| Entity Name: | PROVIDENCE OCCUPATIONAL HEALTH SERVICES, INC. |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Domestic BCA |
| Status: | Dissolved |
| Date Formed: | 11 Mar 1981 |
| Date of Dissolution: | 01 Aug 2006 |
| Company Number: | CORP_52326095 |
| File Number: | 52326095 |
| Date Status Change: | 01 Aug 2006 |
| Place of Formation: | ILLINOIS |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| IPC INTERNATIONAL, INC RETIREMENT PLAN | 2012 | 237091810 | 2013-07-25 | IPC INTERNATIONAL, INC. | 85 | |||||||||||||||||||||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2013-07-25 |
| Name of individual signing | JENNIFER SANDAHL |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2013-07-25 |
| Name of individual signing | JENNIFER SANDAHL |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1992-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 8476157100 |
| Plan sponsor’s address | 3000 LAKESIDE DR, STE 309 S, BANNOCKBURN, IL, 60015 |
Plan administrator’s name and address
| Administrator’s EIN | 237091810 |
| Plan administrator’s name | IPC INTERNATIONAL, INC. |
| Plan administrator’s address | 3000 LAKESIDE DR, STE 309 S, BANNOCKBURN, IL, 60015 |
| Administrator’s telephone number | 8476157100 |
Signature of
| Role | Plan administrator |
| Date | 2012-06-20 |
| Name of individual signing | JENNIFER SANDAHL |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1992-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 8476157100 |
| Plan sponsor’s address | 3000 LAKESIDE DR, STE 309 S, BANNOCKBURN, IL, 60015 |
Plan administrator’s name and address
| Administrator’s EIN | 237091810 |
| Plan administrator’s name | IPC INTERNATIONAL, INC. |
| Plan administrator’s address | 3000 LAKESIDE DR, STE 309 S, BANNOCKBURN, IL, 60015 |
| Administrator’s telephone number | 8476157100 |
Signature of
| Role | Plan administrator |
| Date | 2011-09-22 |
| Name of individual signing | JENNIFER SANDAHL |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1992-01-01 |
| Business code | 541990 |
| Sponsor’s telephone number | 8476157100 |
| Plan sponsor’s address | 3000 LAKESIDE DR, STE 309 S, BANNOCKBURN, IL, 60015 |
Plan administrator’s name and address
| Administrator’s EIN | 237091810 |
| Plan administrator’s name | IPC INTERNATIONAL, INC. |
| Plan administrator’s address | 3000 LAKESIDE DR, STE 309 S, BANNOCKBURN, IL, 60015 |
| Administrator’s telephone number | 8476157100 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-05 |
| Name of individual signing | JENNIFER SANDAHL |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-10-05 |
| Name of individual signing | JENNIFER SANDAHL |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| ILLINOIS CORPORATION SERVICE C, 801 ADLAI STEVENSON DRIVE, SPRINGFIELD, 62703, SANGAMON | Agent | 2003-10-31 |
| Name and Address | Role |
|---|---|
| DENNIS LUTZ 157 SUNDOWN RIDGE MARYVILLE 62062 | President |
| Name | Type | Effective Date | Cancellation Date | Cancellation Type | Last Renewal Date |
|---|---|---|---|---|---|
| PROVIDENCE OCCUPATIONAL HEALTH SERVICES | No data | 1988-12-16 | 1989-11-29 | Voluntary Cancellation | No data |
| PROVIDENCE OXYGEN & MEDICAL EQUIPMENT, INC. | No data | 1984-06-05 | 1990-08-01 | Involuntary Cancellation | No data |
| Name | Change Date |
|---|---|
| PROVIDENCE MANAGEMENT AND MARKETING SERVICES, INC. | 1989-11-29 |
| Class | Series | Voting Rights | Authorized Shares | Issued Shares | Par Value |
|---|---|---|---|---|---|
| COMM | No data | Voting Rights | 10000 | 1500000 | No data |
Date of last update: 16 Jan 2025
