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  5. PATRICK K. SULLIVAN M.D., LTD.

PATRICK K. SULLIVAN M.D., LTD.

Company Details

Name: PATRICK K. SULLIVAN M.D., LTD.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 23 May 1995 (30 years ago)
Identification Number: 000084493
ZIP code: 02905
County: Providence County
Principal Address: 235 PLAIN STREET SUITE 502, PROVIDENCE, RI, 02905, USA
Purpose: TO ENGAGE IN THE PRACTICE OF PLASTIC SURGERY.
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PATRICK K SULLIVAN M D LTD 401(K) PROFIT SHARING PLAN & TRUST 2022 050484627 2023-04-12 PATRICK K SULLIVAN M D LTD 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2023-04-12
Name of individual signing PATRICK SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
PATRICK K SULLIVAN M D LTD 401(K) PROFIT SHARING PLAN & TRUST 2021 050484627 2022-05-09 PATRICK K SULLIVAN M D LTD 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2022-05-09
Name of individual signing PATRICK SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
PATRICK K SULLIVAN M D LTD 401(K) PROFIT SHARING PLAN & TRUST 2020 050484627 2021-07-14 PATRICK K SULLIVAN M D LTD 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2021-07-14
Name of individual signing PATRICK SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
PATRICK K SULLIVAN M D LTD 401(K) PROFIT SHARING PLAN & TRUST 2019 050484627 2020-10-08 PATRICK K SULLIVAN M D LTD 8
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2020-10-08
Name of individual signing PATRICK SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
PATRICK K SULLIVAN M D LTD 401(K) PROFIT SHARING PLAN & TRUST 2019 050484627 2020-06-26 PATRICK K SULLIVAN M D LTD 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2020-06-26
Name of individual signing PATRICK SULLIVAN
Valid signature Filed with authorized/valid electronic signature
PATRICK K SULLIVAN, M.D. 401(K) PROFIT SHARING PLAN & TRUST 2018 050484627 2020-10-08 PATRICK K SULLIVAN M D LTD 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2020-10-08
Name of individual signing PATRICK SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
PATRICK K SULLIVAN, M.D. 401 K PROFIT SHARING PLAN TRUST 2018 050484627 2019-06-28 PATRICK K SULLIVAN M D LTD 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2019-06-28
Name of individual signing PATRICK SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
PATRICK K. SULLIVAN, M.D. 401 K PROFIT SHARING PLAN TRUST 2017 050484627 2019-06-28 PATRICK K. SULLIVAN M. D. LTD 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2019-06-28
Name of individual signing PATRICK SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
PATRICK K. SULLIVAN, M.D. 401(K) PROFIT SHARING PLAN & TRUST 2017 050484627 2020-10-08 PATRICK K. SULLIVAN M. D. LTD 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2020-10-08
Name of individual signing PATRICK SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
PATRICK K. SULLIVAN, M.D. 401 K PROFIT SHARING PLAN TRUST 2017 050484627 2018-07-02 PATRICK K. SULLIVAN M. D. LTD 7
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2018-07-02
Name of individual signing MAUREEN SULLIVAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/07/28/20170728150140P040073897569001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2017-07-28
Name of individual signing MAUREEN SULLIVAN
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2020/10/08/20201008155351NAL0015872128001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2020-10-08
Name of individual signing PATRICK SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/07/12/20160712173307P040022102925001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2016-07-12
Name of individual signing PATRICK K. SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/07/20/20150720140653P040101748119001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2015-07-20
Name of individual signing PATRICK K. SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/23/20140923122617P040005838237001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2014-09-23
Name of individual signing PATRICK K. SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/06/18/20130618160958P040092509957001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050430333
Plan administrator’s name PATRICK K. SULLIVAN, M.D., LTD.
Plan administrator’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905
Administrator’s telephone number 4018318300

Signature of
Role Plan administrator
Date 2013-06-18
Name of individual signing PATRICK K. SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/25/20120725084903P040035101216001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050430333
Plan administrator’s name PATRICK K. SULLIVAN, M.D., LTD.
Plan administrator’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905
Administrator’s telephone number 4018318300

Signature of
Role Plan administrator
Date 2012-07-25
Name of individual signing PATRICK K. SULLIVAN, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/08/11/20110811094127P030515613632001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050430333
Plan administrator’s name PATRICK K. SULLIVAN, M.D., LTD.
Plan administrator’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905
Administrator’s telephone number 4018318300

Signature of
Role Plan administrator
Date 2011-08-11
Name of individual signing PATRICK K. SULLIVAN, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-08-11
Name of individual signing PATRICK K. SULLIVAN, M.D.
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050430333
Plan administrator’s name PATRICK K. SULLIVAN, M.D., LTD.
Plan administrator’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905
Administrator’s telephone number 4018318300

Signature of
Role Plan administrator
Date 2010-09-16
Name of individual signing PATRICK K. SULLIVAN, M.D.
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-09-16
Name of individual signing PATRICK K. SULLIVAN, M.D.
Valid signature Filed with incorrect/unrecognized electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/28/20100928113721P040015554737001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1987-01-01
Business code 621111
Sponsor’s telephone number 4018318300
Plan sponsor’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050430333
Plan administrator’s name PATRICK K. SULLIVAN, M.D., LTD.
Plan administrator’s address 235 PLAIN STREET, SUITE 502, PROVIDENCE, RI, 02905
Administrator’s telephone number 4018318300

Signature of
Role Plan administrator
Date 2010-09-28
Name of individual signing CAROL LIPMAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ADLER POLLOCK & SHEEHAN P.C. Agent ONE CITIZENS PLAZA 8TH FLOOR, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
PATRICK K SULLIVAN MD PRESIDENT 235 PLAIN STREET PROVIDENCE, RI 02905 USA

Filings

Number Name File Date
202451965550 Annual Report 2024-04-22
202332764870 Annual Report 2023-04-12
202214956630 Annual Report 2022-04-17
202193138430 Annual Report 2021-02-26
202034988060 Annual Report 2020-02-24
201983869990 Annual Report 2019-01-07
201855808050 Annual Report 2018-01-08
201729992430 Annual Report 2017-01-12
201690219950 Annual Report 2016-01-07
201451693050 Annual Report 2014-12-22

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Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State

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