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VIJAY M. HARYANI, M.D., S.C.

Company Details

Entity Name: VIJAY M. HARYANI, M.D., S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 07 Nov 1996
Company Number: CORP_59112228
File Number: 59112228
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
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST 2015 364113871 2016-04-22 VIJAY M. HARYANI, M.D., S.C. 20
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 3627 TOULOUSE, BOURBONNAIS, IL, 609144552
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST 2014 364113871 2015-09-15 VIJAY M. HARYANI, M.D., S.C. 23
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 3627 TOULOUSE, BOURBONNAIS, IL, 609144552

Signature of

Role Plan administrator
Date 2015-09-15
Name of individual signing VIJAY M. HARYANI, M.D., PRESIDENT
Valid signature Filed with authorized/valid electronic signature
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST 2014 364113871 2015-10-15 VIJAY M. HARYANI, M.D., S.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 3627 TOULOUSE STREET, BOURBONNAIS, IL, 60914

Signature of

Role Plan administrator
Date 2015-10-15
Name of individual signing VIJAY HARYANI
Valid signature Filed with authorized/valid electronic signature
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST 2014 364113871 2015-04-10 VIJAY M. HARYANI, M.D., S.C. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 3627 TOULOUSE STREET, BOURBONNAIS, IL, 60914

Signature of

Role Plan administrator
Date 2015-04-09
Name of individual signing VIJAY HARYANI
Valid signature Filed with authorized/valid electronic signature
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST 2013 364113871 2014-07-07 VIJAY M. HARYANI, M.D., S.C. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 3627 TOULOUSE, BOURBONNAIS, IL, 609144552

Signature of

Role Plan administrator
Date 2014-07-07
Name of individual signing VIJAY M. HARYANI, M.D., PRESIDENT
Valid signature Filed with authorized/valid electronic signature
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST 2013 364113871 2014-05-06 VIJAY M. HARYANI, M.D., S.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 3627 TOULOUSE STREET, BOURBONNAIS, IL, 60914

Signature of

Role Plan administrator
Date 2014-05-06
Name of individual signing VIJAY HARYANI
Valid signature Filed with authorized/valid electronic signature
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST 2012 364113871 2013-09-05 VIJAY M. HARYANI, M.D., S.C. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 3627 TOULOUSE, BOURBONNAIS, IL, 609144552

Signature of

Role Plan administrator
Date 2013-09-05
Name of individual signing VIJAY M. HARYANI, M.D.
Valid signature Filed with authorized/valid electronic signature
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST 2012 364113871 2013-06-17 VIJAY M. HARYANI, M.D., S.C. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901

Signature of

Role Plan administrator
Date 2013-06-17
Name of individual signing VIJAY HARYANI
Valid signature Filed with authorized/valid electronic signature
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST 2011 364113871 2012-08-09 VIJAY M. HARYANI, M.D., S.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901

Plan administrator’s name and address

Administrator’s EIN 364113871
Plan administrator’s name VIJAY M. HARYANI, M.D., S.C.
Plan administrator’s address 375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901
Administrator’s telephone number 8159363240

Signature of

Role Plan administrator
Date 2012-08-08
Name of individual signing VIJAY HARYANI
Valid signature Filed with authorized/valid electronic signature
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST 2011 364113871 2012-04-11 VIJAY M. HARYANI, M.D., S.C. 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621111
Sponsor’s telephone number 8159363240
Plan sponsor’s address 3627 TOULOUSE, BOURBONNAIS, IL, 609144552

Plan administrator’s name and address

Administrator’s EIN 364113871
Plan administrator’s name VIJAY M. HARYANI, M.D., S.C.
Plan administrator’s address 3627 TOULOUSE, BOURBONNAIS, IL, 609144552
Administrator’s telephone number 8159363240

Signature of

Role Plan administrator
Date 2012-04-11
Name of individual signing VIJAY M. HARYANI, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
MARK D TOLJANIC, 3601 ALGONQUIN RD STE 860, ROLLING MEADOWS, 60008, COOK-NOT IN CITY OF CHICAGO Agent 2022-06-01

President

Name and Address Role
VIJAY M HARYANI 3627 TOULOUSE, BOURBONNAIS, 60914 President

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMM No data Voting Rights 100000 1000000 No data

Date of last update: 13 Feb 2025

Sources: Illinois Office of the Secretary of State