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  5. CHILDREN'S DENTISTRY OF WESTERLY, LLC

CHILDREN'S DENTISTRY OF WESTERLY, LLC

Company Details

Name: CHILDREN'S DENTISTRY OF WESTERLY, LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Dissolved
Date of Organization in Rhode Island: 07 May 2009 (16 years ago)
Date of Dissolution: 29 Mar 2024 (10 months ago)
Date of Status Change: 29 Mar 2024 (10 months ago)
Identification Number: 000506680
ZIP code: 02891
County: Washington County
Principal Address: 130 GRANITE STREET, WESTERLY, RI, 02891, USA
Purpose: PRACTICE OF DENTISTRY AND SPECIALIZING IN PEDIATRIC DENTISTRY
NAICS: 621210 - Offices of Dentists
Fictitious names: Children's Dentistry of Westerly & Wakefield (trading name, 2013-09-17 - )

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CHILDRENS DENTISTRY OF WESTERLY, LLC 401(K) PROFIT SHARING PLAN 2021 270230155 2022-05-25 CHILDREN'S DENTISTRY OF WESTERLY, LLC 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2022-05-25
Name of individual signing ANNA CAPALBO
Valid signature Filed with authorized/valid electronic signature
CHILDREN'S DENTISTRY OF WESTERLY, LLC 401(K) PROFIT SHARING PLAN 2021 270230155 2022-08-31 CHILDREN'S DENTISTRY OF WESTERLY, LLC 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2022-08-31
Name of individual signing ANNA CAPALBO
Valid signature Filed with authorized/valid electronic signature
CHILDRENS DENTISTRY OF WESTERLY, LLC 401(K) PROFIT SHARING PLAN 2020 270230155 2021-07-07 CHILDREN'S DENTISTRY OF WESTERLY, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2021-07-07
Name of individual signing ANNA CAPALBO
Valid signature Filed with authorized/valid electronic signature
CHILDREN'S DENTISTRY OF WESTERLY, LLC CASH BALANCE PLAN 2020 270230155 2021-07-15 CHILDREN'S DENTISTRY OF WESTERLY, LLC 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing ANNA CAPALBO
Valid signature Filed with authorized/valid electronic signature
CHILDREN'S DENTISTRY OF WESTERLY, LLC CASH BALANCE PLAN 2020 270230155 2021-10-06 CHILDREN'S DENTISTRY OF WESTERLY, LLC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2021-10-06
Name of individual signing ANNA CAPALBO
Valid signature Filed with authorized/valid electronic signature
CHILDREN'S DENTISTRY OF WESTERLY, LLC CASH BALANCE PLAN 2019 270230155 2020-10-15 CHILDREN'S DENTISTRY OF WESTERLY, LLC 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2020-10-15
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
CHILDRENS DENTISTRY OF WESTERLY, LLC 401(K) PROFIT SHARING PLAN 2019 270230155 2020-10-15 CHILDREN'S DENTISTRY OF WESTERLY, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2020-10-15
Name of individual signing BRIAN P. SHANNON, D.D.S.
Valid signature Filed with authorized/valid electronic signature
CHILDRENS DENTISTRY OF WESTERLY, LLC 401(K) PROFIT SHARING PLAN 2018 270230155 2019-07-29 CHILDREN'S DENTISTRY OF WESTERLY, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2019-07-29
Name of individual signing BRIAN P. SHANNON, D.D.S.
Valid signature Filed with authorized/valid electronic signature
CHILDREN'S DENTISTRY OF WESTERLY, LLC CASH BALANCE PLAN 2018 270230155 2019-07-29 CHILDREN'S DENTISTRY OF WESTERLY, LLC 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2019-07-29
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
CHILDREN'S DENTISTRY OF WESTERLY, LLC CASH BALANCE PLAN 2017 270230155 2018-07-16 CHILDREN'S DENTISTRY OF WESTERLY, LLC 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2018-07-16
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-16
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/07/16/20180716105951P040066240529001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2018-07-16
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-16
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/10/02/20171002095204P030169257607001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2017-10-02
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-10-02
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/07/28/20170728075151P030062211143001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2017-07-28
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-28
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/10/10/20161010111242P030012135421001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2016-10-10
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-10
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/10/10/20161010142203P040019334705001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2016-10-10
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-10
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/07/23/20150723100651P040107638999001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2015-07-22
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/07/23/20150723085715P040107469911001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2015-07-22
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-22
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/25/20140725071213P040018018959001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2014-07-23
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/07/28/20140728124918P040025611341001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2014-07-28
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-28
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/18/20130718101109P040392846129001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2013-07-18
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/24/20130724135406P030406330161001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1992-01-01
Business code 621210
Sponsor’s telephone number 4015968720
Plan sponsor’s address 130C GRANITE STREET, WESTERLY, RI, 02891

Signature of
Role Plan administrator
Date 2013-07-24
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-24
Name of individual signing BRIAN SHANNON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JASON P. MARSHALL, ESQ. Agent 300 CENTERVILLE ROAD SUMMIT WEST SUITE 204, WARWICK, RI, 02886, USA

Filings

Number Name File Date
202449745760 Articles of Dissolution 2024-03-29
202335553570 Annual Report 2023-05-11
202217473800 Annual Report 2022-05-18
202105358220 Annual Report 2021-11-24
202188121890 Annual Report - Amended 2021-01-28
202071873600 Annual Report 2020-10-29
201926895660 Annual Report 2019-11-04
201925095250 Statement of Change of Registered/Resident Agent Office 2019-10-23
201878199690 Annual Report 2018-09-21
201750127490 Annual Report 2017-09-20

Related by officers

JASON P. MARSHALL, ESQ.

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Related by address

130 GRANITE STREET, WESTERLY, RI, 02891, USA

WESTERLY DENTAL GROUP, INC. R.B.S. REALTY, INC. Valvet, Corp. of Rhode Island SUNRISE MARKET, LLC MMAKKET, LLC Extreme Freeze, llc WESTERLY DENTAL SPECIALISTS, LLC TyMark, Inc. AKCapalbo, LLC

Date of last update: 14 Oct 2024

Sources: Rhode Island Department of State

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