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  5. SOUTH COUNTY PULMONARY MEDICINE, INC.

SOUTH COUNTY PULMONARY MEDICINE, INC.

Company Details

Name: SOUTH COUNTY PULMONARY MEDICINE, INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 10 Feb 1997 (28 years ago)
Date of Dissolution: 21 Sep 2018 (6 years ago)
Date of Status Change: 21 Sep 2018 (6 years ago)
Identification Number: 000093514
ZIP code: 02882
County: Washington County
Principal Address: 360 KINGSTOWN ROAD, NARRAGANSETT, RI, 02882, USA
Purpose: PRACTICE OF PULMONARY MEDICINE.
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1225152085 2007-03-19 2013-09-03 360 KINGSTOWN ROAD, STE 207, NARRAGANSETT, RI, 028823239, US 360 KINGSTOWN ROAD, STE 207, NARRAGANSETT, RI, 028823239, US

Contacts
Phone +1 401-789-0774
Fax 4017891355

Authorized person
Name DR. ANNE M HEBERT
Role PRESIDENT SOUTH COUNTY PULMONARY
Phone 4017890774

Taxonomy
Taxonomy Code 207RP1001X - Pulmonary Disease Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2017 061478000 2018-10-08 SOUTH COUNTY PULMONARY MEDICINE, INC. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2017 061478000 2018-04-23 SOUTH COUNTY PULMONARY MEDICINE, INC. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2016 061478000 2017-03-15 SOUTH COUNTY PULMONARY MEDICINE, INC. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2015 061478000 2016-07-19 SOUTH COUNTY PULMONARY MEDICINE, INC. 3
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2014 061478000 2015-07-07 SOUTH COUNTY PULMONARY MEDICINE, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260

Plan administrator’s name and address
Administrator’s EIN 061478000
Plan administrator’s name SOUTH COUNTY PULMONARY MEDICINE, INC.
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
Administrator’s telephone number 4017890774

Signature of
Role Plan administrator
Date 2015-07-07
Name of individual signing ANNE M. HEBERT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2013 061478000 2014-07-02 SOUTH COUNTY PULMONARY MEDICINE, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260

Plan administrator’s name and address
Administrator’s EIN 061478000
Plan administrator’s name SOUTH COUNTY PULMONARY MEDICINE, INC.
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
Administrator’s telephone number 4017890774

Signature of
Role Plan administrator
Date 2014-07-02
Name of individual signing ANNE M. HEBERT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2012 061478000 2013-07-22 SOUTH COUNTY PULMONARY MEDICINE, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260

Plan administrator’s name and address
Administrator’s EIN 061478000
Plan administrator’s name SOUTH COUNTY PULMONARY MEDICINE, INC.
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
Administrator’s telephone number 4017890774

Signature of
Role Plan administrator
Date 2013-07-22
Name of individual signing ANNE HEBERT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2011 061478000 2012-07-20 SOUTH COUNTY PULMONARY MEDICINE, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260

Plan administrator’s name and address
Administrator’s EIN 061478000
Plan administrator’s name SOUTH COUNTY PULMONARY MEDICINE, INC.
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
Administrator’s telephone number 4017890774

Signature of
Role Plan administrator
Date 2012-07-20
Name of individual signing ANNE HEBERT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2010 061478000 2011-07-13 SOUTH COUNTY PULMONARY MEDICINE, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260

Plan administrator’s name and address
Administrator’s EIN 061478000
Plan administrator’s name SOUTH COUNTY PULMONARY MEDICINE, INC.
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
Administrator’s telephone number 4017890774

Signature of
Role Plan administrator
Date 2011-07-12
Name of individual signing ANNE HEBERT
Valid signature Filed with authorized/valid electronic signature
SOUTH COUNTY PULMONARY MEDICINE, INC. 401(K) PROFIT SHARING PLAN 2009 061478000 2010-07-29 SOUTH COUNTY PULMONARY MEDICINE, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1996-01-01
Business code 621111
Sponsor’s telephone number 4017890774
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260

Plan administrator’s name and address
Administrator’s EIN 061478000
Plan administrator’s name SOUTH COUNTY PULMONARY MEDICINE, INC.
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 207, NARRAGANSETT, RI, 028823260
Administrator’s telephone number 4017890774

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing ANNE HEBERT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
RODERICK A.J. CAVANAGH Agent 148 MAIN STREET, WAKEFIELD, RI, 02879, USA

PRESIDENT

Name Role Address
ANNE M HEBERT MD PRESIDENT 360 KINGSTOWN ROAD NARRAGANSETT, RI 02882 USA

Filings

Number Name File Date
201877947760 Articles of Dissolution 2018-09-21
201859297300 Annual Report 2018-02-26
201734829080 Annual Report 2017-02-23
201603227940 Annual Report 2016-08-03
201601412690 Revocation Notice For Failure to File An Annual Report 2016-07-07
201558034800 Annual Report 2015-03-25
201442154580 Annual Report 2014-07-01
201439449330 Revocation Notice For Failure to File An Annual Report 2014-05-20
201310624210 Annual Report 2013-01-31
201289009450 Annual Report 2012-02-03

Related by officers

RODERICK A.J. CAVANAGH

B & G CONSTRUCTION, INC. Boisverts and Fortin Realty Co. SAILFISH, INC. GEOTECH ENTERPRISES, INC. VIDEO ENCOUNTERS OF HOPE VALLEY, INC. VIDEO ENCOUNTERS OF WESTERLY, INC. W & W LAND SURVEYORS, INC. THE SWEET NUT SHOPPEE, INC. KENNETH J. HATHAWAY, D.O., INC. S. & J. HOPKINS ENTERPRISES, INC.

Related by address

360 KINGSTOWN ROAD, NARRAGANSETT, RI, 02882, USA

KENNETH J. HATHAWAY, D.O., INC. South County Dermatology LLC A. hilton Parmentier, LTD.

Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State

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