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  5. BUSHELL INSURANCE AGENCY, INC.

BUSHELL INSURANCE AGENCY, INC.

Company Details

Name: BUSHELL INSURANCE AGENCY, INC.
Jurisdiction: Colorado
Legal type: Domestic profit corporation
Status: Voluntarily Dissolved
Date of registration: 21 Apr 1980 (45 years ago)
Date dissolved: 12 Sep 2011
Entity Number: 19871398628
ZIP code: 80033
County: Jefferson County
Place of Formation: COLORADO
Principal Address: 12519 W. 32ND AVE. WHEAT RIDGE CO 80033 US
Mailing Address: 12519 W 32nd Ave Wheat Ridge CO 80033 US

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BUSHELL INSURANCE AGENCY, INC. AGE-WEIGHTED PROFIT SHARING PLAN 2010 840814634 2011-12-14 BUSHELL INSURANCE AGENCY, INC. 3
Three-digit plan number (PN) 001
Effective date of plan 1988-08-01
Business code 524210
Sponsor’s telephone number 3032321225
Plan sponsor’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033

Plan administrator’s name and address
Administrator’s EIN 840814634
Plan administrator’s name BUSHELL INSURANCE AGENCY, INC.
Plan administrator’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033
Administrator’s telephone number 3032321225

Signature of
Role Plan administrator
Date 2011-12-14
Name of individual signing ARTHUR BUSHELL
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2011-12-14
Name of individual signing ARTHUR BUSHELL
Valid signature Filed with incorrect/unrecognized electronic signature
BUSHELL INSURANCE AGENCY, INC. AGE-WEIGHTED PROFIT SHARING PLAN 2010 840814634 2011-12-14 BUSHELL INSURANCE AGENCY, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-08-01
Business code 524210
Sponsor’s telephone number 3032321225
Plan sponsor’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033

Plan administrator’s name and address
Administrator’s EIN 840814634
Plan administrator’s name BUSHELL INSURANCE AGENCY, INC.
Plan administrator’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033
Administrator’s telephone number 3032321225

Signature of
Role Plan administrator
Date 2011-12-14
Name of individual signing ARTHUR BUSHELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-12-14
Name of individual signing ARTHUR BUSHELL
Valid signature Filed with authorized/valid electronic signature
BUSHELL INSURANCE AGENCY, INC. AGE-WEIGHTED PROFIT SHARING PLAN 2010 840814634 2011-12-14 BUSHELL INSURANCE AGENCY, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-08-01
Business code 524210
Sponsor’s telephone number 3032321225
Plan sponsor’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033

Plan administrator’s name and address
Administrator’s EIN 840814634
Plan administrator’s name BUSHELL INSURANCE AGENCY, INC.
Plan administrator’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033
Administrator’s telephone number 3032321225

Signature of
Role Plan administrator
Date 2011-12-14
Name of individual signing ARTHUR BUSHELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-12-14
Name of individual signing ARTHUR BUSHELL
Valid signature Filed with authorized/valid electronic signature
BUSHELL INSURANCE AGENCY, INC. AGE-WEIGHTED PROFIT SHARING PLAN 2010 840814634 2011-12-14 BUSHELL INSURANCE AGENCY, INC. 3
Three-digit plan number (PN) 001
Effective date of plan 1988-08-01
Business code 524210
Sponsor’s telephone number 3032321225
Plan sponsor’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033

Plan administrator’s name and address
Administrator’s EIN 840814634
Plan administrator’s name BUSHELL INSURANCE AGENCY, INC.
Plan administrator’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033
Administrator’s telephone number 3032321225

Signature of
Role Plan administrator
Date 2011-12-14
Name of individual signing ARTHUR BUSHELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-12-14
Name of individual signing ARTHUR BUSHELL
Valid signature Filed with authorized/valid electronic signature
BUSHELL INSURANCE AGENCY, INC. AGE WEIGHTED PROFIT SHARING PLAN 2009 840814634 2012-08-03 BUSHELL INSURANCE AGENCY, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1988-07-31
Business code 524210
Sponsor’s telephone number 3032321255
Plan sponsor’s mailing address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033
Plan sponsor’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033

Plan administrator’s name and address
Administrator’s EIN 840814634
Plan administrator’s name BUSHELL INSURANCE AGENCY, INC.
Plan administrator’s address 12519 WEST 32RD AVENUE, WHEAT RIDGE, CO, 80033
Administrator’s telephone number 3032321255

Number of participants as of the end of the plan year
Active participants 3
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 3
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2012-08-03
Name of individual signing ARTHUR BUSHELL
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ARTHUR J. BUSHELL Agent 12519 W. 32ND AVE. WHEAT RIDGE CO 80033 US

Transaction History

Transaction ID Type Date Effective date Name Comment
20111515804 Dissolve a Profit Corporation 2011-09-12 2011-09-12 BUSHELL INSURANCE AGENCY, INC., Dissolved September 12, 2011 No data
20101294005 File Report 2010-05-21 2010-05-21 No data No data
20091238280 File Report 2009-04-29 2009-04-29 No data No data
20081259991 File Report 2008-05-12 2008-05-12 No data No data
20071292693 File Report 2007-06-22 2007-06-22 No data No data
20061352611 File Report 2006-08-28 2006-08-28 No data No data
20051208304 File Report 2005-05-23 2005-05-23 No data No data
20041236132 File Report 2004-07-09 2004-07-09 No data / Change of Entity Address
20031214722 Statement of Older Periodic Report 2003-07-03 2003-07-03 No data CORP REPORT
20021168041 Statement of Older Periodic Report 2002-06-19 2002-06-19 No data CORP REPORT

Related by officers

No related officers

Related by address

12519 W 32nd Ave Wheat Ridge CO 80033 US

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Date of last update: 13 Jan 2025

Sources: Colorado's Secretary of State

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