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MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 401k Plan overview

Plan NameMOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN
Plan identification number 001

MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

MOUNTAIN STATES PATHOLOGY, P.C. has sponsored the creation of one or more 401k plans.

Company Name:MOUNTAIN STATES PATHOLOGY, P.C.
Employer identification number (EIN):841433257
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01DAVID MERBOTH2024-10-02
0012022-01-01JAMES ATKINSON2023-10-11
0012021-01-01DAVID NEWTON2022-08-29
0012020-01-01DAVID NEWTON2021-10-15
0012019-01-01
0012018-01-01
0012017-01-01DAVID NEWTON
0012016-01-01DOUGLAS FRANQUEMONT
0012015-01-01JEROME MYERS
0012014-01-01JEROME MYERS
0012013-01-01DEBORAH HELTON
0012012-01-01ASHLEY WIECHMANN
0012011-01-01ASHLEY WIECHMANN
0012009-01-01ASHLEY A WIECHMANN

Financial Data on MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN

Measure Date Value
2025 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2025 401k financial data
Total liabilities as of the beginning of the plan year2025-07-130
Total expenses incurred by plan in this plan year2025-07-13257884
Net assets as of the end of the plan year2025-07-136048005
Total assets as of the beginning of the plan year2025-07-134967079
Value of plan covered by a fidelity bond2025-07-13500000
Participant contributions to plan in this plan year2025-07-13272341
Other income to plan in this plan year2025-07-13708570
Plan net income in this plan year2025-07-131080926
Net assets as of the end of the plan year2025-07-136048005
Net assets as of the beginning of the plan year2025-07-134967079
Employer contributions to plan in this plan year2025-07-13357899
Expensese paid to adminstrative service provicers from plan in this plan year2025-07-1316754
2024 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2024 401k financial data
Total transfers to/from plan in this plan year2024-10-020
Total liabilities as of the end of the plan year2024-10-020
Total liabilities as of the beginning of the plan year2024-10-020
Total expenses incurred by plan in this plan year2024-10-0212812
Net assets as of the end of the plan year2024-10-024967079
Total assets as of the beginning of the plan year2024-10-023746710
Value of plan covered by a fidelity bond2024-10-02500000
Participant contributions to plan in this plan year2024-10-02264561
Other expenses paid from plan in this plan year2024-10-020
Other contributions to plan in this plan year2024-10-0235743
Other income to plan in this plan year2024-10-02592769
Plan net income in this plan year2024-10-021220369
Net assets as of the end of the plan year2024-10-024967079
Net assets as of the beginning of the plan year2024-10-023746710
Employer contributions to plan in this plan year2024-10-02340108
Expensese paid to adminstrative service provicers from plan in this plan year2024-10-0212812
2021 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources2021-12-31$1,479,809
Expenses. Total of all expenses incurred2021-12-31$3,970,102
Benefits paid (including direct rollovers)2021-12-31$3,951,869
Total plan assets at end of year2021-12-31$6,719,318
Total plan assets at beginning of year2021-12-31$9,209,611
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$240,383
Contributions received from other sources (not participants or employers)2021-12-31$323
Other income received2021-12-31$943,883
Net income (gross income less expenses)2021-12-31$-2,490,293
Net plan assets at end of year (total assets less liabilities)2021-12-31$6,719,318
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$9,209,611
Assets. Value of assets in partnership/joint-venture interests2021-12-31$0
Total contributions received or receivable from employer(s)2021-12-31$295,220
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$18,233
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources2020-12-31$1,194,845
Expenses. Total of all expenses incurred2020-12-31$6,471,022
Benefits paid (including direct rollovers)2020-12-31$6,447,948
Total plan assets at end of year2020-12-31$9,209,611
Total plan assets at beginning of year2020-12-31$14,485,788
Value of fidelity bond covering the plan2020-12-31$500,000
Total contributions received or receivable from participants2020-12-31$274,458
Other income received2020-12-31$511,624
Net income (gross income less expenses)2020-12-31$-5,276,177
Net plan assets at end of year (total assets less liabilities)2020-12-31$9,209,611
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$14,485,788
Assets. Value of assets in partnership/joint-venture interests2020-12-31$44,912
Total contributions received or receivable from employer(s)2020-12-31$408,763
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$23,074
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources2019-12-31$3,301,431
Expenses. Total of all expenses incurred2019-12-31$239,698
Benefits paid (including direct rollovers)2019-12-31$198,273
Total plan assets at end of year2019-12-31$14,485,788
Total plan assets at beginning of year2019-12-31$11,424,055
Value of fidelity bond covering the plan2019-12-31$500,000
Total contributions received or receivable from participants2019-12-31$309,500
Contributions received from other sources (not participants or employers)2019-12-31$200,279
Other income received2019-12-31$2,411,058
Net income (gross income less expenses)2019-12-31$3,061,733
Net plan assets at end of year (total assets less liabilities)2019-12-31$14,485,788
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$11,424,055
Assets. Value of assets in partnership/joint-venture interests2019-12-31$155,087
Total contributions received or receivable from employer(s)2019-12-31$380,594
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$41,425
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources2018-12-31$293,317
Expenses. Total of all expenses incurred2018-12-31$201,944
Benefits paid (including direct rollovers)2018-12-31$169,516
Total plan assets at end of year2018-12-31$11,794,397
Total plan assets at beginning of year2018-12-31$11,703,024
Value of fidelity bond covering the plan2018-12-31$500,000
Total contributions received or receivable from participants2018-12-31$232,750
Other income received2018-12-31$-301,289
Noncash contributions received2018-12-31$5,691
Net income (gross income less expenses)2018-12-31$91,373
Net plan assets at end of year (total assets less liabilities)2018-12-31$11,794,397
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$11,703,024
Assets. Value of assets in partnership/joint-venture interests2018-12-31$76,051
Total contributions received or receivable from employer(s)2018-12-31$356,165
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$32,428
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-12-31$2,060,015
Expenses. Total of all expenses incurred2017-12-31$1,819,402
Benefits paid (including direct rollovers)2017-12-31$1,783,551
Total plan assets at end of year2017-12-31$11,703,024
Total plan assets at beginning of year2017-12-31$11,462,411
Value of fidelity bond covering the plan2017-12-31$500,000
Total contributions received or receivable from participants2017-12-31$258,000
Other income received2017-12-31$1,403,061
Net income (gross income less expenses)2017-12-31$240,613
Net plan assets at end of year (total assets less liabilities)2017-12-31$11,703,024
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$11,462,411
Assets. Value of assets in partnership/joint-venture interests2017-12-31$329,951
Total contributions received or receivable from employer(s)2017-12-31$398,954
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$35,851
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$1,365,964
Expenses. Total of all expenses incurred2016-12-31$51,463
Total plan assets at end of year2016-12-31$11,462,411
Total plan assets at beginning of year2016-12-31$10,147,910
Value of fidelity bond covering the plan2016-12-31$500,000
Total contributions received or receivable from participants2016-12-31$273,500
Other income received2016-12-31$729,447
Net income (gross income less expenses)2016-12-31$1,314,501
Net plan assets at end of year (total assets less liabilities)2016-12-31$11,462,411
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$10,147,910
Assets. Value of assets in partnership/joint-venture interests2016-12-31$255,221
Total contributions received or receivable from employer(s)2016-12-31$363,017
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$51,463
2015 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$428,506
Expenses. Total of all expenses incurred2015-12-31$3,299,274
Benefits paid (including direct rollovers)2015-12-31$3,258,320
Total plan assets at end of year2015-12-31$10,147,910
Total plan assets at beginning of year2015-12-31$13,018,678
Value of fidelity bond covering the plan2015-12-31$500,000
Total contributions received or receivable from participants2015-12-31$271,500
Contributions received from other sources (not participants or employers)2015-12-31$10,375
Other income received2015-12-31$-193,779
Net income (gross income less expenses)2015-12-31$-2,870,768
Net plan assets at end of year (total assets less liabilities)2015-12-31$10,147,910
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$13,018,678
Assets. Value of participant loans2015-12-31$0
Assets. Value of assets in partnership/joint-venture interests2015-12-31$225,363
Total contributions received or receivable from employer(s)2015-12-31$340,410
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$40,954
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$1,157,340
Expenses. Total of all expenses incurred2014-12-31$772,845
Benefits paid (including direct rollovers)2014-12-31$727,259
Total plan assets at end of year2014-12-31$13,018,678
Total plan assets at beginning of year2014-12-31$12,634,183
Value of fidelity bond covering the plan2014-12-31$500,000
Total contributions received or receivable from participants2014-12-31$241,500
Other income received2014-12-31$524,544
Net income (gross income less expenses)2014-12-31$384,495
Net plan assets at end of year (total assets less liabilities)2014-12-31$13,018,678
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$12,634,183
Assets. Value of participant loans2014-12-31$849
Assets. Value of assets in partnership/joint-venture interests2014-12-31$316,984
Total contributions received or receivable from employer(s)2014-12-31$391,296
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$45,586
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at beginning of year2013-12-31$17,179
Total income from all sources2013-12-31$1,665,045
Expenses. Total of all expenses incurred2013-12-31$465,801
Benefits paid (including direct rollovers)2013-12-31$422,313
Total plan assets at end of year2013-12-31$12,634,183
Total plan assets at beginning of year2013-12-31$11,452,118
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$260,000
Other income received2013-12-31$1,013,275
Net income (gross income less expenses)2013-12-31$1,199,244
Net plan assets at end of year (total assets less liabilities)2013-12-31$12,634,183
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$11,434,939
Assets. Value of participant loans2013-12-31$12,061
Assets. Value of assets in partnership/joint-venture interests2013-12-31$412,389
Total contributions received or receivable from employer(s)2013-12-31$391,770
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$43,488
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$17,179
Total plan liabilities at beginning of year2012-12-31$29,528
Total income from all sources2012-12-31$1,560,741
Expenses. Total of all expenses incurred2012-12-31$83,153
Total plan assets at end of year2012-12-31$11,452,118
Total plan assets at beginning of year2012-12-31$9,986,879
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$249,000
Other income received2012-12-31$903,214
Net income (gross income less expenses)2012-12-31$1,477,588
Net plan assets at end of year (total assets less liabilities)2012-12-31$11,434,939
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$9,957,351
Assets. Value of participant loans2012-12-31$20,040
Assets. Value of assets in partnership/joint-venture interests2012-12-31$591,520
Total contributions received or receivable from employer(s)2012-12-31$408,527
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$83,153
2011 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2011 401k financial data
Total plan liabilities at end of year2011-12-31$29,528
Total plan liabilities at beginning of year2011-12-31$31,082
Total income from all sources2011-12-31$462,544
Expenses. Total of all expenses incurred2011-12-31$70,738
Total plan assets at end of year2011-12-31$9,986,879
Total plan assets at beginning of year2011-12-31$9,596,627
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$237,500
Other income received2011-12-31$-170,079
Net income (gross income less expenses)2011-12-31$391,806
Net plan assets at end of year (total assets less liabilities)2011-12-31$9,957,351
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$9,565,545
Assets. Value of participant loans2011-12-31$30,183
Assets. Value of assets in partnership/joint-venture interests2011-12-31$539,598
Total contributions received or receivable from employer(s)2011-12-31$395,123
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$70,738
2010 : MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at end of year2010-12-31$31,082
Total plan liabilities at beginning of year2010-12-31$28,205
Total income from all sources2010-12-31$1,438,555
Expenses. Total of all expenses incurred2010-12-31$46,976
Total plan assets at end of year2010-12-31$9,596,627
Total plan assets at beginning of year2010-12-31$8,202,171
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$249,000
Other income received2010-12-31$783,764
Net income (gross income less expenses)2010-12-31$1,391,579
Net plan assets at end of year (total assets less liabilities)2010-12-31$9,565,545
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$8,173,966
Assets. Value of participant loans2010-12-31$39,787
Assets. Value of assets in partnership/joint-venture interests2010-12-31$429,967
Total contributions received or receivable from employer(s)2010-12-31$405,791
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$46,976

Form 5500 Responses for MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN

2021: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: MOUNTAIN STATES PATHOLOGY, P.C. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract numberVR03060517
Policy instance 1
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract numberVR03060517
Policy instance 1
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract numberVR03060517
Policy instance 1
PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )
Policy contract numberVR03060517
Policy instance 1

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