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  5. URSA CHRISTIAN CHURCH

URSA CHRISTIAN CHURCH

Company Details

Entity Name: URSA CHRISTIAN CHURCH
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 05 Aug 1980
Company Number: CORP_52128366
File Number: 52128366
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LAKESIDE FAMILY PRACTICE 401(K) SAFE HARBOR PLAN 2012 202182402 2013-10-02 LAKESIDE FAMILY PRACTICE 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6308984822
Plan sponsor’s address 1315 MACOM DRIVE, STE. 203, NAPERVILLE, IL, 60564

Signature of
Role Plan administrator
Date 2013-10-02
Name of individual signing ROBERT MILLAR
Valid signature Filed with authorized/valid electronic signature
LAKESIDE FAMILY PRACTICE 401(K) SAFE HARBOR PLAN 2011 202182402 2012-08-08 LAKESIDE FAMILY PRACTICE 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6308984822
Plan sponsor’s address 1315 MACOM DRIVE, STE. 203, NAPERVILLE, IL, 60564

Plan administrator’s name and address
Administrator’s EIN 202182402
Plan administrator’s name LAKESIDE FAMILY PRACTICE
Plan administrator’s address 1315 MACOM DRIVE, STE. 203, NAPERVILLE, IL, 60564
Administrator’s telephone number 6308984822

Signature of
Role Plan administrator
Date 2012-08-06
Name of individual signing ROBERT MILLAR
Valid signature Filed with authorized/valid electronic signature
LAKESIDE FAMILY PRACTICE 401(K) SAFE HARBOR PLAN 2010 202182402 2011-07-12 LAKESIDE FAMILY PRACTICE 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6308984822
Plan sponsor’s address 1315 MACOM DRIVE, STE. 203, NAPERVILLE, IL, 60564

Plan administrator’s name and address
Administrator’s EIN 202182402
Plan administrator’s name LAKESIDE FAMILY PRACTICE
Plan administrator’s address 1315 MACOM DRIVE, STE. 203, NAPERVILLE, IL, 60564
Administrator’s telephone number 6308984822

Signature of
Role Plan administrator
Date 2011-07-12
Name of individual signing ROBERT MILLAR
Valid signature Filed with authorized/valid electronic signature
LAKESIDE FAMILY PRACTICE 401(K) SAFE HARBOR PLAN 2009 202182402 2010-07-12 LAKESIDE FAMILY PRACTICE 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6308984822
Plan sponsor’s address 1315 MACOM DRIVE, STE. 203, NAPERVILLE, IL, 60564

Plan administrator’s name and address
Administrator’s EIN 202182402
Plan administrator’s name LAKESIDE FAMILY PRACTICE
Plan administrator’s address 1315 MACOM DRIVE, STE. 203, NAPERVILLE, IL, 60564
Administrator’s telephone number 6308984822

Signature of
Role Plan administrator
Date 2010-07-12
Name of individual signing ROBERT MILLAR
Valid signature Filed with authorized/valid electronic signature
LAKESIDE FAMILY PRACTICE 401(K) SAFE HARBOR PLAN 2009 202182402 2010-07-08 LAKESIDE FAMILY PRACTICE 8
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 6308984822
Plan sponsor’s address 1315 MACOM DRIVE, STE. 203, NAPERVILLE, IL, 60564

Plan administrator’s name and address
Administrator’s EIN 202182402
Plan administrator’s name LAKESIDE FAMILY PRACTICE
Plan administrator’s address 1315 MACOM DRIVE, STE. 203, NAPERVILLE, IL, 60564
Administrator’s telephone number 6308984822

Signature of
Role Employer/plan sponsor
Date 2010-07-08
Name of individual signing ROBERT MILLAR
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
JUSTIN KNOX, 202 N WARSAW, PO BOX 37, URSA, 62376, ADAMS Agent 2020-07-22

President

Name and Address Role
SHANNON PILKINGTON 7401 N 81ST FOWLER 62338 President

Secretary

Name and Address Role
IRENE BURKE 519 W MAPLE URSA 62376 Secretary

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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