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  5. University Family Medicine, Inc.

University Family Medicine, Inc.

Company Details

Name: University Family Medicine, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 31 Mar 2003 (22 years ago)
Identification Number: 000130952
ZIP code: 02818
County: Kent County
Principal Address: 1351 SOUTH COUNTY TRAIL, EAST GREENWICH, RI, 02818, USA
Purpose: TO CARRY ON ANY AND ALL BUSINESS IN WHICH PHYSICIANS ARE LICENSED TO PRACTICE MEDICINE IN THE STATE OF RHODE ISLAND
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1538474713 2010-08-12 2012-10-23 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA, 921211705, US 1351 S COUNTY TRL, 301, EAST GREENWICH, RI, 028185079, US

Contacts
Phone +1 401-398-0860

Authorized person
Name KENNY HEINE
Role SR DIRECTOR OPS
Phone 8586252990

Taxonomy
Taxonomy Code 332900000X - Non-Pharmacy Dispensing Site
License Number MD08461
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2023 043749650 2024-09-26 UNIVERSITY FAMILY MEDICINE 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Signature of
Role Plan administrator
Date 2024-09-26
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2022 043749650 2023-03-16 UNIVERSITY FAMILY MEDICINE 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Signature of
Role Plan administrator
Date 2023-03-16
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2021 043749650 2022-04-26 UNIVERSITY FAMILY MEDICINE 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Signature of
Role Plan administrator
Date 2022-04-26
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2020 043749650 2021-05-04 UNIVERSITY FAMILY MEDICINE 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Signature of
Role Plan administrator
Date 2021-05-04
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2019 043749650 2020-05-20 UNIVERSITY FAMILY MEDICINE 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Signature of
Role Plan administrator
Date 2020-05-20
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2018 043749650 2019-07-16 UNIVERSITY FAMILY MEDICINE 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Signature of
Role Plan administrator
Date 2019-07-16
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2017 043749650 2018-07-10 UNIVERSITY FAMILY MEDICINE 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Signature of
Role Plan administrator
Date 2018-07-10
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2016 043749650 2017-10-05 UNIVERSITY FAMILY MEDICINE 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Signature of
Role Plan administrator
Date 2017-10-05
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2015 043749650 2016-07-12 UNIVERSITY FAMILY MEDICINE 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Plan administrator’s name and address
Administrator’s EIN 043749650
Plan administrator’s name UNIVERSITY FAMILY MEDICINE
Plan administrator’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083
Administrator’s telephone number 4013980860

Signature of
Role Plan administrator
Date 2016-07-12
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
UNIVERSITY FAMILY MEDICINE 401(K) PROFIT SHARING PLAN AND TRUST 2014 043749650 2015-06-03 UNIVERSITY FAMILY MEDICINE 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Plan administrator’s name and address
Administrator’s EIN 043749650
Plan administrator’s name UNIVERSITY FAMILY MEDICINE
Plan administrator’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083
Administrator’s telephone number 4013980860

Signature of
Role Plan administrator
Date 2015-06-03
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/12/20140612084809P030382462019001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Plan administrator’s name and address
Administrator’s EIN 043749650
Plan administrator’s name UNIVERSITY FAMILY MEDICINE
Plan administrator’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083
Administrator’s telephone number 4013980860

Signature of
Role Plan administrator
Date 2014-06-12
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/04/08/20130408165839P040211354321001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Plan administrator’s name and address
Administrator’s EIN 043749650
Plan administrator’s name UNIVERSITY FAMILY MEDICINE
Plan administrator’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083
Administrator’s telephone number 4013980860

Signature of
Role Plan administrator
Date 2013-04-08
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/26/20120726182546P030001359556001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Plan administrator’s name and address
Administrator’s EIN 043749650
Plan administrator’s name UNIVERSITY FAMILY MEDICINE
Plan administrator’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083
Administrator’s telephone number 4013980860

Signature of
Role Plan administrator
Date 2012-07-26
Name of individual signing PIERRE R. MANZO, MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/03/25/20110325061805P030031058881001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s mailing address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Plan administrator’s name and address
Administrator’s EIN 043749650
Plan administrator’s name UNIVERSITY FAMILY MEDICINE
Plan administrator’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083
Administrator’s telephone number 4013980860

Number of participants as of the end of the plan year
Active participants 13
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 3
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 16
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 1

Signature of
Role Plan administrator
Date 2011-03-25
Name of individual signing DAVID W ASHLEY MD
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/05/28/20100528054823P030061888904001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-10-01
Business code 621111
Sponsor’s telephone number 4013980860
Plan sponsor’s mailing address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083
Plan sponsor’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083

Plan administrator’s name and address
Administrator’s EIN 043749650
Plan administrator’s name UNIVERSITY FAMILY MEDICINE
Plan administrator’s address 1351 S COUNTY TRL STE 301, E GREENWICH, RI, 028185083
Administrator’s telephone number 4013980860

Number of participants as of the end of the plan year
Active participants 12
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 5
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 17
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2

Signature of
Role Plan administrator
Date 2010-05-28
Name of individual signing DAVID ASHLEY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
TERRENCE G. SIMPSON, ESQ.. Agent 65 BOSTON NECK ROAD, NORTH KINGSTOWN, RI, 02852, USA

PRESIDENT

Name Role Address
PIERRE R MANZO PRESIDENT 28 MYRICK DRIVE SLATERSVILLE, RI 02876 USA

Filings

Number Name File Date
202454416220 Annual Report 2024-05-01
202332300230 Annual Report 2023-04-03
202221658020 Annual Report 2022-04-06
202195165100 Annual Report 2021-03-29
202193727030 Statement of Change of Registered/Resident Agent Office 2021-03-09
202036975770 Annual Report 2020-03-30
202034814260 Statement of Change of Registered/Resident Agent 2020-02-20
201986481720 Annual Report 2019-02-11
201858911900 Annual Report 2018-02-20
201737737850 Annual Report 2017-03-06

Related by officers

TERRENCE G. SIMPSON, ESQ..

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Related by address

1351 SOUTH COUNTY TRAIL, EAST GREENWICH, RI, 02818, USA

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Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State

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