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  5. AFFILIATED HEALTH CLINICS, LLC

AFFILIATED HEALTH CLINICS, LLC

Company Details

Entity Name: AFFILIATED HEALTH CLINICS, LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 05 Oct 2016 (8 years ago)
Document Number: L16000185298
FEI/EIN Number 81-4048640
Address: 1515 22nd Ave N, ST PETERSBURG, FL, 33704, US
Mail Address: 1515 22nd Ave N, ST PETERSBURG, FL, 33704, US
ZIP code: 33704
County: Pinellas
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1831632900 2016-11-22 2023-07-12 1515 22ND AVE N, ST PETERSBURG, FL, 337043113, US 1515 22ND AVE N, ST PETERSBURG, FL, 337043113, US

Contacts
Phone +1 727-322-4227

Authorized person
Name DYLAN DINESH
Role OWNER
Phone 7273224227

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes
Taxonomy Code 207QS0010X - Sports Medicine (Family Medicine) Physician
Is Primary No
Taxonomy Code 207R00000X - Internal Medicine Physician
Is Primary No
Taxonomy Code 208M00000X - Hospitalist Physician
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 019761700
State FL
Issuer BCBS
Number BT37F

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AFFILIATED HEALTH CLINICS 401(K) PROFIT SHARING PLAN & TRUST 2023 814048640 2024-10-23 AFFILIATED HEALTH CLINICS 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-03-01
Business code 621111
Sponsor’s telephone number 7273224227
Plan sponsor’s address 1515 22ND AVENUE N, SAINT PETERSBURG, FL, 33704

Signature of
Role Plan administrator
Date 2024-10-23
Name of individual signing LORRI LACZYNSKI
Valid signature Filed with authorized/valid electronic signature
AFFILIATED HEALTH CLINICS 401(K) PROFIT SHARING PLAN & TRUST 2022 814048640 2023-10-10 AFFILIATED HEALTH CLINICS 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-03-01
Business code 621111
Sponsor’s telephone number 7273224227
Plan sponsor’s address 1515 22ND AVE N, SAINT PETERSBURG, FL, 33704

Signature of
Role Plan administrator
Date 2023-10-10
Name of individual signing LORRI LACZYNSKI
Valid signature Filed with authorized/valid electronic signature
AFFILIATED HEALTH CLINICS 401(K) PROFIT SHARING PLAN & TRUST 2021 814048640 2022-09-15 AFFILIATED HEALTH CLINICS 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-03-01
Business code 621111
Sponsor’s telephone number 7273224227
Plan sponsor’s address 3600 CENTRAL AVE, SAINT PETERSBURG, FL, 33711

Signature of
Role Plan administrator
Date 2022-09-15
Name of individual signing LORRI LACZYNSKI
Valid signature Filed with authorized/valid electronic signature
AFFILIATED HEALTH CLINICS 401(K) PROFIT SHARING PLAN & TRUST 2020 814048640 2021-06-17 AFFILIATED HEALTH CLINICS 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-03-01
Business code 621111
Sponsor’s telephone number 7273224227
Plan sponsor’s address 3600 CENTRAL AVE, SAINT PETERSBURG, FL, 33711

Signature of
Role Plan administrator
Date 2021-06-17
Name of individual signing LORRI LACZYNSKI
Valid signature Filed with authorized/valid electronic signature
AFFILIATED HEALTH CLINICS 401(K) PROFIT SHARING PLAN & TRUST 2019 814048640 2020-07-31 AFFILIATED HEALTH CLINICS 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-03-01
Business code 621111
Sponsor’s telephone number 7273224227
Plan sponsor’s address 3600 CENTRAL AVE, SAINT PETERSBURG, FL, 33711

Signature of
Role Plan administrator
Date 2020-07-31
Name of individual signing GIOVANNI BAULA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED HEALTH CLINICS 401 K PROFIT SHARING PLAN TRUST 2018 814048640 2019-05-10 AFFILIATED HEALTH CLINICS 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-03-01
Business code 621111
Sponsor’s telephone number 7273224227
Plan sponsor’s address 3600 CENTRAL AVE, SAINT PETERSBURG, FL, 33711

Signature of
Role Plan administrator
Date 2019-05-10
Name of individual signing GIOVANNI BAULA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED HEALTH CLINICS-401K 2017 814048640 2018-07-03 AFFILIATED HEALTH CLINICS 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-04-01
Business code 621111
Sponsor’s telephone number 7273224227
Plan sponsor’s address 3600 CENTRAL AVE, SAINT PETERSBURG, FL, 337111345

Signature of
Role Plan administrator
Date 2018-07-03
Name of individual signing LORRI LACZYNSKI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Dinesh Dylan Dr. Agent 1515 22nd Ave N, ST PETERSBURG, FL, 33704

Manager

Name Role Address
Dinesh Dylan Dr. Manager 1515 22nd Ave N, ST PETERSBURG, FL, 33704

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-08-03 1515 22nd Ave N, ST PETERSBURG, FL 33704 No data
CHANGE OF MAILING ADDRESS 2023-08-03 1515 22nd Ave N, ST PETERSBURG, FL 33704 No data
REGISTERED AGENT ADDRESS CHANGED 2023-08-03 1515 22nd Ave N, ST PETERSBURG, FL 33704 No data
REGISTERED AGENT NAME CHANGED 2022-09-21 Dinesh, Dylan, Dr. No data

Documents

Name Date
ANNUAL REPORT 2024-02-19
AMENDED ANNUAL REPORT 2023-08-03
ANNUAL REPORT 2023-01-05
AMENDED ANNUAL REPORT 2022-09-21
AMENDED ANNUAL REPORT 2022-08-25
AMENDED ANNUAL REPORT 2022-06-24
ANNUAL REPORT 2022-01-31
ANNUAL REPORT 2021-01-29
ANNUAL REPORT 2020-03-19
ANNUAL REPORT 2019-03-06

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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