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DEVINA SHAH, S.C.

Company Details

Entity Name: DEVINA SHAH, S.C.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Dissolved
Date Formed: 05 Jan 2011
Date of Dissolution: 11 Jun 2021
Company Number: CORP_67608119
File Number: 67608119
Type of Business: Incorporated under the Medical Corporation Act
Date Status Change: 11 Jun 2021
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DEVINA SHAH, S.C. 401(K) PROFIT SHARING PLAN & TRUST 2019 274481548 2020-06-08 DEVINA SHAH, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7734689000
Plan sponsor’s address 3040 SCOTT CRESCENT, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2020-06-07
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-07
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
DEVINA SHAH, S.C. 401(K) PROFIT SHARING PLAN & TRUST 2019 274481548 2020-12-09 DEVINA SHAH, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7234689000
Plan sponsor’s address 3040 SCOTT CRESCENT, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2020-12-09
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-12-09
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
DEVINA SHAH, S.C. CASH BALANCE PENSION PLAN & TRUST 2019 274481548 2020-06-08 DEVINA SHAH, S.C. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7234689000
Plan sponsor’s address 3040 SCOTT CRESCENT, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2020-06-07
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-07
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
DEVINA SHAH, S.C. CASH BALANCE PENSION PLAN & TRUST 2019 274481548 2020-12-14 DEVINA SHAH, S.C. 2
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7234689000
Plan sponsor’s address 3040 SCOTT CRESCENT, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2020-12-10
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-12-10
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
DEVINA SHAH, S.C. 401(K) PROFIT SHARING PLAN & TRUST 2018 274481548 2019-06-14 DEVINA SHAH, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7734689000
Plan sponsor’s address 11240 S. MICHIGAN AVENUE, CHICAGO, IL, 60628

Signature of

Role Plan administrator
Date 2019-06-13
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-13
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
DEVINA SHAH, S.C. CASH BALANCE PENSION PLAN & TRUST 2018 274481548 2019-06-14 DEVINA SHAH, S.C. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7234689000
Plan sponsor’s address 11240 S. MICHIGAN AVENUE, CHICAGO, IL, 60628

Signature of

Role Plan administrator
Date 2019-06-13
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-13
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
DEVINA SHAH, S.C. CASH BALANCE PENSION PLAN & TRUST 2017 274481548 2018-07-05 DEVINA SHAH, S.C. 1
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7234689000
Plan sponsor’s address 11240 S. MICHIGAN AVENUE, CHICAGO, IL, 60628

Signature of

Role Plan administrator
Date 2018-07-05
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-05
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
DEVINA SHAH, S.C. 401(K) PROFIT SHARING PLAN & TRUST 2017 274481548 2018-07-05 DEVINA SHAH, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7734689000
Plan sponsor’s address 11240 S. MICHIGAN AVENUE, CHICAGO, IL, 60628

Signature of

Role Plan administrator
Date 2018-07-05
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-05
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
DEVINA SHAH, S.C. 401(K) PROFIT SHARING PLAN & TRUST 2016 274481548 2017-09-25 DEVINA SHAH, S.C. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7234689000
Plan sponsor’s address 11240 S. MICHIGAN AVENUE, CHICAGO, IL, 60628

Signature of

Role Plan administrator
Date 2017-09-25
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-25
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
DEVINA SHAH, S.C. CASH BALANCE PENSION PLAN & TRUST 2016 274481548 2017-09-25 DEVINA SHAH, S.C. 2
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 7234689000
Plan sponsor’s address 11240 S. MICHIGAN AVENUE, CHICAGO, IL, 60628

Signature of

Role Plan administrator
Date 2017-09-25
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-25
Name of individual signing DEVINA SHAH
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
DEVINA SHAH, 11240 S MICHIGAN AVE, CHICAGO, 60628, COOK-NOT IN CITY OF CHICAGO Agent 2012-01-10

President

Name and Address Role
DEVINA SHAH 11240 S MICHIGAN CHICAGO 60628 President

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 10000 1000000 No data

Date of last update: 20 Jan 2025

Sources: Illinois Office of the Secretary of State