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  5. COLUMBINE FAMILY PRACTICE, P.C.

COLUMBINE FAMILY PRACTICE, P.C.

Company Details

Name: COLUMBINE FAMILY PRACTICE, P.C.
Jurisdiction: Colorado
Legal type: Domestic profit corporation
Status: Voluntarily Dissolved
Date of registration: 03 Nov 1999 (25 years ago)
Date dissolved: 26 Jun 2018
Entity Number: 19991206577
ZIP code: 80113
County: Arapahoe County
Place of Formation: COLORADO
Principal Address: 22 Cherrymoor Dr Cherry Hills Village CO 80113 US

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COLUMBINE FAMILY PRACTICE, P.C. 401K PLAN 2014 841521396 2015-09-29 COLUMBINE FAMILY PRACTICE, P.C. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3039797200
Plan sponsor’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571

Signature of
Role Plan administrator
Date 2015-09-29
Name of individual signing EMILY B. CROCKETT, M.D.
Valid signature Filed with authorized/valid electronic signature
COLUMBINE FAMILY PRACTICE, P.C. 401K PLAN 2013 841521396 2014-10-15 COLUMBINE FAMILY PRACTICE, P.C. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3039797200
Plan sponsor’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571

Signature of
Role Plan administrator
Date 2014-10-15
Name of individual signing EMILY B. CROCKETT, M.D.
Valid signature Filed with authorized/valid electronic signature
COLUMBINE FAMILY PRACTICE, P.C. 401K PLAN 2012 841521396 2013-08-14 COLUMBINE FAMILY PRACTICE, P.C. 20
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3039797200
Plan sponsor’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571

Plan administrator’s name and address
Administrator’s EIN 841521396
Plan administrator’s name COLUMBINE FAMILY PRACTICE, P.C.
Plan administrator’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571
Administrator’s telephone number 3039797200

Signature of
Role Plan administrator
Date 2013-08-14
Name of individual signing EMILY B. CROCKETT, M.D.
Valid signature Filed with authorized/valid electronic signature
COLUMBINE FAMILY PRACTICE, P.C. 401K PLAN 2011 841521396 2012-04-05 COLUMBINE FAMILY PRACTICE, P.C. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3039797200
Plan sponsor’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571

Plan administrator’s name and address
Administrator’s EIN 841521396
Plan administrator’s name COLUMBINE FAMILY PRACTICE, P.C.
Plan administrator’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571
Administrator’s telephone number 3039797200

Signature of
Role Plan administrator
Date 2012-04-05
Name of individual signing EMILY B. CROCKETT, M.D.
Valid signature Filed with authorized/valid electronic signature
COLUMBINE FAMILY PRACTICE, P.C. 401K PLAN 2010 841521396 2011-04-14 COLUMBINE FAMILY PRACTICE, P.C. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3039797200
Plan sponsor’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571

Plan administrator’s name and address
Administrator’s EIN 841521396
Plan administrator’s name COLUMBINE FAMILY PRACTICE, P.C.
Plan administrator’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571
Administrator’s telephone number 3039797200

Signature of
Role Plan administrator
Date 2011-04-14
Name of individual signing EMILY B. CROCKETT, M.D.
Valid signature Filed with authorized/valid electronic signature
COLUMBINE FAMILY PRACTICE, P.C. 401K PLAN 2009 841521396 2010-04-06 COLUMBINE FAMILY PRACTICE, P.C. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 3039797200
Plan sponsor’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571

Plan administrator’s name and address
Administrator’s EIN 841521396
Plan administrator’s name COLUMBINE FAMILY PRACTICE, P.C.
Plan administrator’s address 7335 S. PIERCE STREET, LITTLETON, CO, 801284571
Administrator’s telephone number 3039797200

Signature of
Role Plan administrator
Date 2010-04-06
Name of individual signing EMILY B. CROCKETT, M.D.
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-04-06
Name of individual signing EMILY B. CROCKETT, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Emily Crockett Agent 22 Cherrymoor Dr Englewood CO 80113 US

Transaction History

Transaction ID Type Date Effective date Name Comment
20181507456 Dissolve a Profit Corporation 2018-06-26 2018-06-26 COLUMBINE FAMILY PRACTICE, P.C., Dissolved June 26, 2018 No data
20181128925 File Report 2018-02-14 2018-02-14 No data Change of Entity Address
20171406592 Statement of Change Changing the Registered Agent Information 2017-05-26 2017-05-26 No data Registered agent information changed;
20171066134 File Report 2017-01-24 2017-01-24 No data No data
20151738992 File Report 2015-11-19 2015-11-19 No data No data
20141760228 File Report 2014-12-16 2014-12-16 No data No data
20131742047 File Report 2013-12-27 2013-12-27 No data No data
20131055807 File Report 2013-01-24 2013-01-24 No data No data
20111687307 File Report 2011-12-14 2011-12-14 No data No data
20101631547 File Report 2010-11-17 2010-11-17 No data Change of Registered Agent / Change of Registered Agent Address / Change of Entity Address

Related by officers

Emily Crockett

Columbine Aesthetics, LLC

Related by address

22 Cherrymoor Dr Cherry Hills Village CO 80113 US

Team Stepan

Date of last update: 13 Jan 2025

Sources: Colorado's Secretary of State

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