| Name: | Bloom Insurance Agency LLC |
| Jurisdiction: | Minnesota |
| Legal type: | Limited Liability Company (Foreign) |
| Status: | Active / In Good Standing |
| Date formed: | 08 Feb 2018 (7 years ago) |
| Company Number: | 352bfde9-ee0c-e811-9156-00155d0d6f70 |
| File Number: | 999482000024 |
| Registered Office Address: | 1010 DALE STREET N, SAINT PAUL, MN 55117–5603, USA |
| Principal Place of Business Address: | 1801 S Liberty Drive, Bloomington, IN 47403, USA |
| Principal Executive Office Address: | 1801 S LIBERTY DR, BLOOMINGTON, IN 47403–5164, USA |
| ZIP code: | 55117 |
| County: | Ramsey County |
| Place of Formation: | Indiana |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BLOOM INSURANCE MONEY PURCHAE PLAN | 2010 | 411112919 | 2011-08-22 | BLOOM INSURANCE AGENCY | 1 | |||||||||||||||||||||||||||||||||||||
|
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| Administrator’s EIN | 411112919 |
| Plan administrator’s name | BLOOM INSURANCE AGENCY |
| Plan administrator’s address | 1919 WORCHESTER AVE, ST PAUL, MN, 55116 |
| Administrator’s telephone number | 6516461881 |
Number of participants as of the end of the plan year
| Active participants | 1 |
| Number of participants with account balances as of the end of the plan year | 1 |
Signature of
| Role | Plan administrator |
| Date | 2011-08-22 |
| Name of individual signing | GARY BLOOM |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1974-10-15 |
| Business code | 524210 |
| Sponsor’s telephone number | 6516461881 |
| Plan sponsor’s mailing address | 1919 WORCHESTER AVE, ST PAUL, MN, 55116 |
| Plan sponsor’s address | 1919 WORCHESTER AVE, ST PAUL, MN, 55116 |
Plan administrator’s name and address
| Administrator’s EIN | 411112919 |
| Plan administrator’s name | BLOOM INSURANCE AGENCY |
| Plan administrator’s address | 1919 WORCHESTER AVE, ST PAUL, MN, 55116 |
| Administrator’s telephone number | 6516461881 |
Number of participants as of the end of the plan year
| Active participants | 1 |
| Number of participants with account balances as of the end of the plan year | 1 |
Signature of
| Role | Employer/plan sponsor |
| Date | 2011-08-22 |
| Name of individual signing | GARY BLOOM |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1974-10-15 |
| Business code | 524210 |
| Sponsor’s telephone number | 6516461881 |
| Plan sponsor’s mailing address | 1919 WORCHESTER AVE, ST PAUL, MN, 55116 |
| Plan sponsor’s address | 1919 WORCHESTER AVE, ST PAUL, MN, 55116 |
Plan administrator’s name and address
| Administrator’s EIN | 411112919 |
| Plan administrator’s name | BLOOM INSURANCE AGENCY |
| Plan administrator’s address | 1919 WORCHESTER AVE, ST PAUL, MN, 55116 |
| Administrator’s telephone number | 6516461881 |
Number of participants as of the end of the plan year
| Active participants | 1 |
| Number of participants with account balances as of the end of the plan year | 1 |
Signature of
| Role | Plan administrator |
| Date | 2010-08-04 |
| Name of individual signing | GARY BLOOM |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| NATIONAL REGISTERED AGENTS, INC | Agent |
| Name | Role | Address |
|---|---|---|
| MEREDITH ROGERS | Manager | 1801 S LIBERTY DR, BLOOMINGTON, IN 47403–5164, USA |
| Filing Name | Filing date |
|---|---|
| Amendment - Limited Liability Company (Foreign) | 2023-05-16 |
| Original Filing - Limited Liability Company (Foreign) (Business Name: Bloom Insurance Agency LLC) | 2018-02-08 |
Date of last update: 06 Dec 2024
Sources: Minnesota's Official State Website
