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  5. TOM OLSEN AGENCY, INC.

TOM OLSEN AGENCY, INC.

Company Details

Entity Name: TOM OLSEN AGENCY, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 28 Jul 2003
Company Number: CORP_63012424
File Number: 63012424
Type of Business: Transportation – Freight
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TOM OLSEN AGENCY INC 401(K) PLAN 2020 200351691 2021-05-13 TOM OLSEN AGENCY INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 635 HARLEM RD., MACHESNEY, IL, 61115
TOM OLSEN AGENCY INC 401(K) PLAN 2019 200351691 2020-07-02 TOM OLSEN AGENCY INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 635 HARLEM RD., MACHESNEY, IL, 61115
TOM OLSEN AGENCY INC 401(K) PLAN 2018 200351691 2019-06-11 TOM OLSEN AGENCY INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 635 HARLEM RD., MACHESNEY, IL, 61115
TOM OLSEN AGENCY INC 401(K) PLAN 2017 200351691 2018-06-20 TOM OLSEN AGENCY INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 635 HARLEM RD., MACHESNEY, IL, 61115
TOM OLSEN AGENCY INC 401(K) PLAN 2016 200351691 2017-06-14 TOM OLSEN AGENCY INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 3814 11TH ST STE C, ROCKFORD, IL, 611093021

Signature of
Role Plan administrator
Date 2017-06-14
Name of individual signing TOM OLSEN
Valid signature Filed with authorized/valid electronic signature
TOM OLSEN AGENCY INC 401(K) PLAN 2015 200351691 2016-07-05 TOM OLSEN AGENCY INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 3814 11TH ST STE C, ROCKFORD, IL, 611093021

Signature of
Role Plan administrator
Date 2016-06-26
Name of individual signing TOM OLSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-26
Name of individual signing TOM OLSEN
Valid signature Filed with authorized/valid electronic signature
TOM OLSEN AGENCY INC 401K PLAN 2014 200351691 2015-07-05 TOM OLSEN AGENCY INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 3814 11TH ST STE C, ROCKFORD, IL, 611093021

Signature of
Role Plan administrator
Date 2015-07-05
Name of individual signing MONA OLSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-05
Name of individual signing MONA OLSEN
Valid signature Filed with authorized/valid electronic signature
TOM OLSEN AGENCY INC 401K PLAN 2013 200351691 2014-07-01 TOM OLSEN AGENCY INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 3814 11TH ST STE C, ROCKFORD, IL, 611093021

Signature of
Role Plan administrator
Date 2014-07-01
Name of individual signing MONA OLSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-01
Name of individual signing MONA OLSEN
Valid signature Filed with authorized/valid electronic signature
TOM OLSEN AGENCY INC 401K PLAN 2012 200351691 2013-05-27 TOM OLSEN AGENCY INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 3814 11TH ST STE C, ROCKFORD, IL, 611093021

Signature of
Role Plan administrator
Date 2013-05-27
Name of individual signing MONA OLSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-27
Name of individual signing MONA OLSEN
Valid signature Filed with authorized/valid electronic signature
TOM OLSEN AGENCY INC 401K PLAN 2011 200351691 2012-06-13 TOM OLSEN AGENCY INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-09
Business code 484120
Sponsor’s telephone number 8153941500
Plan sponsor’s address 3814 11TH ST STE C, ROCKFORD, IL, 611093021

Plan administrator’s name and address
Administrator’s EIN 200351691
Plan administrator’s name TOM OLSEN AGENCY INC
Plan administrator’s address 3814 11TH ST STE C, ROCKFORD, IL, 611093021
Administrator’s telephone number 8153941500

Signature of
Role Plan administrator
Date 2012-06-13
Name of individual signing MONA OLSEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-13
Name of individual signing MONA OLSEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
MONA J OLSEN, 3303 APPLEWOOD LN, ROCKFORD, 61114, WINNEBAGO Agent 2021-06-01

President

Name and Address Role
THOMAS E OLSEN 3303 APPLEWOODLANE ROCKFORD IL 61114 President

Secretary

Name and Address Role
MONA J OLSEN 3303 APPLEWOOD LANE ROCKFORD IL 61114 Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 1000 1000000 No data

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 23 Jan 2025

Sources: Illinois Office of the Secretary of State

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