUTH COUNTY INTERNAL MEDICINE, INC.

Company Details

Name: SOUTH COUNTY INTERNAL MEDICINE, INC.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 07 Jul 1992 (33 years ago)
Identification Number: 000068930
ZIP code: 02879
County: Washington County
Principal Address: 481 KINGSTOWN ROAD, WAKEFIELD, RI, 02879, USA
Purpose: TO OWN AND OPERATE A BUSINESS ENGAGED IN THE PRACTICE OF INTERNAL MEDICINE.
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1215946827 2006-08-05 2017-04-26 481 KINGSTOWN RD, WAKEFIELD, RI, 028793626, US 481 KINGSTOWN RD, WAKEFIELD, RI, 028793626, US

Contacts
Phone +1 401-789-0283
Fax 4017890314

Authorized person
Name SHARIN M GUERRIERI
Role MANAGER ENROLLMENT
Phone 4017890283

Taxonomy
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH COUNTY INTERNAL MEDICINE 401(K) PROFIT SHARING PLAN & TRUST 2023 050465994 2024-05-25 SOUTH COUNTY INTERNAL MEDICINE 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2024-05-25
Name of individual signing PAUL BARRATT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY INTERNAL MEDICINE 401(K) PROFIT SHARING PLAN & TRUST 2022 050465994 2023-03-29 SOUTH COUNTY INTERNAL MEDICINE 48
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2023-03-29
Name of individual signing DAWN BUCKLEY
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY INTERNAL MEDICINE 401(K) PROFIT SHARING PLAN & TRUST 2021 050465994 2022-05-28 SOUTH COUNTY INTERNAL MEDICINE 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2022-05-28
Name of individual signing DAWN BUCKLEY
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY INTERNAL MEDICINE 401(K) PROFIT SHARING PLAN & TRUST 2020 050465994 2021-07-04 SOUTH COUNTY INTERNAL MEDICINE 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2021-07-04
Name of individual signing DAWN BUCKLEY
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY INTERNAL MEDICINE 401(K) PROFIT SHARING PLAN & TRUST 2019 050465994 2020-05-28 SOUTH COUNTY INTERNAL MEDICINE 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2020-05-28
Name of individual signing KRISTEN COUTURIER
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY INTERNAL MEDICINE 401 K PROFIT SHARING PLAN TRUST 2018 050465994 2019-07-05 SOUTH COUNTY INTERNAL MEDICINE 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2019-07-05
Name of individual signing PAUL F BARRATT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY INTERNAL MEDICINE 401 K PROFIT SHARING PLAN TRUST 2017 050465994 2018-07-03 SOUTH COUNTY INTERNAL MEDICINE 41
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2018-07-03
Name of individual signing PAUL F BARRATT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY INTERNAL MEDICINE 401 K PROFIT SHARING PLAN TRUST 2016 050465994 2017-06-23 SOUTH COUNTY INTERNAL MEDICINE 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2017-06-23
Name of individual signing PAUL F BARRATT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY INTERNAL MEDICINE 401 K PROFIT SHARING PLAN TRUST 2015 050465994 2016-06-21 SOUTH COUNTY INTERNAL MEDICINE 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2016-06-21
Name of individual signing PAUL F BARRATT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY INTERNAL MEDICINE 401 K PROFIT SHARING PLAN TRUST 2014 050465994 2015-07-13 SOUTH COUNTY INTERNAL MEDICINE 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017820429
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2015-07-13
Name of individual signing PAUL F BARRATT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/13/20140613080136P030384339811001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017833332
Plan sponsor’s address 481 KINGSTOWN RD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2014-06-13
Name of individual signing PAUL F. BARRATT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/06/17/20130617135726P040091467429001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017833332
Plan sponsor’s address 481 KINGSTOWN RD, WAKEFIELD, RI, 028793626

Signature of
Role Plan administrator
Date 2013-06-17
Name of individual signing SOUTH COUNTY INTERNAL MEDICINE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/25/20120725080721P040035026112001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017833332
Plan sponsor’s address 481 KINGSTOWN RD, WAKEFIELD, RI, 028793626

Plan administrator’s name and address
Administrator’s EIN 050465994
Plan administrator’s name SOUTH COUNTY INTERNAL MEDICINE
Plan administrator’s address 481 KINGSTOWN RD, WAKEFIELD, RI, 028793626
Administrator’s telephone number 4017833332

Signature of
Role Plan administrator
Date 2012-07-25
Name of individual signing SOUTH COUNTY INTERNAL MEDICINE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/06/23/20110623131500P030382904256001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017833332
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Plan administrator’s name and address
Administrator’s EIN 050465994
Plan administrator’s name SOUTH COUNTY INTERNAL MEDICINE
Plan administrator’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626
Administrator’s telephone number 4017833332

Signature of
Role Plan administrator
Date 2011-06-23
Name of individual signing SOUTH COUNTY INTERNAL MEDICINE
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/07/23/20100723081416P030021311364001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-01-10
Business code 621111
Sponsor’s telephone number 4017833332
Plan sponsor’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626

Plan administrator’s name and address
Administrator’s EIN 050465994
Plan administrator’s name SOUTH COUNTY INTERNAL MEDICINE
Plan administrator’s address 481 KINGSTOWN ROAD, WAKEFIELD, RI, 028793626
Administrator’s telephone number 4017833332

Signature of
Role Plan administrator
Date 2010-07-23
Name of individual signing SOUTH COUNTY INTERNAL MEDICINE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PAUL F. BARRATT Agent 481 KINGSTOWN ROAD, WAKEFIELD, RI, 02879, USA

TREASURER

Name Role Address
TIMOTHY O'MARA MD TREASURER 481 KINGSTOWN ROAD WAKEFIELD, RI 02879 USA

SECRETARY

Name Role Address
LETITIA HORRIGAN DO SECRETARY 481 KINGSTOWN ROAD WAKEFIELD, RI 02879 USA

PRESIDENT

Name Role Address
PAUL F. BARRATT MD PRESIDENT 481 KINGSTOWN ROAD WAKEFIELD, RI 02879 USA

VICE PRESIDENT

Name Role Address
NITIN DAMLE MD VICE PRESIDENT 481 KINGSTOWN ROAD WAKEFIELD, RI 02879 USA

Filings

Number Name File Date
202445451980 Annual Report 2024-02-03
202330435240 Annual Report 2023-03-09
202330340760 Statement of Change of Registered/Resident Agent 2023-03-09
202211297880 Annual Report 2022-02-17
202192444000 Annual Report 2021-02-18
202077281210 Statement of Change of Registered/Resident Agent 2020-11-23
202033706610 Annual Report 2020-02-03
201985556410 Annual Report 2019-01-30
201985556870 Statement of Change of Registered/Resident Agent 2019-01-30
201858292810 Annual Report 2018-02-12

Related by officers

LETITIA HORRIGAN DO

The Rhode Island Society of Osteopathic Physicians and Surgeons

Related by address

481 KINGSTOWN ROAD, WAKEFIELD, RI, 02879, USA

BERTRAM, GIBBES, Ph.D, INC

Date of last update: 07 Oct 2024

Sources: Rhode Island Department of State

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