0001651072-16-000003.txt : 20161128 0001651072-16-000003.hdr.sgml : 20161128 20161128164402 ACCESSION NUMBER: 0001651072-16-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20161128 DATE AS OF CHANGE: 20161128 EFFECTIVENESS DATE: 20161128 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Bluestone Life Insurance Co CENTRAL INDEX KEY: 0001651072 IRS NUMBER: 474735789 STATE OF INCORPORATION: VT FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-275219 FILM NUMBER: 162020403 BUSINESS ADDRESS: STREET 1: 654 GRANGER ROAD CITY: BERLIN STATE: VT ZIP: 05602 BUSINESS PHONE: 802-595-2014 MAIL ADDRESS: STREET 1: 654 GRANGER ROAD CITY: BERLIN STATE: VT ZIP: 05602 D 1 primary_doc.xml X0707 D LIVE 0001651072 Bluestone Life Insurance Co 654 Granger Road Suite 5 Berlin VT VERMONT 05641 8025950272 VERMONT None None Corporation true 2015 Nathan Irons c/o Bluestone Life Insurance Co PO Box 4458 Burlington VT VERMONT 05406 Executive Officer Director Andrew Cosgrove c/o Bluestone Life Insurance Co PO Box 4458 Burlington VT VERMONT 05406 Director Brody Gilbert c/o Bluestone Life Insurance Co PO Box 4458 Burlington VT VERMONT 05406 Director Eric Phaneuf c/o Bluestone Life Insurance Co PO Box 4458 Burlington VT VERMONT 05406 Director Insurance Decline to Disclose 06b false 2016-11-14 false true convertible debt false 10000 2000000 472000 1528000 false 6 0 0 360000 true Up to $360,000 may be used to meet payroll obligations to executive officers over the next 12 months. false Bluestone Life Insurance Co Nathan Irons Nathan Irons President 2016-11-28