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POTENTIATECH INC.

POTENTIATECH INC.

Company Details

Entity Name:	POTENTIATECH INC.
Jurisdiction:	Illinois
Entity Type:	Corporation - Domestic BCA
Status:	Goodstanding
Date Formed:	24 Feb 2015
Company Number:	CORP_70032821
File Number:	70032821
Type of Business:	All Inclusive Purpose
Place of Formation:	ILLINOIS

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

POTENTIATECH INC 401(K)

2022

473227368

2023-10-19

POTENTIATECH INC

1

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	541519
Sponsor’s telephone number	7739521894
Plan sponsor’s address	3640 N PAULINA ST, CHICAGO, IL, 60613

Signature of

Role	Plan administrator
Date	2023-10-19
Name of individual signing	MANSOUR JABALAMELI
Valid signature	Filed with authorized/valid electronic signature

POTENTIATECH INC 401(K)

2019

473227368

2020-10-09

POTENTIATECH INC

1

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	541519
Sponsor’s telephone number	7739521894
Plan sponsor’s address	3640 N PAULINA ST, CHICAGO, IL, 60613

Signature of

Role	Plan administrator
Date	2020-10-09
Name of individual signing	MANSOUR JABALAMELI
Valid signature	Filed with authorized/valid electronic signature

POTENTIATECH INC 401(K)

2018

473227368

2019-06-13

POTENTIATECH INC

1

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	541519
Sponsor’s telephone number	7739521894
Plan sponsor’s address	3640 N PAULINA ST, CHICAGO, IL, 60613

Signature of

Role	Plan administrator
Date	2019-06-13
Name of individual signing	MANSOUR JABALAMELI
Valid signature	Filed with authorized/valid electronic signature

POTENTIATECH INC 401(K)

2017

473227368

2018-09-27

POTENTIATECH INC

1

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	541519
Sponsor’s telephone number	7739521894
Plan sponsor’s address	3640 N PAULINA ST, CHICAGO, IL, 60613

Signature of

Role	Plan administrator
Date	2018-09-27
Name of individual signing	MANSOUR JABALAMELI
Valid signature	Filed with authorized/valid electronic signature

POTENTIATECH INC 401(K)

2016

473227368

2017-10-03

POTENTIATECH INC

0

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2016-01-01
Business code	541519
Sponsor’s telephone number	7739521894
Plan sponsor’s address	3640 N PAULINA ST, CHICAGO, IL, 60613

Signature of

Role	Plan administrator
Date	2017-10-03
Name of individual signing	MANSOUR JABALAMELI
Valid signature	Filed with authorized/valid electronic signature

Agent

Name and Address	Role	Appointment Date
MANSOUR JABALAMELI, 3640 N PAULINA ST, CHICAGO, 60613, COOK-NOT IN CITY OF CHICAGO	Agent	2015-02-24

President

Name and Address	Role
MANS JABAL 3640 N PAULINA STREET, CHICAGO, IL 60613	President

Shares

Class	Series	Voting Rights	Authorized Shares	Issued Shares	Par Value
COMMON	No data	Voting Rights	1000	1000000	No data

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State