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PROVIDA HEALTH CENTER, S.C.

Company Details

Entity Name: PROVIDA HEALTH CENTER, S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 06 May 1999
Company Number: CORP_60481938
File Number: 60481938
Type of Business: Incorporated under the Medical Corporation Act
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2023 364292273 2024-10-14 PROVIDA HEALTH CENTER, S.C. 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 1425 N. HUNT CLUB ROAD, SUITE 100, GURNEE, IL, 60031

Signature of

Role Plan administrator
Date 2024-10-05
Name of individual signing LUIS I. SALAZAR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-10-05
Name of individual signing LUIS I. SALAZAR
Valid signature Filed with authorized/valid electronic signature
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2022 364292273 2024-01-04 PROVIDA HEALTH CENTER, S.C. 50
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 1425 N. HUNT CLUB ROAD, SUITE 100, GURNEE, IL, 60031

Signature of

Role Plan administrator
Date 2024-01-03
Name of individual signing CONSUELO SALAZAR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-01-03
Name of individual signing CONSUELO SALAZAR
Valid signature Filed with authorized/valid electronic signature
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2022 364292273 2023-10-16 PROVIDA HEALTH CENTER, S.C. 50
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 1425 N. HUNT CLUB ROAD, SUITE 100, GURNEE, IL, 60031
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2021 364292273 2022-06-29 PROVIDA HEALTH CENTER, S.C. 54
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 1425 N. HUNT CLUB ROAD, SUITE 100, GURNEE, IL, 60031

Signature of

Role Plan administrator
Date 2022-06-29
Name of individual signing LUIS SALAZAR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-29
Name of individual signing LUIS SALAZAR
Valid signature Filed with authorized/valid electronic signature
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2020 364292273 2021-08-26 PROVIDA HEALTH CENTER, S.C. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 1425 N. HUNT CLUB ROAD, SUITE 100, GURNEE, IL, 60031

Signature of

Role Plan administrator
Date 2021-08-24
Name of individual signing LUIS I. SALAZAR
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-08-24
Name of individual signing LUIS I. SALAZAR
Valid signature Filed with authorized/valid electronic signature
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2019 364292273 2020-07-28 PROVIDA HEALTH CENTER, S.C. 44
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 1425 N. HUNT CLUB ROAD, SUITE 100, GURNEE, IL, 60031
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2018 364292273 2019-06-26 PROVIDA HEALTH CENTER, S.C. 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 1425 N. HUNT CLUB ROAD, SUITE 100, GURNEE, IL, 60031
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2017 364292273 2018-09-14 PROVIDA HEALTH CENTER, S.C. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 1425 N. HUNT CLUB RD, GURNEE, IL, 60031
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2016 364292273 2017-09-28 PROVIDA HEALTH CENTER, S.C. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 18931 W WASHINGTON STREET SUITE 100, THIRD LAKE, IL, 600301162
PROVIDA HEALTH CENTER, S.C. 401(K) PROFIT SHARING PLAN 2015 364292273 2016-07-06 PROVIDA HEALTH CENTER, S.C. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 8475482200
Plan sponsor’s address 18931 W WASHINGTON STREET SUITE 100, THIRD LAKE, IL, 600301162

Agent

Name and Address Role Appointment Date
LUIS IGNACIO SALAZAR, 1425 N HUNT CLUB RD #100, GURNEE, 60031, LAKE Agent 2018-04-27

President

Name and Address Role
LUIS I SALAZAR MD 1425 HUNT CLUB RD #100 GURNEE IL 60031 President

Secretary

Name and Address Role
LUIS I. SALAZAR, M.D. Secretary

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
PROVIDA FAMILY MEDICINE Assume Name 2013-05-06 No data No data No data

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 10000 1000000 1

Date of last update: 13 Feb 2025

Sources: Illinois Office of the Secretary of State