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  5. UNIVERSITY PEDIATRICS, INC.

UNIVERSITY PEDIATRICS, INC.

Company Details

Name: UNIVERSITY PEDIATRICS, INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Revoked Entity
Date of Organization in Rhode Island: 18 Aug 1998 (26 years ago)
Date of Dissolution: 15 Nov 2018 (6 years ago)
Date of Status Change: 15 Nov 2018 (6 years ago)
Identification Number: 000102102
ZIP code: 02906
County: Providence County
Principal Address: 100 HIGHLAND AVENUE SUITE 302, PROVIDENCE, RI, 02906, USA
Purpose: TO PROVIDE PROFESSIONAL MEDICAL SERVICES.
NAICS: 62 - Health Care and Social Assistance

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1932117702 2006-08-04 2014-03-27 100 HIGHLAND AVE, SUITE 201, PROVIDENCE, RI, 029062740, US 100 HIGHLAND AVE, SUITE 201, PROVIDENCE, RI, 029062740, US

Contacts
Phone +1 401-633-1100
Fax 4016330047

Authorized person
Name ROBERT E EDEN
Role OWNER
Phone 4016331100

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number UP29391
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2019 050500549 2020-10-15 UNIVERSITY PEDIATRICS INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Signature of
Role Plan administrator
Date 2020-10-15
Name of individual signing ROBERT EDEN
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2018 050500549 2019-10-15 UNIVERSITY PEDIATRICS INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Signature of
Role Plan administrator
Date 2019-10-15
Name of individual signing ROBERT EDEN
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2017 050500549 2018-10-15 UNIVERSITY PEDIATRICS INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing ROBERT EDEN
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2016 050500549 2017-10-16 UNIVERSITY PEDIATRICS INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Signature of
Role Plan administrator
Date 2017-10-16
Name of individual signing LETITIA VELLECA
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2015 050500549 2016-10-17 UNIVERSITY PEDIATRICS INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Signature of
Role Plan administrator
Date 2016-10-17
Name of individual signing ROBYN PERROTTI
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2014 050500549 2015-10-26 UNIVERSITY PEDIATRICS INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Signature of
Role Plan administrator
Date 2015-10-26
Name of individual signing ROBYN PERROTTI
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2013 050500549 2014-10-08 UNIVERSITY PEDIATRICS INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Signature of
Role Plan administrator
Date 2014-10-08
Name of individual signing ROBYN PERROTTI
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2012 050500549 2013-07-29 UNIVERSITY PEDIATRICS INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Plan administrator’s name and address
Administrator’s EIN 050500549
Plan administrator’s name UNIVERSITY PEDIATRICS INC.
Plan administrator’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906
Administrator’s telephone number 4016331100

Signature of
Role Plan administrator
Date 2013-07-29
Name of individual signing ROBYN PERROTTI
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2011 050500549 2012-10-01 UNIVERSITY PEDIATRICS INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Plan administrator’s name and address
Administrator’s EIN 050500549
Plan administrator’s name UNIVERSITY PEDIATRICS INC.
Plan administrator’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906
Administrator’s telephone number 4016331100

Signature of
Role Plan administrator
Date 2012-10-01
Name of individual signing ROBYN PERROTTI
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY PEDIATRICS INC. 401(K) PLAN 2010 050500549 2011-10-12 UNIVERSITY PEDIATRICS INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Plan administrator’s name and address
Administrator’s EIN 050500549
Plan administrator’s name UNIVERSITY PEDIATRICS INC.
Plan administrator’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906
Administrator’s telephone number 4016331100

Signature of
Role Plan administrator
Date 2011-10-12
Name of individual signing ROBYN PERROTTI
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/13/20101013075700P040009126466001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2008-01-01
Business code 621111
Sponsor’s telephone number 4016331100
Plan sponsor’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906

Plan administrator’s name and address
Administrator’s EIN 050500549
Plan administrator’s name UNIVERSITY PEDIATRICS INC.
Plan administrator’s address 100 HIGHLAND AVENUE, SUITE 201, PROVIDENCE, RI, 02906
Administrator’s telephone number 4016331100

Signature of
Role Plan administrator
Date 2010-10-13
Name of individual signing ROBYN PERROTTI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JEFFREY F. CHASE-LUBITZ, ESQ. Agent DONOGHUE BARRETT & SINGAL P.C. ONE CEDAR STREET SUITE 300, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
ROBERT E. EDEN, M.D. PRESIDENT 100 HIGHLAND AVENUE, SUITE 302 PROVIDENCE, RI 02906 USA

Filings

Number Name File Date
201881219770 Revocation Certificate For Failure to File the Annual Report for the Year 2018-11-15
201875473810 Revocation Notice For Failure to File An Annual Report 2018-08-24
201737745620 Annual Report 2017-03-07
201695362480 Annual Report 2016-03-29
201561855300 Statement of Change of Registered Office by the Registered Agent 2015-05-20
201452503150 Annual Report 2014-12-29
201432310240 Annual Report 2014-01-02
201311810900 Annual Report 2013-02-15
201288569810 Annual Report 2012-01-26
201176592210 Annual Report 2011-03-14

Related by officers

JEFFREY F. CHASE-LUBITZ, ESQ.

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Related by address

No related companies by address

Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State

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