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  5. JAC STORES, INC.

JAC STORES, INC.

Company Details

Entity Name: JAC STORES, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 05 Mar 1982
Company Number: CORP_52665795
File Number: 52665795
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
JAC STORES, INC. 401(K) PLAN 2023 371113611 2024-12-02 JAC STORES, INC. 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2024-12-02
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-12-02
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
JAC STORES, INC. 401(K) PLAN 2022 371113611 2023-09-18 JAC STORES, INC. 58
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2023-09-18
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-09-18
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
JAC STORES, INC. 401(K) PLAN 2021 371113611 2022-11-09 JAC STORES, INC. 67
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2022-11-09
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
JAC STORES, INC. 401(K) PLAN 2020 371113611 2021-10-01 JAC STORES, INC. 93
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2021-10-01
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-10-01
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
JAC STORES, INC. 401(K) PLAN 2019 371113611 2020-05-29 JAC STORES, INC. 92
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2020-05-29
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-29
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
JAC STORES, INC. 401(K) PLAN 2018 371113611 2019-08-05 JAC STORES, INC. 93
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2019-08-05
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-08-05
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
JAC STORES, INC. 401(K) PLAN 2017 371113611 2018-04-14 JAC STORES, INC. 86
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2018-04-14
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-04-14
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
JAC STORES, INC. 401(K) PLAN 2016 371113611 2017-07-11 JAC STORES, INC. 89
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2017-07-11
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-11
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
JAC STORES, INC. 401(K) PLAN 2015 371113611 2016-07-11 JAC STORES, INC. 89
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2016-07-11
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-11
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
JAC STORES, INC. 401(K) PLAN 2014 371113611 2015-06-29 JAC STORES, INC. 86
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-11-01
Business code 446110
Sponsor’s telephone number 2173626226
Plan sponsor’s address 2245 W MOUND RD, DECATUR, IL, 625269367

Signature of
Role Plan administrator
Date 2015-06-29
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-06-29
Name of individual signing DAVID FALK
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
DAVID EDWARD FALK, 2245 W MOUND RD, DECATUR, 62526, MACON Agent 2007-03-15

President

Name and Address Role
DAVID E FALK 2245 W MOUND ROADDECATUR IL 62526 President

Secretary

Name and Address Role
KIM SPEASL 1591 RIEDEL AVE, DECATUR IL 62526 Secretary

License

License Type License Number Status License Code License Description Business Activity Date Issued Effective Date Expiration Date
PHARMACY 054020304 No data No data LICENSED PHARMACY No data 2017-04-04 2024-01-12 2026-03-31
PHARMACY 054020026 No data No data LICENSED PHARMACY No data 2016-08-24 2018-02-27 2020-09-30
PHARMACY 054019675 No data No data LICENSED PHARMACY No data 2016-02-17 2024-01-12 2026-03-31
PHARMACY 054019683 No data No data LICENSED PHARMACY No data 2016-02-09 2024-01-12 2026-03-31
PHARMACY 054018035 No data No data LICENSED PHARMACY No data 2014-02-26 2016-02-25 2018-03-31
PHARMACY 054018036 No data No data LICENSED PHARMACY No data 2014-02-14 2016-02-25 2018-03-31
PHARMACY 054018253 No data No data LICENSED PHARMACY No data 2013-06-27 2018-02-27 2020-09-30
PHARMACY 054018054 No data No data LICENSED PHARMACY No data 2012-10-30 2014-02-14 2016-03-31
PHARMACY 054015766 No data No data LICENSED PHARMACY No data 2012-02-06 2016-02-25 2018-03-31
HME AND SERVICES PROV 203001325 No data No data HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER No data 2011-06-08 2015-02-20 2018-03-31

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
THE PHARMACIE SHOPPE No data 2012-10-11 2017-03-22 Voluntary Cancellation No data
SAV MOR PHARMACY Assume Name 2010-09-23 No data No data No data

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
1 No data Voting Rights 2000 500000 No data

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6469607002 2020-04-07 0507 PPP 2245 W. Mound Rd, Decatur, IL, 62526
Loan Status Date 2021-07-15
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 858600
Loan Approval Amount (current) 858600
Undisbursed Amount 0
Franchise Name -
Lender Location ID 455644
Servicing Lender Name Live Oak Banking Company
Servicing Lender Address 1741 Tiburon Dr, WILMINGTON, NC, 28403-6244
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Decatur, MACON, IL, 62526-0800
Project Congressional District IL-13
Number of Employees 88
NAICS code 446110
Borrower Race White
Borrower Ethnicity Not Hispanic or Latino
Business Type Corporation
Originating Lender ID 455644
Originating Lender Name Live Oak Banking Company
Originating Lender Address WILMINGTON, NC
Gender Male Owned
Veteran Non-Veteran
Forgiveness Amount 868950.25
Forgiveness Paid Date 2021-06-30

Related by officers

No related officers

Related by address

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Date of last update: 13 Mar 2025

Sources: Illinois Office of the Secretary of State

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