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  5. METACOM MEDICAL ASSOCIATES, INC.

METACOM MEDICAL ASSOCIATES, INC.

Company Details

Name: METACOM MEDICAL ASSOCIATES, INC.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Dissolved
Date of Organization in Rhode Island: 10 Nov 1994 (30 years ago)
Date of Dissolution: 01 Feb 2018 (7 years ago)
Date of Status Change: 01 Feb 2018 (7 years ago)
Identification Number: 000081929
ZIP code: 02885
County: Bristol County
Principal Address: 639 METACOM AVENUE, WARREN, RI, 02885, USA
Purpose: TO RENDER PROFESSIONAL SERVICES BY PERSONS AUTHORIZED TO PRACTICE MEDICINE IN RHODE ISLAND

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1326149170 2006-09-26 2008-03-03 639 METACOM AVE, WARREN, RI, 02885, US 639 METACOM AVE, WARREN, RI, 02885, US

Contacts
Phone +1 401-245-1500
Fax 4012472618

Authorized person
Name FRANK AMALFITANO
Role TREASURER
Phone 4012451500

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

Other Provider Identifiers
Issuer MEDICAID
Number 9002628
State RI
Issuer BLUE CHIP GROUP NUMBER
Number 204049
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
METACOM MEDICAL ASSOCIATES, INC. 401(K) PLAN 2015 050480913 2016-05-23 METACOM MEDICAL ASSOCIATES, INC. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4012451500
Plan sponsor’s address 639 METACOM AVENUE, WARREN, RI, 02885

Signature of
Role Plan administrator
Date 2016-05-23
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-23
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
METACOM MEDICAL ASSOCIATES, INC. 401(K) PLAN 2015 050480913 2016-02-04 METACOM MEDICAL ASSOCIATES, INC. 20
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4012451500
Plan sponsor’s address 639 METACOM AVENUE, WARREN, RI, 02885

Signature of
Role Plan administrator
Date 2016-02-04
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-02-04
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
METACOM MEDICAL ASSOCIATES, INC. 401(K) PLAN 2014 050480913 2015-04-28 METACOM MEDICAL ASSOCIATES, INC. 21
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4012451500
Plan sponsor’s address 639 METACOM AVENUE, WARREN, RI, 02885

Signature of
Role Plan administrator
Date 2015-04-28
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-28
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
METACOM MEDICAL ASSOCIATES, INC. 401(K) PLAN 2013 050480913 2014-06-20 METACOM MEDICAL ASSOCIATES, INC. 20
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4012451500
Plan sponsor’s address 639 METACOM AVENUE, WARREN, RI, 02885

Signature of
Role Plan administrator
Date 2014-06-20
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-20
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
METACOM MEDICAL ASSOCIATES, INC. 401(K) PLAN 2012 050480913 2013-06-21 METACOM MEDICAL ASSOCIATES, INC. 24
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4012451500
Plan sponsor’s address 639 METACOM AVENUE, WARREN, RI, 02885

Signature of
Role Plan administrator
Date 2013-06-21
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-21
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
METACOM MEDICAL ASSOCIATES, INC. 401(K) PLAN 2011 050480913 2012-04-10 METACOM MEDICAL ASSOCIATES, INC. 23
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4012451500
Plan sponsor’s address 639 METACOM AVENUE, WARREN, RI, 02885

Plan administrator’s name and address
Administrator’s EIN 050480913
Plan administrator’s name METACOM MEDICAL ASSOCIATES, INC.
Plan administrator’s address 639 METACOM AVENUE, WARREN, RI, 02885
Administrator’s telephone number 4012451500

Signature of
Role Plan administrator
Date 2012-04-10
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-04-10
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
METACOM MEDICAL ASSOCIATES, INC. 401(K) PLAN 2010 050480913 2011-04-11 METACOM MEDICAL ASSOCIATES, INC. 24
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4012451500
Plan sponsor’s address 639 METACOM AVENUE, WARREN, RI, 02885

Plan administrator’s name and address
Administrator’s EIN 050480913
Plan administrator’s name METACOM MEDICAL ASSOCIATES, INC.
Plan administrator’s address 639 METACOM AVENUE, WARREN, RI, 02885
Administrator’s telephone number 4012451500

Signature of
Role Plan administrator
Date 2011-04-11
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-04-11
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
METACOM MEDICAL ASSOCIATES, INC. 401(K) PLAN 2009 050480913 2010-08-12 METACOM MEDICAL ASSOCIATES, INC. 22
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1994-01-01
Business code 621111
Sponsor’s telephone number 4012451500
Plan sponsor’s address 639 METACOM AVENUE, WARREN, RI, 02885

Plan administrator’s name and address
Administrator’s EIN 050480913
Plan administrator’s name METACOM MEDICAL ASSOCIATES, INC.
Plan administrator’s address 639 METACOM AVENUE, WARREN, RI, 02885
Administrator’s telephone number 4012451500

Signature of
Role Plan administrator
Date 2010-08-12
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-12
Name of individual signing FRANK AMALFITANO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
BRUCE A. WOLPERT, ESQ. Agent 10 DORRANCE STREET SUITE 530, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
PAUL T MARCACCIO MD PRESIDENT 639 METACOM AVENUE WARREN, RI 02885 USA

Filings

Number Name File Date
201857219700 Articles of Dissolution 2018-02-01
201730940400 Annual Report 2017-01-26
201691014860 Annual Report 2016-01-19
201553970950 Annual Report 2015-01-20
201433789450 Annual Report 2014-01-21
201310443550 Annual Report 2013-01-25
201288419520 Annual Report 2012-01-23
201174205130 Annual Report 2011-01-28
201057380200 Annual Report 2010-01-25
200942140680 Annual Report 2009-02-09

Related by officers

BRUCE A. WOLPERT, ESQ.

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Related by address

639 METACOM AVENUE, WARREN, RI, 02885, USA

TRIM TIME, INC. 639 REALTY ASSOCIATES, LLC

Date of last update: 07 Oct 2024

Sources: Rhode Island Department of State

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