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  5. KINGSTOWN PEDIATRICS, INC.

KINGSTOWN PEDIATRICS, INC.

Company Details

Name: KINGSTOWN PEDIATRICS, INC.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 01 Dec 2004 (20 years ago)
Identification Number: 000144307
ZIP code: 02852
County: Washington County
Principal Address: 426F SCRABBLETOWN RD, NORTH KINGSTOWN, RI, 02852, USA
Purpose: TO OWN AND OPERATE A PEDIATRIC MEDICAL PRACTICE

Industry & Business Activity

NAICS

621111 Offices of Physicians (except Mental Health Specialists)

This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau

Companies doing Offices of physicians (except mental health specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1912030792 2007-03-13 2013-06-21 420 SCRABBLETOWN RD STE A, NORTH KINGSTOWN, RI, 028523638, US 420 SCRABBLETOWN RD STE A, NORTH KINGSTOWN, RI, 028523638, US

Contacts
Phone +1 401-295-7400
Fax 4012957825

Authorized person
Name COLLEEN ANN POWERS
Role OWNER
Phone 4012957400

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
License Number RI09449
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 9004013
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2023 201840282 2024-07-23 KINGSTOWN PEDIATRICS INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2024-07-23
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-23
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2022 201840282 2023-08-15 KINGSTOWN PEDIATRICS INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 02852

Signature of
Role Plan administrator
Date 2023-08-15
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-08-15
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2021 201840282 2022-07-12 KINGSTOWN PEDIATRICS INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2022-07-12
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-07-12
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2020 201840282 2021-08-10 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2021-08-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-08-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2019 201840282 2020-08-18 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2020-08-18
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-08-18
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2018 201840282 2019-05-08 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2019-05-08
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-05-08
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2017 201840282 2018-07-10 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2018-07-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2016 201840282 2017-09-25 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2017-09-25
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-25
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2015 201840282 2016-09-12 KINGSTOWN PEDIATRICS INC. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 028523638

Signature of
Role Plan administrator
Date 2016-09-12
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-09-12
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
KINGSTOWN PEDIATRICS INC. 401(K) PLAN 2014 201840282 2015-08-19 KINGSTOWN PEDIATRICS INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 02852

Signature of
Role Plan administrator
Date 2015-08-19
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-08-19
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/06/20141006092610P030011100527001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 426 SCRABBLETOWN ROAD, SUITE F, NORTH KINGSTOWN, RI, 02852

Signature of
Role Plan administrator
Date 2014-10-06
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-06
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/09/10/20130910112854P030051582455001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852

Signature of
Role Plan administrator
Date 2013-09-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-09-10
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/27/20120927160816P030004365973001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 201840282
Plan administrator’s name KINGSTOWN PEDIATRICS INC.
Plan administrator’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4012957400

Signature of
Role Plan administrator
Date 2012-09-27
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-09-27
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/21/20110721155455P040100715585001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 621111
Sponsor’s telephone number 4012957400
Plan sponsor’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852

Plan administrator’s name and address
Administrator’s EIN 201840282
Plan administrator’s name KINGSTOWN PEDIATRICS INC.
Plan administrator’s address 420 SCRABBLETOWN ROAD, SUITE A, NORTH KINGSTOWN, RI, 02852
Administrator’s telephone number 4012957400

Signature of
Role Plan administrator
Date 2011-07-21
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-07-21
Name of individual signing COLLEEN POWERS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MARTHA DAY Agent 27 OAK STREET, WAKEFIELD, RI, 02879, USA

TREASURER

Name Role Address
COLLEEN POWERS TREASURER 115 B WINCHESTER DRIVE WAKEFIELD, RI 02879 USA

SECRETARY

Name Role Address
COLLEEN POWERS SECRETARY 115 B WINCHESTER DRIVE WAKEFIELD, RI 02879 USA

PRESIDENT

Name Role Address
COLLEEN POWERS PRESIDENT 115 B WINCHESTER DRIVE WAKEFIELD, RI 02879- USA

DIRECTOR

Name Role Address
COLLEEN POWERS DIRECTOR 115 B WINCHESTER DRIVE WAKEFIELD, RI 02879 USA

Filings

Number Name File Date
202450539220 Annual Report 2024-04-09
202333184820 Annual Report 2023-04-18
202214058000 Annual Report 2022-04-06
202193239830 Annual Report 2021-02-28
202185838890 Statement of Change of Registered/Resident Agent Office 2021-01-11
202034698040 Annual Report 2020-02-19
201987803990 Annual Report 2019-02-28
201858086040 Annual Report 2018-02-12
201730972690 Annual Report 2017-01-27
201691550250 Annual Report 2016-02-01

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8235737100 2020-04-15 0165 PPP 426F Scrabbletown Rd., North Kingstown, RI, 02852
Loan Status Date 2021-01-21
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 70500
Loan Approval Amount (current) 70500
Undisbursed Amount 0
Franchise Name -
Lender Location ID 434162
Servicing Lender Name Citizens Bank, National Association
Servicing Lender Address 1 Citizens Plaza, PROVIDENCE, RI, 02903-1344
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address North Kingstown, WASHINGTON, RI, 02852-0001
Project Congressional District RI-02
Number of Employees 13
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Not Hispanic or Latino
Business Type Subchapter S Corporation
Originating Lender ID 434162
Originating Lender Name Citizens Bank, National Association
Originating Lender Address PROVIDENCE, RI
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 70972.28
Forgiveness Paid Date 2021-02-16

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Related by address

No related companies by address

Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State

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