| Name: | The Rhode Island Free Clinic, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 29 Sep 1998 (26 years ago) |
| Identification Number: | 000102746 |
| ZIP code: | 02907 |
| County: | Providence County |
| Principal Address: | 655 BROAD STREET, PROVIDENCE, RI, 02907, USA |
| Purpose: | OFFERING HIGH QUALITY PHYSICIAN PRIMARY CARE AND PREVENTATIVE HEALTH SERVICES TO CHILDREN AND ADULTS WHO DO NOT HAVE HEALTH INSURANCE OR CANNOT AFFORD TO PURCHASE SUCH SERVICES. |
| NAICS: | 622110 - General Medical and Surgical Hospitals |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558706267 | 2013-05-08 | 2013-05-08 | 655 BROAD ST, PROVIDENCE, RI, 029071444, US | 655 BROAD ST, PROVIDENCE, RI, 029071444, US | |||||||||||||||||
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| Phone | +1 401-274-6347 |
Authorized person
| Name | MS. MARIE GHAZAL |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 4012746347 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | ACF01570 |
| State | RI |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RHODE ISLAND FREE CLINIC 403(B) PLAN | 2014 | 050501276 | 2015-07-27 | RHODE ISLAND FREE CLINIC, INC. | 13 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2015-07-27 |
| Name of individual signing | MARIE GHAZAL |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2010-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 4012746347 |
| Plan sponsor’s address | 655 BROAD STREET, PROVIDENCE, RI, 02903 |
Signature of
| Role | Plan administrator |
| Date | 2014-05-16 |
| Name of individual signing | MARIE GHAZAL |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| ANDREW W. DAVIS, ESQ. | Agent | 101 DYER STREET, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| CARRIE BRIDGES FELIZ, MPH | PRESIDENT | 335R PRAIRIE AVENUE, SUITE 2B PROVIDENCE , RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| PATRICK MARTIN, CPA | TREASURER | KAHN, LITWIN, RENZA 951 N. MAIN STREET, PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| DIANA DUCHARME ESQ | SECRETARY | CERVENKA GREEN & DUCHARME LLC 235 PROMENADE ST. PROVIDENCE, RI 02908 USA |
| Name | Role | Address |
|---|---|---|
| MICHELE LEDERBERG, ESQ. | VICE PRESIDENT | BLUE CROSS & BLUE SHIELD OF RHODE ISLAND 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA |
| Name | Role | Address |
|---|---|---|
| WILLIAM FITZGERALD | DIRECTOR | AMICA MUTUAL INSURANCE COMPANY 100 AMICA WAY LINCOLN, RI 02865 USA |
| MICHELE LEDERBERG, ESQ. | DIRECTOR | BLUE CROSS & BLUE SHIELD OF RHODE ISLAND 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA |
| PATRICK MARTIN, CPA | DIRECTOR | KAHN, LITWIN, RENZA 951 N. MAIN STREET PROVIDENCE, RI 02904 USA |
| JEFFREY F. CHASE-LUBITZ, ESQ. | DIRECTOR | ONE RICHMOND SQ., SUITE 165W PROVIDENCE , RI 02906 USA |
| SAMUEL BRADNER | DIRECTOR | PEREGRINE GROUP, LLC. 20 NEWMAN AVE,STE 1005 RUMFORD, RI 02916 USA |
| JEHANNE BJORNEBYE. ESQ. | DIRECTOR | CVS HEALTH ONE CVS DRIVE, WOONSOCKET , RI 02895 USA |
| MARINA RODRIGUEZ, MD | DIRECTOR | 655 BROAD ST. PROVIDENCE , RI 02907 USA |
| CAROLINE TROISE, MD | DIRECTOR | ANCHOR MEDICAL ASSOCIATES, 180 CORLISS ST. FL. 2 PROVIDENCE, RI 02904 USA |
| BRENDAN KANE | DIRECTOR | PEREGRINE PROPERTY MANAGEMENT 20 NEWMAN AVE STE.1005 RUMFORD, RI 02916 USA |
| LOREE DUBOIS, CPA, MBA | DIRECTOR | KAHN LITWIN & RENZA 951 N. MAIN STREET PROVIDENCE, RI 02904 USA |
| Number | Name | File Date |
|---|---|---|
| 202455166700 | Annual Report | 2024-05-31 |
| 202335830310 | Annual Report | 2023-05-19 |
| 202216329720 | Annual Report | 2022-04-29 |
| 202207913390 | Annual Report - Amended | 2022-01-12 |
| 202198829360 | Annual Report | 2021-06-30 |
| 202041887020 | Annual Report | 2020-06-11 |
| 201997179740 | Annual Report | 2019-06-17 |
| 201985961700 | Annual Report | 2019-02-05 |
| 201985482700 | Revocation Notice For Failure to File An Annual Report | 2019-01-30 |
| 201857086140 | Articles of Amendment | 2018-01-30 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
