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  5. KELLY PROVENANCE LLC

KELLY PROVENANCE LLC

Company Details

Entity Name: KELLY PROVENANCE LLC
Jurisdiction: Illinois
Entity Type: Limited Liability Company
Status: Goodstanding
Date Formed: 28 May 2004
Company Number: LLC_01203843
File Number: 01203843
Type of Management: Manager Managed
Date Status Change: 17 Apr 2024
Address 701 HARGER RD STE 121, OAK BROOK, 60523, IL
Place of Formation: DELAWARE

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BUSJAHN FARMS INC MONEY PURCHASE PLAN 2012 363055651 2013-06-14 BUSJAHN FARMS INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-01-01
Business code 112120
Sponsor’s telephone number 8152381343
Plan sponsor’s address 3296 E ROCK GROVE ROAD, ORANGEVILLE, IL, 61060

Plan administrator’s name and address
Administrator’s EIN 363055651
Plan administrator’s name BUSJAHN FARMS INC
Plan administrator’s address 3296 E ROCK GROVE ROAD, ORANGEVILLE, IL, 61060
Administrator’s telephone number 8152381343

Signature of
Role Plan administrator
Date 2013-06-14
Name of individual signing DARRELL BUSJAHN
Valid signature Filed with authorized/valid electronic signature
BUSJAHN FARMS INC MONEY PURCHASE PENSION PLAN 2011 363055651 2012-05-23 BUSJAHN FARMS INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-01-01
Business code 112120
Sponsor’s telephone number 8157894670
Plan sponsor’s address 3296 E ROCK GROVE ROAD, ORANGEVILLE, IL, 61060

Plan administrator’s name and address
Administrator’s EIN 363055651
Plan administrator’s name BUSJAHN FARMS INC
Plan administrator’s address 3296 E ROCK GROVE ROAD, ORANGEVILLE, IL, 61060
Administrator’s telephone number 8157894670

Signature of
Role Plan administrator
Date 2012-05-23
Name of individual signing DARRELL BUSJAHN
Valid signature Filed with authorized/valid electronic signature
BUSJAHN FARMS INC MONEY PURCHASE PENSION PLAN 2010 363055651 2011-06-15 BUSJAHN FARMS INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-01-01
Business code 112120
Sponsor’s telephone number 8157894670
Plan sponsor’s address 3296 E ROCK GROVE ROAD, ORANGEVILLE, IL, 61060

Plan administrator’s name and address
Administrator’s EIN 363055651
Plan administrator’s name BUSJAHN FARMS INC
Plan administrator’s address 3296 E ROCK GROVE ROAD, ORANGEVILLE, IL, 61060
Administrator’s telephone number 8157894670

Signature of
Role Plan administrator
Date 2011-06-15
Name of individual signing DARRELL BUSJAHN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-15
Name of individual signing DARRELL BUSJAHN
Valid signature Filed with authorized/valid electronic signature
BUSJAHN FARMS INC MONEY PURCHASE PENSION PLAN 2009 363055651 2010-07-30 BUSJAHN FARMS INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-01-01
Business code 112120
Sponsor’s telephone number 8157894670
Plan sponsor’s address 3296 E ROCK GROVE ROAD, ORANGEVILLE, IL, 61060

Plan administrator’s name and address
Administrator’s EIN 363055651
Plan administrator’s name BUSJAHN FARMS INC
Plan administrator’s address 3296 E ROCK GROVE ROAD, ORANGEVILLE, IL, 61060
Administrator’s telephone number 8157894670

Signature of
Role Plan administrator
Date 2010-07-30
Name of individual signing DARRELL BUSJAHN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-30
Name of individual signing DARRELL BUSJAHN
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name and Address Role Appointment Date
STEPHEN M. SCHUSTER, 701 HARGER RD., STE 121, OAK BROOK, 60523, DU PAGE Agent 2019-04-30

Manager

Name and Address Role Appointment Date
KELLY, PATRICK J., 701 HARGER RD STE 121, OAK BROOK, IL, 60523 Manager 2024-04-17
SMITH, LAURA K., 701 HARGER RD STE 121, OAK BROOK, IL, 60523 Manager 2024-04-17
KELLY, THOMAS N., 701 HARGER RD STE. 121, OAK BROOK, IL, 60523 Manager 2024-04-17

Related by officers

STEPHEN M. SCHUSTER, 701 HARGER RD., STE 121, OAK BROOK, 60523, DU PAGE

CLARK RUN LLC COUNCIL OAK LLC PECUMSAUGAN LLC WOODLAND PATH LLC TOWPATH LLC POKAGON LLC KINMOUNT EXCURSIONS LLC

Related by address

701 HARGER RD STE 121, OAK BROOK, 60523, IL

KILDARE LLC COUNCIL OAK LLC TOWPATH LLC POKAGON LLC LONGWALL LLC KINMOUNT EXCURSIONS LLC

Date of last update: 16 Jan 2025

Sources: Illinois Office of the Secretary of State

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