| Entity Name: | OPTIMAL HEALTH MEDICINE, LLC |
| Jurisdiction: | Illinois |
| Entity Type: | Limited Liability Company |
| Status: | Goodstanding |
| Date Formed: | 30 Aug 2012 |
| Company Number: | LLC_03977684 |
| File Number: | 03977684 |
| Type of Management: | Member Managed |
| Date Status Change: | 03 Jul 2024 |
| Address | 1368 D'ADRIAN PROFESSIONAL PAR, GODFREY, 62035, IL |
| Place of Formation: | ILLINOIS |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| ETQDE672K4T4 | 2024-07-18 | 1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035, 1685, USA | 1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035, 1685, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Doing Business As | OPTIMAL HEALTH MEDICINE |
| Congressional District | 15 |
| State/Country of Incorporation | IL, USA |
| Activation Date | 2023-07-25 |
| Initial Registration Date | 2023-06-28 |
| Entity Start Date | 2012-08-30 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 621111 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JENNIFER WAGNON |
| Address | 1368 D'ADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035, USA |
| Title | ALTERNATE POC |
| Name | JON WAGNON |
| Role | DR. |
| Address | 1368 D'ADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JENNIFER WAGNON |
| Address | 1368 D'ADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035, USA |
| Title | ALTERNATE POC |
| Name | JON WAGNON |
| Role | DR. |
| Address | 1368 D'ADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035, USA |
| Past Performance | |
|---|---|
| Title | PRIMARY POC |
| Name | JON WAGNON |
| Role | DR. |
| Address | 1368 D'ADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035, USA |
| Title | ALTERNATE POC |
| Name | JON WAGNON |
| Role | DR. |
| Address | 1368 D'ADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035, USA |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OPTIMAL HEALTH MEDICINE 401K PLAN | 2023 | 460895473 | 2024-11-26 | OPTIMAL HEALTH MEDICINE | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-11-26 |
| Name of individual signing | JON WAGNON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 6184339701 |
| Plan sponsor’s address | 1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035 |
Signature of
| Role | Plan administrator |
| Date | 2024-07-16 |
| Name of individual signing | JON WAGNON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 6184339701 |
| Plan sponsor’s address | 1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035 |
Signature of
| Role | Plan administrator |
| Date | 2024-07-03 |
| Name of individual signing | ASHLEY DUNHAM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 6184339701 |
| Plan sponsor’s address | 1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035 |
Signature of
| Role | Plan administrator |
| Date | 2024-11-26 |
| Name of individual signing | JON WAGNON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 6184339701 |
| Plan sponsor’s address | 1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-26 |
| Name of individual signing | JON WAGNON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 6184339701 |
| Plan sponsor’s address | 1368 DADRIAN PROFESSIONAL PARK, GODFREY, IL, 62035 |
Signature of
| Role | Plan administrator |
| Date | 2022-08-22 |
| Name of individual signing | NARMIN NOORANI |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| JON ANTHONY WAGNON, 1368 D'ADRIAN PROFESSIONALPARK, GODFREY, 62035 | Agent | 2017-02-22 |
| Name and Address | Role | Appointment Date |
|---|---|---|
| WAGNON DO, JON A, 1368 DADRIAN PROFESSIONAL PAR, GODFREY, IL, 62035 | Manager | 2024-07-03 |
Date of last update: 13 Jan 2025
