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  5. SAM'S FLOORING AND SUPPLY CO.

SAM'S FLOORING AND SUPPLY CO.

Company Details

Entity Name: SAM'S FLOORING AND SUPPLY CO.
Jurisdiction: Illinois
Entity Type: Corporation - Foreign BCA
Status: Goodstanding
Date Formed: 24 Apr 2009
Company Number: CORP_66607534
File Number: 66607534
Type of Business: All Inclusive Purpose
Place of Formation: DELAWARE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SAM'S RETIREMENT & INCENTIVE PLAN 2023 264656343 2024-07-22 SAM'S FLOORING AND SUPPLY CO. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362881
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2024-07-22
Name of individual signing GREG STIRRETT
Valid signature Filed with authorized/valid electronic signature
SAM'S RETIREMENT & INCENTIVE PLAN 2022 264656343 2023-07-24 SAM'S FLOORING AND SUPPLY CO. 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362881
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2023-07-24
Name of individual signing GREG STIRRETT
Valid signature Filed with authorized/valid electronic signature
SAM'S RETIREMENT & INCENTIVE PLAN 2021 264656343 2022-10-07 SAM'S FLOORING AND SUPPLY CO. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362881
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2022-10-07
Name of individual signing GREG STIRRETT
Valid signature Filed with authorized/valid electronic signature
SAM'S RETIREMENT & INCENTIVE PLAN 2020 264656343 2021-06-25 SAM'S FLOORING AND SUPPLY CO. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362881
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2021-06-25
Name of individual signing GREG STIRRETT
Valid signature Filed with authorized/valid electronic signature
SAM'S RETIREMENT & INCENTIVE PLAN 2019 264656343 2020-07-29 SAM'S FLOORING AND SUPPLY CO. 51
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362887
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2020-07-29
Name of individual signing GREG STIRRETT
Valid signature Filed with authorized/valid electronic signature
SAM'S RETIREMENT & INCENTIVE PLAN 2018 264656343 2019-10-11 SAM'S FLOORING AND SUPPLY CO. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362881
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2019-10-11
Name of individual signing GREG STIRRETT
Valid signature Filed with authorized/valid electronic signature
SAM'S RETIREMENT & INCENTIVE PLAN 2017 264656343 2018-07-17 SAM'S FLOORING AND SUPPLY CO. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362887
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2018-07-17
Name of individual signing GREG STIRRETT
Valid signature Filed with authorized/valid electronic signature
SAM'S RETIREMENT & INCENTIVE PLAN 2016 264656343 2017-10-12 SAM'S FLOORING AND SUPPLY CO. 53
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362881
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2017-10-12
Name of individual signing GREG STIRRETT
Valid signature Filed with authorized/valid electronic signature
SAM'S RETIREMENT & INCENTIVE PLAN 2015 264656343 2016-07-11 SAM'S FLOORING AND SUPPLY CO. 52
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362881
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2016-07-11
Name of individual signing GREGORY STIRRETT
Valid signature Filed with authorized/valid electronic signature
SAM'S RETIREMENT & INCENTIVE PLAN 2014 264656343 2015-07-29 SAM'S FLOORING AND SUPPLY CO. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-10-01
Business code 442210
Sponsor’s telephone number 8158362881
Plan sponsor’s address FLORSTAR SALES, INC., 1075 TAYLOR RD, ROMEOVILLE, IL, 604464265

Signature of
Role Plan administrator
Date 2015-07-29
Name of individual signing GREGORY STIRRETT
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
FRANCIS WADE CASSIDY, 619 S VERMONT, PALATINE, 60067, COOK-NOT IN CITY OF CHICAGO Agent 2017-12-08

President

Name and Address Role
SCOTT ROZMUS 1075 TAYLOR RD ROMEOVILLE IL 60446 President

Secretary

Name and Address Role
KELLY CASSIDY Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 1000 100000 0.001

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
347434318 0524200 2024-04-24 619 S. VERMONT, PALATINE, IL, 60067
Inspection Type Planned
Scope NoInspection
Safety/Health Safety
Close Conference 2024-04-24
Emphasis N: AMPUTATE, P: AMPUTATE
Case Closed 2024-04-26

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2363637102 2020-04-10 0507 PPP 619 S. VERMONT, PALATINE, IL, 60067
Loan Status Date 2022-03-05
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 585455
Loan Approval Amount (current) 585455
Undisbursed Amount 0
Franchise Name -
Lender Location ID 58036
Servicing Lender Name Fifth Third Bank
Servicing Lender Address 38 Fountain Sq Plz, CINCINNATI, OH, 45263
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description New Business or 2 years or less
Project Address PALATINE, COOK, IL, 60067-0200
Project Congressional District IL-05
Number of Employees 40
NAICS code 423220
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 58036
Originating Lender Name Fifth Third Bank
Originating Lender Address CINCINNATI, OH
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 591033.09
Forgiveness Paid Date 2021-03-30

Motor Carrier Census

USDOT Number Carrier Operation MCS-150 Form Date MCS-150 Mileage MCS-150 Year Power Units Drivers Operation Classification
695612 Intrastate Non-Hazmat 2023-01-24 250000 2022 10 10 Private(Property)
Legal Name SAM'S FLOORING AND SUPPLY CO
DBA Name BLAKE STEVENS FLOORING-T&G FLOORING-GEORGIA OAK
Physical Address 619 S VERMONT, PALATINE, IL, 60067, US
Mailing Address 619 S VERMONT, PALATINE, IL, 60067, US
Phone (847) 991-9663
Fax (847) 991-0847
E-mail KEITH@CHICAGOHFS.COM

Safety Measurement System - All Transportation
Total Number of Inspections for the measurement period (24 months) 8
Driver Fitness BASIC Serious Violation Indicator No
Vehicle Maintenance BASIC Acute/Critical Indicator No
Unsafe Driving BASIC Acute/Critical Indicator No
Driver Fitness BASIC Roadside Performance measure value .09
Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value 0
Total Number of Driver Inspections for the measurment period 8
Vehicle Maintenance BASIC Roadside Performance measure value 1
Total Number of Vehicle Inspections for the measurement period 4
Controlled Substances and Alcohol BASIC Roadside Performance measure value 0
Unsafe Driving BASIC Roadside Performance Measure Value 2
Number of inspections with at least one Driver Fitness BASIC violation 1
Number of inspections with at least one Hours-of-Service BASIC violation 0
Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation 0
Number of inspections with at least one Vehicle Maintenance BASIC violation 1
Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation 0
Number of inspections with at least one Controlled Substances and Alcohol BASIC violation 0
Number of inspections with at least one Unsafe Driving BASIC violation 3

Inspections
Unique report number of the inspection 3912510789
State abbreviation that indicates the state the inspector is from IL
The date of the inspection 2024-03-19
ID that indicates the level of inspection Full
State abbreviation that indicates where the inspection occurred IL
Time weight of the inspection 2
Number of Out-Of-Service violations related to Driver 0
Number of Out-Of-Service violations related to vehicle 0
Number of violations related to Hazardous Materials 0
Total number of Out-Of-Service violations 0
Total number of Out-Of-Service violations related to Hazardous Materials 0
Description of the type of the main unit STRAIGHT TRUCK
Description of the make of the main unit ISUZU
License plate of the main unit 164916H
License state of the main unit IL
Vehicle Identification Number of the main unit JALE5W161J7301980
Unsafe Driving BASIC inspection Y
Hours-of-Service Compliance BASIC inspection Y
Driver Fitness BASIC inspection Y
Controlled Substances/Alcohol BASIC inspection Y
Vehicle Maintenance BASIC inspection Y
Total number of BASIC violations 1
Number of Unsafe Driving BASIC violations 0
Number of Hours-of-Service Compliance BASIC violations 0
Number of Driver Fitness BASIC violations 0
Number of Controlled Substances/Alcohol BASIC violations 0
Number of Vehicle Maintenance BASIC violations 1
Number of Hazardous Materials Compliance BASIC violations 0
Unique report number of the inspection 4039510423
State abbreviation that indicates the state the inspector is from IL
The date of the inspection 2024-04-30
ID that indicates the level of inspection Full
State abbreviation that indicates where the inspection occurred IL
Time weight of the inspection 2
Number of Out-Of-Service violations related to Driver 0
Number of Out-Of-Service violations related to vehicle 0
Number of violations related to Hazardous Materials 0
Total number of Out-Of-Service violations 0
Total number of Out-Of-Service violations related to Hazardous Materials 0
Description of the type of the main unit STRAIGHT TRUCK
Description of the make of the main unit ISUZU
License plate of the main unit 164916H
License state of the main unit IL
Vehicle Identification Number of the main unit JALE5W161J7301980
Unsafe Driving BASIC inspection Y
Hours-of-Service Compliance BASIC inspection Y
Driver Fitness BASIC inspection Y
Controlled Substances/Alcohol BASIC inspection Y
Vehicle Maintenance BASIC inspection Y
Total number of BASIC violations 0
Number of Unsafe Driving BASIC violations 0
Number of Hours-of-Service Compliance BASIC violations 0
Number of Driver Fitness BASIC violations 0
Number of Controlled Substances/Alcohol BASIC violations 0
Number of Vehicle Maintenance BASIC violations 0
Number of Hazardous Materials Compliance BASIC violations 0
Unique report number of the inspection 1318000107
State abbreviation that indicates the state the inspector is from GA
The date of the inspection 2024-03-20
ID that indicates the level of inspection Driver-Only
State abbreviation that indicates where the inspection occurred GA
Time weight of the inspection 2
Number of Out-Of-Service violations related to Driver 0
Number of Out-Of-Service violations related to vehicle 0
Number of violations related to Hazardous Materials 0
Total number of Out-Of-Service violations 0
Total number of Out-Of-Service violations related to Hazardous Materials 0
Description of the type of the main unit STRAIGHT TRUCK
Description of the make of the main unit ISUZU
License plate of the main unit WXI536
License state of the main unit GA
Vehicle Identification Number of the main unit JALE5W164J7302833
Unsafe Driving BASIC inspection Y
Hours-of-Service Compliance BASIC inspection Y
Driver Fitness BASIC inspection Y
Controlled Substances/Alcohol BASIC inspection Y
Total number of BASIC violations 0
Number of Unsafe Driving BASIC violations 0
Number of Hours-of-Service Compliance BASIC violations 0
Number of Driver Fitness BASIC violations 0
Number of Controlled Substances/Alcohol BASIC violations 0
Number of Vehicle Maintenance BASIC violations 0
Number of Hazardous Materials Compliance BASIC violations 0
Unique report number of the inspection 3998220699
State abbreviation that indicates the state the inspector is from IL
The date of the inspection 2023-12-11
ID that indicates the level of inspection Full
State abbreviation that indicates where the inspection occurred IL
Time weight of the inspection 1
Number of Out-Of-Service violations related to Driver 0
Number of Out-Of-Service violations related to vehicle 0
Number of violations related to Hazardous Materials 0
Total number of Out-Of-Service violations 0
Total number of Out-Of-Service violations related to Hazardous Materials 0
Description of the type of the main unit STRAIGHT TRUCK
Description of the make of the main unit ISUZU
License plate of the main unit 164916H
License state of the main unit IL
Vehicle Identification Number of the main unit JALE5W161J7301980
Unsafe Driving BASIC inspection Y
Hours-of-Service Compliance BASIC inspection Y
Driver Fitness BASIC inspection Y
Controlled Substances/Alcohol BASIC inspection Y
Vehicle Maintenance BASIC inspection Y
Total number of BASIC violations 0
Number of Unsafe Driving BASIC violations 0
Number of Hours-of-Service Compliance BASIC violations 0
Number of Driver Fitness BASIC violations 0
Number of Controlled Substances/Alcohol BASIC violations 0
Number of Vehicle Maintenance BASIC violations 0
Number of Hazardous Materials Compliance BASIC violations 0
Unique report number of the inspection 2592000119
State abbreviation that indicates the state the inspector is from WI
The date of the inspection 2023-11-10
ID that indicates the level of inspection Driver-Only
State abbreviation that indicates where the inspection occurred WI
Time weight of the inspection 1
Number of Out-Of-Service violations related to Driver 0
Number of Out-Of-Service violations related to vehicle 0
Number of violations related to Hazardous Materials 0
Total number of Out-Of-Service violations 0
Total number of Out-Of-Service violations related to Hazardous Materials 0
Description of the type of the main unit STRAIGHT TRUCK
Description of the make of the main unit ISU
License plate of the main unit FB51501
License state of the main unit WI
Vehicle Identification Number of the main unit JALE5W165N7304449
Unsafe Driving BASIC inspection Y
Hours-of-Service Compliance BASIC inspection Y
Driver Fitness BASIC inspection Y
Controlled Substances/Alcohol BASIC inspection Y
Total number of BASIC violations 1
Number of Unsafe Driving BASIC violations 1
Number of Hours-of-Service Compliance BASIC violations 0
Number of Driver Fitness BASIC violations 0
Number of Controlled Substances/Alcohol BASIC violations 0
Number of Vehicle Maintenance BASIC violations 0
Number of Hazardous Materials Compliance BASIC violations 0
Unique report number of the inspection 1411000023
State abbreviation that indicates the state the inspector is from GA
The date of the inspection 2023-09-20
ID that indicates the level of inspection Driver-Only
State abbreviation that indicates where the inspection occurred GA
Time weight of the inspection 1
Number of Out-Of-Service violations related to Driver 0
Number of Out-Of-Service violations related to vehicle 0
Number of violations related to Hazardous Materials 0
Total number of Out-Of-Service violations 0
Total number of Out-Of-Service violations related to Hazardous Materials 0
Description of the type of the main unit STRAIGHT TRUCK
Description of the make of the main unit ISUZU
License plate of the main unit WXI536
License state of the main unit GA
Vehicle Identification Number of the main unit JALE5W164J7302833
Unsafe Driving BASIC inspection Y
Hours-of-Service Compliance BASIC inspection Y
Driver Fitness BASIC inspection Y
Controlled Substances/Alcohol BASIC inspection Y
Total number of BASIC violations 2
Number of Unsafe Driving BASIC violations 1
Number of Hours-of-Service Compliance BASIC violations 0
Number of Driver Fitness BASIC violations 1
Number of Controlled Substances/Alcohol BASIC violations 0
Number of Vehicle Maintenance BASIC violations 0
Number of Hazardous Materials Compliance BASIC violations 0
Unique report number of the inspection 1237005700
State abbreviation that indicates the state the inspector is from GA
The date of the inspection 2023-06-16
ID that indicates the level of inspection Driver-Only
State abbreviation that indicates where the inspection occurred GA
Time weight of the inspection 1
Number of Out-Of-Service violations related to Driver 0
Number of Out-Of-Service violations related to vehicle 0
Number of violations related to Hazardous Materials 0
Total number of Out-Of-Service violations 0
Total number of Out-Of-Service violations related to Hazardous Materials 0
Description of the type of the main unit STRAIGHT TRUCK
Description of the make of the main unit ISU
License plate of the main unit WXI536
License state of the main unit GA
Vehicle Identification Number of the main unit JALE5W164J7302833
Unsafe Driving BASIC inspection Y
Hours-of-Service Compliance BASIC inspection Y
Driver Fitness BASIC inspection Y
Controlled Substances/Alcohol BASIC inspection Y
Total number of BASIC violations 1
Number of Unsafe Driving BASIC violations 1
Number of Hours-of-Service Compliance BASIC violations 0
Number of Driver Fitness BASIC violations 0
Number of Controlled Substances/Alcohol BASIC violations 0
Number of Vehicle Maintenance BASIC violations 0
Number of Hazardous Materials Compliance BASIC violations 0
Unique report number of the inspection 2659002842
State abbreviation that indicates the state the inspector is from WI
The date of the inspection 2023-03-29
ID that indicates the level of inspection Walk-around
State abbreviation that indicates where the inspection occurred WI
Time weight of the inspection 1
Number of Out-Of-Service violations related to Driver 0
Number of Out-Of-Service violations related to vehicle 0
Number of violations related to Hazardous Materials 0
Total number of Out-Of-Service violations 0
Total number of Out-Of-Service violations related to Hazardous Materials 0
Description of the type of the main unit STRAIGHT TRUCK
Description of the make of the main unit ISU
License plate of the main unit FB51502
License state of the main unit WI
Vehicle Identification Number of the main unit JALE5W168N7304316
Unsafe Driving BASIC inspection Y
Hours-of-Service Compliance BASIC inspection Y
Driver Fitness BASIC inspection Y
Controlled Substances/Alcohol BASIC inspection Y
Vehicle Maintenance BASIC inspection Y
Total number of BASIC violations 0
Number of Unsafe Driving BASIC violations 0
Number of Hours-of-Service Compliance BASIC violations 0
Number of Driver Fitness BASIC violations 0
Number of Controlled Substances/Alcohol BASIC violations 0
Number of Vehicle Maintenance BASIC violations 0
Number of Hazardous Materials Compliance BASIC violations 0

Violations
The date of the inspection 2024-03-19
Code of the violation 39381
Name of the BASIC Vehicle Maintenance
The violation is identified as Out-Of-Service violation N
The weight that is assigned to a violation if it's identified as an Out-Of-Service violation 0
The severity weight that is assigned to a violation 3
The time weight that is assigned to a violation 2
The description of a violation Horn inoperative
The description of the violation group Other Vehicle Defect
The unit a violation is cited against Vehicle main unit
The date of the inspection 2023-11-10
Code of the violation 3922ML
Name of the BASIC Unsafe Driving
The violation is identified as Out-Of-Service violation N
The weight that is assigned to a violation if it's identified as an Out-Of-Service violation 0
The severity weight that is assigned to a violation 5
The time weight that is assigned to a violation 1
The description of a violation Failure to Maintain Lane
The description of the violation group Dangerous Driving
The unit a violation is cited against Driver
The date of the inspection 2023-09-20
Code of the violation 3922SLLTCD
Name of the BASIC Unsafe Driving
The violation is identified as Out-Of-Service violation N
The weight that is assigned to a violation if it's identified as an Out-Of-Service violation 0
The severity weight that is assigned to a violation 5
The time weight that is assigned to a violation 1
The description of a violation State/Local Laws - Failed to obey a traffic control device - Permanent or Temporary - e.g. safety official signal sign light lane marking other
The description of the violation group Dangerous Driving
The unit a violation is cited against Driver
The date of the inspection 2023-09-20
Code of the violation 39141AMCPC
Name of the BASIC Driver Fitness
The violation is identified as Out-Of-Service violation N
The weight that is assigned to a violation if it's identified as an Out-Of-Service violation 0
The severity weight that is assigned to a violation 1
The time weight that is assigned to a violation 1
The description of a violation Medical (Certificate) - Operating a property-carrying vehicle without possessing a valid medical certificate
The description of the violation group Medical Certificate
The unit a violation is cited against Driver
The date of the inspection 2023-06-16
Code of the violation 39282A1
Name of the BASIC Unsafe Driving
The violation is identified as Out-Of-Service violation N
The weight that is assigned to a violation if it's identified as an Out-Of-Service violation 0
The severity weight that is assigned to a violation 10
The time weight that is assigned to a violation 1
The description of a violation Using a hand-held mobile telephone while operating a CMV
The description of the violation group Phone Call
The unit a violation is cited against Driver

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 27 Feb 2025

Sources: Illinois Office of the Secretary of State

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