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PRIME HEALTH OF NORTH PORT, LLC

Company Details

Entity Name: PRIME HEALTH OF NORTH PORT, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 04 Mar 2004 (21 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 08 Nov 2021 (3 years ago)
Document Number: L04000017407
FEI/EIN Number 200825333
Address: 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 34288, US
Mail Address: 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 34288, US
ZIP code: 34288
County: Sarasota
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1740228386 2006-06-04 2011-09-27 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342884600, US 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342884600, US

Contacts

Phone +1 941-423-9936
Fax 9414269794

Authorized person

Name LEE GROSS
Role OWNER
Phone 9414239936

Taxonomy

Taxonomy Code 207Q00000X - Family Medicine Physician
License Number ME84648
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2023 200825333 2024-07-20 PRIME HEALTH OF NORTH PORT, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2024-07-20
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-20
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2022 200825333 2023-07-09 PRIME HEALTH OF NORTH PORT, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2023-07-09
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-09
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2021 200825333 2022-10-05 PRIME HEALTH OF NORTH PORT, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2022-10-05
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-05
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2020 200825333 2021-07-18 PRIME HEALTH OF NORTH PORT, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2021-07-18
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-07-18
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2019 200825333 2020-05-24 PRIME HEALTH OF NORTH PORT, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2020-05-24
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-24
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2018 200825333 2019-07-05 PRIME HEALTH OF NORTH PORT, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2019-07-05
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-05
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2017 200825333 2018-06-25 PRIME HEALTH OF NORTH PORT, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2018-06-25
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-06-25
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2016 200825333 2017-06-15 PRIME HEALTH OF NORTH PORT, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2017-06-15
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-15
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2015 200825333 2016-07-15 PRIME HEALTH OF NORTH PORT, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2016-07-15
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-15
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
PRIME HEALTH OF NORTH PORT RETIREMENT PLAN 2014 200825333 2015-07-06 PRIME HEALTH OF NORTH PORT, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-06-01
Business code 621111
Sponsor’s telephone number 9414239936
Plan sponsor’s address 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL, 342888661

Signature of

Role Plan administrator
Date 2015-07-06
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-06
Name of individual signing JANICE GROSS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GROSS LEE S Agent 2975 BOBCAT VILLAGE CENTER RD, NORTH PORT, FL, 34288

Managing Member

Name Role Address
GROSS LEE SMD Managing Member 132 COLONIAL ST SW, PORT CHARLOTTE, FL, 33952

Authorized Member

Name Role Address
CROUCH WILLIAM LIV, M.D Authorized Member 2401 ISLE OF PALM DR., VENICE, FL, 34292

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G18000128064 EPIPHANY HEALTH ACTIVE 2018-12-04 2028-12-31 No data 132 COLONIAL STREET SW, SUITE100, PORT CHARLOTTE, US, 33952

Events

Event Type Filed Date Value Description
LC AMENDMENT 2021-11-08 No data No data
REGISTERED AGENT ADDRESS CHANGED 2015-04-17 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL 34288 No data
CHANGE OF PRINCIPAL ADDRESS 2010-04-01 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL 34288 No data
CHANGE OF MAILING ADDRESS 2010-04-01 2975 BOBCAT VILLAGE CENTER RD, SUITE 100, NORTH PORT, FL 34288 No data
REGISTERED AGENT NAME CHANGED 2005-04-14 GROSS, LEE S No data

Documents

Name Date
ANNUAL REPORT 2024-04-06
ANNUAL REPORT 2023-04-23
ANNUAL REPORT 2022-04-22
LC Amendment 2021-11-08
ANNUAL REPORT 2021-03-28
ANNUAL REPORT 2020-05-05
ANNUAL REPORT 2019-04-13
ANNUAL REPORT 2018-04-15
ANNUAL REPORT 2017-04-24
ANNUAL REPORT 2016-04-26

Date of last update: 02 Feb 2025

Sources: Florida Department of State