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  5. GOOD SHEPHERD MANOR, INC.

GOOD SHEPHERD MANOR, INC.

Company Details

Entity Name: GOOD SHEPHERD MANOR, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 05 May 1970
Company Number: CORP_49658478
File Number: 49658478
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
YA7BM21TZRC3 2025-03-06 4129 N RTE 1&17, MOMENCE, IL, 60954, USA PO BOX 260, MOMENCE, IL, 60954, 3482, USA

Business Information
Congressional District 02
State/Country of Incorporation IL, USA
Activation Date 2024-03-08
Initial Registration Date 2010-06-24
Entity Start Date 1971-03-01
Fiscal Year End Close Date Jun 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name EMILY BONVALLET
Address PO BOX 260, MOMENCE, IL, 60954, 3482, USA
Title ALTERNATE POC
Name KRISTEN STOCKLE
Address PO BOX 260, MOMENCE, IL, 60954, USA
Government Business
Title PRIMARY POC
Name EMILY BONVALLET
Address PO BOX 260, MOMENCE, IL, 60954, 3482, USA
Title ALTERNATE POC
Name KRISTEN STOCKLE
Address PO BOX 260, MOMENCE, IL, 60954, USA
Past Performance
Title PRIMARY POC
Name EMILY BONVALLET
Address PO BOX 260, MOMENCE, IL, 60954, USA
Title ALTERNATE POC
Name KRISTEN STOCKLE
Address PO BOX 260, MOMENCE, IL, 60954, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2023 366799361 2024-04-24 GOOD SHEPHERD MANOR INC. 126
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s DBA name GOOD SHEPHERD MANOR
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 609540260
Plan sponsor’s address 4129 N STATE RTS 1-17, MOMENCE, IL, 60954

Number of participants as of the end of the plan year
Active participants 129

Signature of
Role Plan administrator
Date 2024-04-24
Name of individual signing KRISTEN STOCKLE
Valid signature Filed with authorized/valid electronic signature
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2022 366799361 2023-04-18 GOOD SHEPHERD MANOR INC. 110
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s DBA name GOOD SHEPHERD MANOR
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 609540260
Plan sponsor’s address 4129 N STATE RTS 1-17, MOMENCE, IL, 60954

Number of participants as of the end of the plan year
Active participants 126

Signature of
Role Plan administrator
Date 2023-04-18
Name of individual signing KRISTEN STOCKLE
Valid signature Filed with authorized/valid electronic signature
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2021 366799361 2022-05-02 GOOD SHEPHERD MANOR INC. 112
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s DBA name GOOD SHEPHERD MANO
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 609540260
Plan sponsor’s address 4129 N STATE RTS 1-17, MOMENCE, IL, 60954

Number of participants as of the end of the plan year
Active participants 110

Signature of
Role Plan administrator
Date 2022-05-02
Name of individual signing KRISTEN STOCKLE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-05-02
Name of individual signing KRISTEN STOCKLE
Valid signature Filed with authorized/valid electronic signature
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2020 366799361 2021-04-19 GOOD SHEPHERD MANOR INC. 124
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s DBA name GOOD SHEPHERD MANOR
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 609540260
Plan sponsor’s address 4129 N STATE RTS 1-17, MOMENCE, IL, 60954

Number of participants as of the end of the plan year
Active participants 112

Signature of
Role Plan administrator
Date 2021-04-19
Name of individual signing KRISTEN STOCKLE
Valid signature Filed with authorized/valid electronic signature
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2019 366799361 2020-05-05 GOOD SHEPHERD MANOR INC 131
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s DBA name GOOD SHEPHERD MANOR
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 60954
Plan sponsor’s address 4129 N STATE RTS 1-17, MOMENCE, IL, 60954

Number of participants as of the end of the plan year
Active participants 124

Signature of
Role Plan administrator
Date 2020-05-05
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2018 366799361 2019-10-24 GOOD SHEPHERD MANOR INC 124
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s DBA name GOOD SHEPHERD MANOR
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 60954
Plan sponsor’s address 4129 N STATE RTS 1-17, MOMENCE, IL, 60954

Number of participants as of the end of the plan year
Active participants 131
Number of participants with account balances as of the end of the plan year 131

Signature of
Role Plan administrator
Date 2019-10-24
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2017 366799361 2018-11-09 GOOD SHEPHERD MANOR INC 116
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s DBA name GOOD SHEPHERD MANOR
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 609540260
Plan sponsor’s address 4129 N STATE RTS 1-17, MOMENCE, IL, 60954

Plan administrator’s name and address
Administrator’s EIN 366799361
Plan administrator’s name GOOD SHEPHERD MANOR INC
Plan administrator’s address PO BOX 260, MOMENCE, IL, 609540260
Administrator’s telephone number 8154723700

Number of participants as of the end of the plan year
Active participants 124
Number of participants with account balances as of the end of the plan year 124

Signature of
Role Plan administrator
Date 2018-11-09
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-11-09
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2016 366799361 2017-04-25 GOOD SHEPHERD MANOR INC 126
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 609540260
Plan sponsor’s address 4129 N STATE RTS 1-17, MOMENCE, IL, 60954

Number of participants as of the end of the plan year
Active participants 116
Number of participants with account balances as of the end of the plan year 116

Signature of
Role Plan administrator
Date 2017-04-25
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-25
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2015 366799361 2016-04-26 GOOD SHEPHERD MANOR, INC 118
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s DBA name GOOD SHEPHERD MANOR
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 609540260
Plan sponsor’s address PO BOX 260, MOMENCE, IL, 60954

Number of participants as of the end of the plan year
Active participants 126

Signature of
Role Plan administrator
Date 2016-04-26
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-04-26
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
GOOD SHEPHERD EMPLOYEES PRE-TAX MEDICAL & DENTAL PLAN 2014 366799361 2015-06-10 GOOD SHEPHERD MANOR, INC. 118
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2001-01-01
Business code 623000
Sponsor’s telephone number 8154723700
Plan sponsor’s DBA name GOOD SHEPHERD MANOR
Plan sponsor’s mailing address PO BOX 260, MOMENCE, IL, 60954
Plan sponsor’s address 4129 N RTS 1-17, MOMENCEE, IL, 60954

Number of participants as of the end of the plan year
Active participants 118

Signature of
Role Plan administrator
Date 2015-06-10
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-10
Name of individual signing BRUCE FITZPATRICK
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
KRISTEN STOCKLE, 4129 N RTE 1&17 PO BOX 260, MOMENCE, 60954, KANKAKEE Agent 2020-11-30

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
GOOD SHEPHERD MANOR GROUP HOMES NFP Assume Name 2011-08-26 No data No data No data

Historical Names

Name Change Date
THE BROTHERS OF THE GOOD SHEPHERD, INC. 1991-07-17

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 13 Jan 2025

Sources: Illinois Office of the Secretary of State

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