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  5. ADELSBACH INSURANCE AGENCY, INC.

ADELSBACH INSURANCE AGENCY, INC.

Company Details

Entity Name: ADELSBACH INSURANCE AGENCY, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 07 May 2003
Company Number: CORP_62877677
File Number: 62877677
Type of Business: Insurance and/or real estate agencies and brokers
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2023 753115492 2024-05-06 ADELSBACH INSURANCE AGENCY, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 18 E BURLINGTON ST, RIVERSIDE, IL, 60546

Signature of
Role Plan administrator
Date 2024-05-06
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2022 753115492 2023-05-08 ADELSBACH INSURANCE AGENCY, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 7840 W. OGDEN AVENUE, SUITE 1, LYONS, IL, 60534

Signature of
Role Plan administrator
Date 2023-05-08
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2021 753115492 2022-05-13 ADELSBACH INSURANCE AGENCY, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 7840 W. OGDEN AVENUE, SUITE 1, LYONS, IL, 60534

Signature of
Role Plan administrator
Date 2022-05-13
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2020 753115492 2021-04-28 ADELSBACH INSURANCE AGENCY, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 7840 W. OGDEN AVENUE, SUITE 1, LYONS, IL, 60534

Signature of
Role Plan administrator
Date 2021-04-28
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2019 753115492 2020-06-18 ADELSBACH INSURANCE AGENCY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 7840 W. OGDEN AVENUE, SUITE 1, LYONS, IL, 60534

Signature of
Role Plan administrator
Date 2020-06-18
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-18
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2018 753115492 2019-06-06 ADELSBACH INSURANCE AGENCY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 7840 W. OGDEN AVENUE, SUITE 1, LYONS, IL, 60534

Signature of
Role Plan administrator
Date 2019-06-06
Name of individual signing MICHAEL S ADELSBACH
Valid signature Filed with authorized/valid electronic signature
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2017 753115492 2018-07-18 ADELSBACH INSURANCE AGENCY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 7840 W. OGDEN AVENUE, SUITE 1, LYONS, IL, 60534

Signature of
Role Plan administrator
Date 2018-07-18
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2016 753115492 2017-05-22 ADELSBACH INSURANCE AGENCY, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 7840 W. OGDEN AVENUE, SUITE 1, LYONS, IL, 60534

Signature of
Role Plan administrator
Date 2017-05-22
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-22
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2015 753115492 2016-11-07 ADELSBACH INSURANCE AGENCY, INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 7840 W. OGDEN AVENUE, SUITE 1, LYONS, IL, 60534

Signature of
Role Plan administrator
Date 2016-11-07
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-11-07
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
ADELSBACH INSURANCE AGENCY, INC 401(K) PLAN 2015 364401196 2016-05-23 ADELSBACH INSURANCE AGENCY, INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 524210
Sponsor’s telephone number 7084471630
Plan sponsor’s address 7840 W. OGDEN AVENUE, SUITE 1, LYONS, IL, 60534

Signature of
Role Plan administrator
Date 2016-05-23
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-05-23
Name of individual signing MICHAEL ADELSBACH
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
MICHAEL S ADELSBACH, 18 E BURLINGTON ST, RIVERSIDE, 60546, COOK-NOT IN CITY OF CHICAGO Agent 2024-03-06

President

Name and Address Role
MICHAEL S ADELSBACH 773 S FAIRFIELD AVE ELMHURST IL 60126 President

Secretary

Name and Address Role
VACANT Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 10000 1000000 1

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Related by address

No related companies by address

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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