GOLF SHACK LLC

Company Details

Entity Name:	GOLF SHACK LLC
Jurisdiction:	Illinois
Entity Type:	Limited Liability Company
Status:	Goodstanding
Date Formed:	13 Mar 2000
Company Number:	LLC_00387428
File Number:	00387428
Type of Management:	Manager Managed
Date Status Change:	05 Feb 2024
Address	1631 N BELL SCHOOL ROAD, ROCKFORD, 61107, IL
Place of Formation:	ILLINOIS

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

GOLF SHACK RETIREMENT PLAN

2009

371396387

2010-06-21

GOLF SHACK, LLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1974-02-15
Business code	423910
Sponsor’s telephone number	8153973709
Plan sponsor’s address	1631 N BELL SCHOOL ROAD, ROCKFORD, IL, 61107

Plan administrator’s name and address

Administrator’s EIN	371396387
Plan administrator’s name	GOLF SHACK, LLC
Plan administrator’s address	1631 N BELL SCHOOL ROAD, ROCKFORD, IL, 61107
Administrator’s telephone number	8153973709

Signature of

Role	Plan administrator
Date	2010-06-21
Name of individual signing	TODD POLIVKA
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2010-06-18
Name of individual signing	TODD POLIVKA
Valid signature	Filed with authorized/valid electronic signature

GOLF SHACK RETIREMENT PLAN

2009

371396387

2010-06-21

GOLF SHACK, LLC

Three-digit plan number (PN)	001
Effective date of plan	1974-02-15
Business code	423910
Sponsor’s telephone number	8153973709
Plan sponsor’s address	1631 N BELL SCHOOL ROAD, ROCKFORD, IL, 61107

Plan administrator’s name and address

Administrator’s EIN	371396387
Plan administrator’s name	GOLF SHACK, LLC
Plan administrator’s address	1631 N BELL SCHOOL ROAD, ROCKFORD, IL, 61107
Administrator’s telephone number	8153973709

Signature of

Role	Employer/plan sponsor
Date	2010-06-18
Name of individual signing	TODD POLIVKA
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
TODD G. POLIVKA, 1631 N BELL SCHOOL RD, ROCKFORD, 61107, WINNEBAGO	Agent	2024-02-22

Name and Address	Role	Appointment Date
POLIVKA, TODD G., 1631 N BELL SCHOOL RD, ROCKFORD, IL, 61107	Manager	2024-02-05

Date of last update: 23 Dec 2024