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  5. Blackstone Valley Pediatric & Adolescent Medicine, PC.

Blackstone Valley Pediatric & Adolescent Medicine, PC.

Company Details

Name: Blackstone Valley Pediatric & Adolescent Medicine, PC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Activ
Date of Organization in Rhode Island: 03 Nov 1995 (29 years ago)
Identification Number: 000086739
ZIP code: 02864
County: Providence County
Principal Address: 2 MEEHAN LANE, CUMBERLAND, RI, 02864, USA
Purpose: TO PROVIDE MEDICAL SERVICES AND ACTIVITIES RELATED THERETO.
NAICS: 541990 - All Other Professional, Scientific, and Technical Services
Fictitious names: Blackstone Valley Pediatric & Adolescent Medicine (trading name, 2009-12-03 - 2017-10-19)
Historical names: Peter T. Yasigian, M.D., Professional Corporation

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PETER T. YASIGIAN, M.D., PROFESSIONAL CORPORATION RETIREMENT PLAN 2016 050487191 2017-05-05 PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 4016582525
Plan sponsor’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864

Signature of
Role Plan administrator
Date 2017-05-05
Name of individual signing PETER T YASIGIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-05
Name of individual signing PETER T YASIGIAN
Valid signature Filed with authorized/valid electronic signature
PETER T. YASIGIAN, M.D., PROFESSIONAL CORPORATION RETIREMENT PLAN 2015 050487191 2016-04-27 PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 4016582525
Plan sponsor’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864

Signature of
Role Plan administrator
Date 2016-04-27
Name of individual signing PETER YASIGIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-04-27
Name of individual signing PETER YASIGIAN
Valid signature Filed with authorized/valid electronic signature
PETER T. YASIGIAN, M.D., PROFESSIONAL CORPORATION RETIREMENT PLAN 2014 050487191 2015-04-07 PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 4016582525
Plan sponsor’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864

Signature of
Role Plan administrator
Date 2015-04-07
Name of individual signing PETER T YASIGIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-07
Name of individual signing PETER T YASIGIAN
Valid signature Filed with authorized/valid electronic signature
PETER T. YASIGIAN, M.D., PROFESSIONAL CORPORATION RETIREMENT PLAN 2013 050487191 2014-04-16 PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 4016582525
Plan sponsor’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864

Signature of
Role Plan administrator
Date 2014-04-16
Name of individual signing PETER T. YASIGIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-04-16
Name of individual signing PETER T. YASIGIAN
Valid signature Filed with authorized/valid electronic signature
PETER T. YASIGIAN, M.D., PROFESSIONAL CORPORATION RETIREMENT PLAN 2012 050487191 2013-03-20 PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 4016582525
Plan sponsor’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864

Signature of
Role Plan administrator
Date 2013-03-20
Name of individual signing PETER T YASIGIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-03-20
Name of individual signing PETER T YASIGIAN
Valid signature Filed with authorized/valid electronic signature
PETER T. YASIGIAN, M.D., PROFESSIONAL CORPORATION RETIREMENT PLAN 2011 050487191 2012-05-02 PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 4016582525
Plan sponsor’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864

Plan administrator’s name and address
Administrator’s EIN 050487191
Plan administrator’s name PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION
Plan administrator’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864
Administrator’s telephone number 4016582525

Signature of
Role Plan administrator
Date 2012-05-02
Name of individual signing DEBORAH YASIGIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-05-02
Name of individual signing DEBORAH YASIGIAN
Valid signature Filed with authorized/valid electronic signature
PETER T. YASIGIAN, M.D., PROFESSIONAL CORPORATION RETIREMENT PLAN 2010 050487191 2011-03-21 PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 4016582525
Plan sponsor’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864

Plan administrator’s name and address
Administrator’s EIN 050487191
Plan administrator’s name PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION
Plan administrator’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864
Administrator’s telephone number 4016582525

Signature of
Role Plan administrator
Date 2011-03-21
Name of individual signing PETER YASIGIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-03-21
Name of individual signing PETER YASIGIAN
Valid signature Filed with authorized/valid electronic signature
PETER T. YASIGIAN, M.D., PROFESSIONAL CORPORATION RETIREMENT PLAN 2009 050487191 2010-09-22 PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 4016582525
Plan sponsor’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864

Plan administrator’s name and address
Administrator’s EIN 050487191
Plan administrator’s name PETER T. YASIGIAN, M.D. PROFESSIONAL CORPORATION
Plan administrator’s address 2 MEEHAN LANE, CUMBERLAND, RI, 02864
Administrator’s telephone number 4016582525

Signature of
Role Plan administrator
Date 2010-09-22
Name of individual signing PETER YASIGIAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-09-22
Name of individual signing PETER YASIGIAN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MARLENE B MARSHALL, ESQ. Agent 655 MENDON ROAD, CUMBERLAND, RI, 02864, USA

PRESIDENT

Name Role Address
MAUREEN A. CROTTY, MD PRESIDENT 2 MEEHAN LANE CUMBERLAND, RI 02864 USA

TREASURER

Name Role Address
ALEXANDER LEE, MD TREASURER 2 MEEHAN LANE CUMBERLAND, RI 02864 USA

SECRETARY

Name Role Address
MAUREEN A. CROTTY, MD SECRETARY 2 MEEHAN LANE CUMBERLAND, RI 02864 USA

VICE PRESIDENT

Name Role Address
ALEXANDER LEE, MD VICE PRESIDENT 2 MEEHAN LANE CUMBERLAND, RI 02864 USA

Events

Type Date Old Value New Value
Name Change 2017-10-19 Peter T. Yasigian, M.D., Professional Corporation Blackstone Valley Pediatric & Adolescent Medicine, PC.

Filings

Number Name File Date
202450590230 Annual Report 2024-04-08
202340791000 Statement of Change of Registered Office by the Registered Agent 2023-09-05
202333543230 Annual Report 2023-04-20
202223091320 Statement of Change of Registered/Resident Agent 2022-09-29
202217943060 Annual Report 2022-05-29
202188005460 Annual Report 2021-01-27
202033665700 Annual Report 2020-02-04
201989520480 Annual Report 2019-03-29
201859816880 Annual Report 2018-03-05
201751877420 Statement of Abandonment of Use of Fictitious Business Name 2017-10-19

Related by officers

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Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State

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