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  5. University Dermatology, Inc.

University Dermatology, Inc.

Company Details

Name: University Dermatology, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Dissolved
Date of Organization in Rhode Island: 09 Apr 1997 (28 years ago)
Date of Dissolution: 01 Jun 2020 (5 years ago)
Date of Status Change: 01 Jun 2020 (5 years ago)
Identification Number: 000094453
ZIP code: 02903
County: Providence County
Principal Address: 593 EDDY STREET APC 10, PROVIDENCE, RI, 02903, USA
Purpose: TO ENGAGE PRIMARILY IN THE SPECIFIC BUSINESS OF PRACTICING MEDICINE.
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1316996101 2006-05-09 2014-05-07 593 EDDY STREET, APC-10, PROVIDENCE, RI, 02903, US 593 EDDY ST, APC#10, PROVIDENCE, RI, 029034923, US

Contacts
Phone +1 401-444-7959
Fax 4014447144

Authorized person
Name ABRAR A QURESHI
Role PRESIDENT
Phone 4014447137

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
UNIVERSITY DERMATOLOGY INC 401 K PROFIT SHARING PLAN TRUST 2015 061475105 2016-05-25 UNIVERSITY DERMATOLOGY INC 78
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 4014442595
Plan sponsor’s address 593 EDDY STREET 10TH FLOOR, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2016-05-25
Name of individual signing ABRAR QURESHI
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY DERMATOLOGY INC. 401 K PROFIT SHARING PLAN TRUST 2014 061475105 2015-05-28 UNIVERSITY DERMATOLOGY INC. 70
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621111
Sponsor’s telephone number 4014442595
Plan sponsor’s address 593 EDDY STREET 10TH FLOOR, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2015-05-28
Name of individual signing ABRAR QURESHI
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY DERMATOLOGY, INC. RETIREMENT PLAN 2012 061475105 2013-06-06 UNIVERSITY DERMATOLOGY, INC. 68
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-04-01
Business code 621111
Sponsor’s telephone number 4014444509
Plan sponsor’s mailing address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903
Plan sponsor’s address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903

Plan administrator’s name and address
Administrator’s EIN 061475105
Plan administrator’s name UNIVERSITY DERMATOLOGY, INC.
Plan administrator’s address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903
Administrator’s telephone number 4014444509

Number of participants as of the end of the plan year
Active participants 51
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 17
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 60
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2013-06-06
Name of individual signing CHARLES MCDONALD
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-06
Name of individual signing CHARLES MCDONALD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY DERMATOLOGY, INC. RETIREMENT PLAN 2011 061475105 2012-06-13 UNIVERSITY DERMATOLOGY, INC. 66
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-04-01
Business code 621111
Sponsor’s telephone number 4014447137
Plan sponsor’s mailing address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903
Plan sponsor’s address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903

Plan administrator’s name and address
Administrator’s EIN 061475105
Plan administrator’s name UNIVERSITY DERMATOLOGY, INC.
Plan administrator’s address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903
Administrator’s telephone number 4014447137

Number of participants as of the end of the plan year
Active participants 49
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 19
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 60
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 3

Signature of
Role Plan administrator
Date 2012-06-13
Name of individual signing CHARLES MCDONALD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY DERMATOLOGY, INC. RETIREMENT PLAN 2010 061475105 2011-05-25 UNIVERSITY DERMATOLOGY, INC. 69
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-04-01
Business code 621111
Sponsor’s telephone number 4014447137
Plan sponsor’s mailing address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903
Plan sponsor’s address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903

Plan administrator’s name and address
Administrator’s EIN 061475105
Plan administrator’s name UNIVERSITY DERMATOLOGY, INC.
Plan administrator’s address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903
Administrator’s telephone number 4014447137

Number of participants as of the end of the plan year
Active participants 55
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 11
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 62
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-05-25
Name of individual signing CHARLES MCDONALD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY DERMATOLOGY, INC. RETIREMENT PLAN 2009 061475105 2010-06-04 UNIVERSITY DERMATOLOGY, INC. 69
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-04-01
Business code 621111
Sponsor’s telephone number 4014447137
Plan sponsor’s mailing address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903
Plan sponsor’s address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903

Plan administrator’s name and address
Administrator’s EIN 061475105
Plan administrator’s name UNIVERSITY DERMATOLOGY, INC.
Plan administrator’s address 593 EDDY STREET, APC 10, PROVIDENCE, RI, 02903
Administrator’s telephone number 4014447137

Number of participants as of the end of the plan year
Active participants 54
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 15
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 63
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 4

Signature of
Role Plan administrator
Date 2010-06-04
Name of individual signing CHARLES MCDONALD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ABRAR QURESHI, MD, MPH Agent 593 EDDY STREET APC-10, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
ABRAR A QURESHI MD, MPH PRESIDENT 24 HALLETT HILL ROAD WESTON, MA 02493 USA

TREASURER

Name Role Address
ABRAR A QURESHI, MD, MPH TREASURER 24 HALLETT HILL ROAD WESTON, MA 02493 USA

SECRETARY

Name Role Address
DAVID FARRELL, MD SECRETARY 27 JENNY LANE BARRINGTON, RI 02806 USA

VICE PRESIDENT

Name Role Address
JENNIE MUGLIA, MD VICE PRESIDENT 3 DIELD LANE BARRINGTON, RI 02806 USA

DIRECTOR

Name Role Address
ABRAR A QURESHI, MD, MPH DIRECTOR 24 HALLETT HILL ROAD WESTON, MA 02493 USA

Filings

Number Name File Date
202041207080 Articles of Dissolution 2020-06-01
202041008830 Annual Report 2020-05-28
201985017100 Annual Report 2019-01-22
201878815310 Annual Report 2018-10-03
201875467350 Revocation Notice For Failure to File An Annual Report 2018-08-24
201737801920 Annual Report 2017-03-08
201696993890 Annual Report 2016-05-04
201695787760 Statement of Change of Registered/Resident Agent 2016-04-11
201564467320 Annual Report 2015-07-07
201432339430 Annual Report 2014-01-03

Related by officers

No related officers

Related by address

593 EDDY STREET APC 10, PROVIDENCE, RI, 02903, USA

Dermatology Foundation of Rhode Island, Inc.

Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State

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