| Entity Name: | MOHIN TISSA SAMARAWEERA, M.D., S.C. |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Domestic BCA |
| Status: | Dissolved |
| Date Formed: | 02 Jun 1980 |
| Date of Dissolution: | 13 Nov 2015 |
| Company Number: | CORP_52073812 |
| File Number: | 52073812 |
| Date Status Change: | 13 Nov 2015 |
| Place of Formation: | ILLINOIS |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MOHIN TISSA SAMARAWEERA, M.D., S.C. PROFIT SHARING PLAN | 2013 | 363075818 | 2014-06-06 | MOHIN TISSA SAMARAWEERA, M.D., S.C. | 2 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 363075818 |
| Plan administrator’s name | MOHIN TISSA SAMARAWEERA, M.D., S.C. |
| Plan administrator’s address | 24016 W MAIN ST, PLAINFIELD, IL, 605442232 |
| Administrator’s telephone number | 8154367303 |
Signature of
| Role | Plan administrator |
| Date | 2014-06-06 |
| Name of individual signing | MOHIN TISSA SAMARAWEERA, M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1988-06-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8154367303 |
| Plan sponsor’s address | 24016 W MAIN ST, PLAINFIELD, IL, 605442232 |
Plan administrator’s name and address
| Administrator’s EIN | 363075818 |
| Plan administrator’s name | MOHIN TISSA SAMARAWEERA, M.D., S.C. |
| Plan administrator’s address | 24016 W MAIN ST, PLAINFIELD, IL, 605442232 |
| Administrator’s telephone number | 8154367303 |
Signature of
| Role | Plan administrator |
| Date | 2013-06-03 |
| Name of individual signing | MOHIN TISSA SAMARAWEERA, M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1988-06-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8154367303 |
| Plan sponsor’s address | 24016 W MAIN ST, PLAINFIELD, IL, 605442232 |
Plan administrator’s name and address
| Administrator’s EIN | 363075818 |
| Plan administrator’s name | MOHIN TISSA SAMARAWEERA, M.D., S.C. |
| Plan administrator’s address | 24016 W MAIN ST, PLAINFIELD, IL, 605442232 |
| Administrator’s telephone number | 8154367303 |
Signature of
| Role | Plan administrator |
| Date | 2012-08-16 |
| Name of individual signing | MOHIN TISSA SAMARAWEERA, M.D. |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| MOHIN TISSA SAMARAWEERA, 409 W MAIN ST, PLAINFIELD, 60544, WILL | Agent | 1985-07-08 |
| Name and Address | Role |
|---|---|
| MOHIN TISSA SAMARAWEERA, 409 W MAIN ST PLAINFIELD 60544 | President |
| Class | Series | Voting Rights | Authorized Shares | Issued Shares | Par Value |
|---|---|---|---|---|---|
| COMM | No data | Voting Rights | 100000 | 1000000 | No data |
Date of last update: 30 Jan 2025
