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BANSAN FOUNDATION

Company Details

Entity Name: BANSAN FOUNDATION
Jurisdiction: Illinois
Entity Type: Corporation - Not-for-Profit
Status: Goodstanding
Date Formed: 28 Nov 2006
Company Number: CORP_65222337
File Number: 65222337
Type of Business: Not for Profit
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BANSAN FOUNDATION 403(B) PLAN 2023 205970885 2024-07-02 BANSAN FOUNDATION 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 611000
Sponsor’s telephone number 7087984600
Plan sponsor’s address 740 WESTERN AVE, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2024-07-02
Name of individual signing SANJIV S MODI
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-02
Name of individual signing SANJIV S MODI
Valid signature Filed with authorized/valid electronic signature
BANSAN FOUNDATION 403(B) PLAN 2023 205970885 2024-06-18 BANSAN FOUNDATION 13
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 611000
Sponsor’s telephone number 7087984600
Plan sponsor’s address 740 WESTERN AVE, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2024-06-18
Name of individual signing SANIJV S MODI
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2024-06-18
Name of individual signing BANSARI S MODI
Valid signature Filed with authorized/valid electronic signature
BANSAN FOUNDATION 403(B) PLAN 2022 205970885 2023-04-03 BANSAN FOUNDATION 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 611000
Sponsor’s telephone number 7087984600
Plan sponsor’s address 740 WESTERN AVENUE, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2023-04-03
Name of individual signing SANJIV S MODI
Valid signature Filed with authorized/valid electronic signature
BANSAN FOUNDATION 403(B) PLAN 2021 205970885 2022-07-06 BANSAN FOUNDATION 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 611000
Sponsor’s telephone number 7087984600
Plan sponsor’s address 740 WESTERN AVENUE, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2022-07-06
Name of individual signing BANSARI MODI
Valid signature Filed with authorized/valid electronic signature
BANSAN FOUNDATION 403(B) PLAN 2020 205970885 2021-05-18 BANSAN FOUNDATION 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 611000
Sponsor’s telephone number 7087984600
Plan sponsor’s address 740 WESTERN AVE, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2021-05-18
Name of individual signing SANJIV S MODI
Valid signature Filed with authorized/valid electronic signature
BANSAN FOUNDATION 403(B) PLAN 2019 205970885 2020-03-18 BANSAN FOUNDATION 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 611000
Sponsor’s telephone number 7087984600
Plan sponsor’s address 740 WESTERN AVE, FLOSSMOOR, IL, 60422

Signature of

Role Plan administrator
Date 2020-03-18
Name of individual signing SANJIV S MODI
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
BANSARI S MODI, 740 WESTERN AVE, FLOSSMOOR, 60422, COOK-NOT IN CITY OF CHICAGO Agent 2014-01-16

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2448918305 2021-01-20 0507 PPS 740 Western Ave, Flossmoor, IL, 60422-1375
Loan Status Date 2021-09-08
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 86737
Loan Approval Amount (current) 86737.5
Undisbursed Amount 0
Franchise Name -
Lender Location ID 21641
Servicing Lender Name Old National Bank
Servicing Lender Address One Main St, EVANSVILLE, IN, 47708-1449
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Flossmoor, COOK, IL, 60422-1375
Project Congressional District IL-02
Number of Employees 11
NAICS code 923110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 22050
Originating Lender Name First Midwest Bank, A Division of Old National Bank
Originating Lender Address Chicago, IL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 87262.74
Forgiveness Paid Date 2021-08-27
6736307208 2020-04-28 0507 PPP 740 Western Ave, Flossmoor, IL, 60422-1375
Loan Status Date 2021-02-20
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 86737.5
Loan Approval Amount (current) 86737.5
Undisbursed Amount 0
Franchise Name -
Lender Location ID 21641
Servicing Lender Name Old National Bank
Servicing Lender Address One Main St, EVANSVILLE, IN, 47708-1449
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Flossmoor, COOK, IL, 60422-1375
Project Congressional District IL-02
Number of Employees 5
NAICS code 923110
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 22050
Originating Lender Name First Midwest Bank, A Division of Old National Bank
Originating Lender Address Chicago, IL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 87356.71
Forgiveness Paid Date 2021-01-13

Date of last update: 13 Feb 2025

Sources: Illinois Office of the Secretary of State