| Entity Name: | PRIME ONE INSURANCE AGENCY, INC. |
| Jurisdiction: | Illinois |
| Entity Type: | Corporation - Domestic BCA |
| Status: | Goodstanding |
| Date Formed: | 08 Apr 2018 |
| Company Number: | CORP_71783928 |
| File Number: | 71783928 |
| Type of Business: | All Inclusive Purpose |
| Place of Formation: | ILLINOIS |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PRIME ONE INSURANCE, INC. 401(K) PLAN | 2023 | 825114941 | 2024-09-19 | PRIME ONE INSURANCE, INC. | 4 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-19 |
| Name of individual signing | MICHAEL VANDERFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 524210 |
| Sponsor’s telephone number | 8158612222 |
| Plan sponsor’s address | 1416 BLUE HERON DR., CRYSTAL LAKE, IL, 60014 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-21 |
| Name of individual signing | MICHAEL VANDERFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 524210 |
| Sponsor’s telephone number | 8158612222 |
| Plan sponsor’s address | 1416 BLUE HERON DR., CRYSTAL LAKE, IL, 60014 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-03 |
| Name of individual signing | MARY EDWARDS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name and Address | Role | Appointment Date |
|---|---|---|
| MARY M. EDWARDS, 1416 BLUE HERON DR, CRYSTAL LAKE, 60014, MC HENRY | Agent | 2018-04-08 |
| Name and Address | Role |
|---|---|
| 1416 BLUE HERON DR CRYSTAL LAKE IL 60014 | President |
| Name | Change Date |
|---|---|
| PRIME ONE INSURANCE, INC. | 2024-09-10 |
| Class | Series | Voting Rights | Authorized Shares | Issued Shares | Par Value |
|---|---|---|---|---|---|
| COMMON | No data | Voting Rights | 1000 | 1000000 | No data |
Date of last update: 16 Jan 2025
