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  5. CARLINVILLE NATIONAL BANK SHARES, INC.

CARLINVILLE NATIONAL BANK SHARES, INC.

Company Details

Entity Name: CARLINVILLE NATIONAL BANK SHARES, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Foreign BCA
Status: Merged/Consolidated
Date Formed: 28 Dec 1984
Company Number: CORP_53690718
File Number: 53690718
Type of Business: Business Corporations
Date Status Change: 26 Jun 2013
Place of Formation: DELAWARE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CARLINVILLE NATIONAL BANK SHARES FLEXIBLE SPENDING ACCOUNT 2012 371125050 2013-06-13 CARLINVILLE NATIONAL BANK SHARES INC 167
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2001-09-01
Business code 522110
Sponsor’s telephone number 2178542674
Plan sponsor’s mailing address PO BOX 350, CARLINVILLE, IL, 62626
Plan sponsor’s address 450 W SIDE OF SQUARE, CARLINVILLE, IL, 62626

Number of participants as of the end of the plan year
Active participants 173
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2013-06-13
Name of individual signing DWAN GROSS
Valid signature Filed with authorized/valid electronic signature
CARLINVILLE NATIONAL BANK SHARES INC HEALTH REIMBURSEMENT ARRANGEMENT 2012 371125050 2013-06-13 CARLINVILLE NATIONAL BANK SHARES INC 146
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2010-01-01
Business code 522110
Sponsor’s telephone number 2178542674
Plan sponsor’s mailing address PO BOX 350, CARLINVILLE, IL, 62626
Plan sponsor’s address 450 W SIDE OF SQUARE, CARLINVILLE, IL, 62626

Number of participants as of the end of the plan year
Active participants 127
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2013-06-13
Name of individual signing DWAN GROSS
Valid signature Filed with authorized/valid electronic signature
CARLINVILLE NATIONAL BANK SHARES FLEXIBLE SPENDING ACCOUNT 2011 371125050 2012-07-10 CARLINVILLE NATIONAL BANK SHARES INC 182
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2001-09-01
Business code 522110
Sponsor’s telephone number 2178542674
Plan sponsor’s mailing address PO BOX 350, CARLINVILLE, IL, 62626
Plan sponsor’s address 450 W SIDE OF SQUARE, CARLINVILLE, IL, 62626

Plan administrator’s name and address
Administrator’s EIN 371125050
Plan administrator’s name CARLINVILLE NATIONAL BANK SHARES INC
Plan administrator’s address PO BOX 350, CARLINVILLE, IL, 62626
Administrator’s telephone number 2178542674

Number of participants as of the end of the plan year
Active participants 166
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-07-10
Name of individual signing DWAN GROSS
Valid signature Filed with authorized/valid electronic signature
CARLINVILLE NATIONAL BANK SHARES INC HEALTH REIMBURSEMENT ARRANGEMENT 2011 371125050 2012-07-10 CARLINVILLE NATIONAL BANK SHARES INC 143
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2010-01-01
Business code 522110
Sponsor’s telephone number 2178542674
Plan sponsor’s mailing address PO BOX 350, CARLINVILLE, IL, 62626
Plan sponsor’s address 450 W SIDE OF SQUARE, CARLINVILLE, IL, 62626

Plan administrator’s name and address
Administrator’s EIN 371125050
Plan administrator’s name CARLINVILLE NATIONAL BANK SHARES INC
Plan administrator’s address PO BOX 350, CARLINVILLE, IL, 62626
Administrator’s telephone number 2178542674

Number of participants as of the end of the plan year
Active participants 146
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-07-10
Name of individual signing DWAN GROSS
Valid signature Filed with authorized/valid electronic signature
CARLINVILLE NATIONAL BANK SHARES INC HEALTH REIMBURSEMENT ARRANGEMENT 2010 371125050 2011-10-13 CARLINVILLE NATIONAL BANK SHARES, INC. 144
File View Page
Three-digit plan number (PN) 503
Effective date of plan 2010-01-01
Business code 522110
Sponsor’s telephone number 2178542674
Plan sponsor’s mailing address PO BOX 350, CARLINVILLE, IL, 62626
Plan sponsor’s address 450 W SIDE OF SQUARE, CARLINVILLE, IL, 62626

Plan administrator’s name and address
Administrator’s EIN 371125050
Plan administrator’s name CARLINVILLE NATIONAL BANK SHARES, INC.
Plan administrator’s address PO BOX 350, CARLINVILLE, IL, 62626
Administrator’s telephone number 2178542674

Number of participants as of the end of the plan year
Active participants 143
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-10-13
Name of individual signing DWAN GROSS
Valid signature Filed with authorized/valid electronic signature
CARLINVILLE NATIONAL BANK SHARES FLEXIBLE SPENDING ACCOUNT 2010 371125050 2011-08-01 CARLINVILLE NATIONAL BANK SHARES INC 171
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2001-09-01
Business code 522110
Sponsor’s telephone number 2178542674
Plan sponsor’s mailing address PO BOX 350, CARLINVILLE, IL, 62626
Plan sponsor’s address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626

Plan administrator’s name and address
Administrator’s EIN 371125050
Plan administrator’s name CARLINVILLE NATIONAL BANK SHARES INC
Plan administrator’s address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626
Administrator’s telephone number 2178542674

Number of participants as of the end of the plan year
Active participants 181
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2011-08-01
Name of individual signing DWAN GROSS
Valid signature Filed with authorized/valid electronic signature
CARLINVILLE NATIONAL BANK SHARES FLEXIBLE SPENDING ACCOUNT 2009 371125050 2010-07-29 CARLINVILLE NATIONAL BANK SHARES INC 134
File View Page
Three-digit plan number (PN) 502
Effective date of plan 2001-09-01
Business code 522110
Sponsor’s telephone number 2178542674
Plan sponsor’s mailing address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626
Plan sponsor’s address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626

Plan administrator’s name and address
Administrator’s EIN 371125050
Plan administrator’s name CARLINVILLE NATIONAL BANK SHARES INC
Plan administrator’s address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626
Administrator’s telephone number 2178542674

Number of participants as of the end of the plan year
Active participants 171
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing DWAN GROSS
Valid signature Filed with authorized/valid electronic signature
CARLINVILLE NATIONAL BANK SHARES FLEXIBLE SPENDING ACCOUNT 2009 371125050 2010-07-29 CARLINVILLE NATIONAL BANK SHARES INC 134
Three-digit plan number (PN) 502
Effective date of plan 2001-09-01
Business code 522110
Sponsor’s telephone number 2178542674
Plan sponsor’s mailing address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626
Plan sponsor’s address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626

Plan administrator’s name and address
Administrator’s EIN 371125050
Plan administrator’s name CARLINVILLE NATIONAL BANK SHARES INC
Plan administrator’s address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626
Administrator’s telephone number 2178542674

Number of participants as of the end of the plan year
Active participants 171
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing DWAN GROSS
Valid signature Filed with authorized/valid electronic signature
CARLINVILLE NATIONAL BANK SHARES FLEXIBLE SPENDING ACCOUNT 2009 371125050 2010-07-29 CARLINVILLE NATIONAL BANK SHARES INC 134
Three-digit plan number (PN) 502
Effective date of plan 2001-09-01
Business code 522110
Sponsor’s telephone number 2178542674
Plan sponsor’s mailing address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626
Plan sponsor’s address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626

Plan administrator’s name and address
Administrator’s EIN 371125050
Plan administrator’s name CARLINVILLE NATIONAL BANK SHARES INC
Plan administrator’s address 450 WEST SIDE OF SQUARE, CARLINVILLE, IL, 62626
Administrator’s telephone number 2178542674

Number of participants as of the end of the plan year
Active participants 171
Retired or separated participants receiving benefits 1
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing DWAN GROSS
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
JAMES T ASHWORTH, W SIDE SQ, CARLINVILLE, 62626, MACOUPIN Agent 1991-12-05

President

Name and Address Role
JAMES T ASHWORTH 15581 RT 108 EAST CARLINVILLE IL 62626 President

Assumed Names

Name Type Effective Date Cancellation Date Cancellation Type Last Renewal Date
CARLINVILLE NATIONAL BANCSHARES, INC. No data 1984-12-28 2013-06-26 FAS Cancellation No data

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 310000 262710000 1

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 27 Jan 2025

Sources: Illinois Office of the Secretary of State

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