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  5. POWELL INSURANCE AGENCY, INC.

POWELL INSURANCE AGENCY, INC.

Company Details

Entity Name: POWELL INSURANCE AGENCY, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 29 Dec 2003
Company Number: CORP_63280291
File Number: 63280291
Type of Business: Business Corporations
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
POWELL INSURANCE AGENCY, INC. 401(K) PLAN 2023 200386296 2024-06-04 POWELL INSURANCE AGENCY, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-05-22
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address 114 E. COOKE, MT. PULASKI, IL, 62548

Signature of
Role Plan administrator
Date 2024-06-04
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-06-04
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
POWELL INSURANCE AGENCY INC 401(K) PLAN 2022 200386296 2023-07-25 POWELL INSURANCE AGENCY INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-12
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address PO BOX 78, MOUNT PULASKI, IL, 62548

Signature of
Role Plan administrator
Date 2023-07-25
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
POWELL INSURANCE AGENCY INC 401(K) PLAN 2021 200386296 2022-07-27 POWELL INSURANCE AGENCY INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-12
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address PO BOX 78, MOUNT PULASKI, IL, 62548

Signature of
Role Plan administrator
Date 2022-07-27
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
POWELL INSURANCE AGENCY INC 401(K) PLAN 2020 200386296 2021-09-13 POWELL INSURANCE AGENCY INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-12
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address PO BOX 78, MOUNT PULASKI, IL, 625480078

Signature of
Role Plan administrator
Date 2021-09-13
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
POWELL INSURANCE AGENCY INC 401(K) PLAN 2019 200386296 2020-09-22 POWELL INSURANCE AGENCY INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-12
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address PO BOX 78, MOUNT PULASKI, IL, 625480078

Signature of
Role Plan administrator
Date 2020-09-22
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
POWELL INSURANCE AGENCY INC 401(K) PLAN 2018 200386296 2019-07-24 POWELL INSURANCE AGENCY INC 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-12
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address PO BOX 78, MOUNT PULASKI, IL, 625480078

Signature of
Role Plan administrator
Date 2019-07-24
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
POWELL INSURANCE AGENCY INC 401(K) PLAN 2017 200386296 2018-07-16 POWELL INSURANCE AGENCY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-12
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address PO BOX 78, MOUNT PULASKI, IL, 625480078

Signature of
Role Plan administrator
Date 2018-07-16
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
POWELL INSURANCE AGENCY INC 401(K) PLAN 2016 200386296 2017-07-24 POWELL INSURANCE AGENCY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-12
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address PO BOX 78, MOUNT PULASKI, IL, 625480078

Signature of
Role Plan administrator
Date 2017-07-24
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
POWELL INSURANCE AGENCY INC 401(K) PLAN 2015 200386296 2016-07-14 POWELL INSURANCE AGENCY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-12
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address PO BOX 78, MOUNT PULASKI, IL, 625480078

Signature of
Role Plan administrator
Date 2016-07-14
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-14
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
POWELL INSURANCE AGENCY INC 401K PLAN 2014 200386296 2015-07-21 POWELL INSURANCE AGENCY INC 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-12
Business code 524210
Sponsor’s telephone number 2177923371
Plan sponsor’s address PO BOX 78, MOUNT PULASKI, IL, 625480078

Signature of
Role Plan administrator
Date 2015-07-21
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-21
Name of individual signing DERON POWELL
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
DERON K POWELL, 114 E COOKE PO BOX 78, MT PULASKI, 62548, LOGAN Agent 2007-11-30

President

Name and Address Role
DERON POWELL 16 ST ANDREWS DR LINCOLN IL 62656 President

Secretary

Name and Address Role
DERON POWELL Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 1000 1000000 No data

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 23 Dec 2024

Sources: Illinois Office of the Secretary of State

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