401k Plan data: PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN plan

PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN 401k Plan overview

Plan Name	PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN
Plan identification number	501

PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

PACIFIC CONSOLIDATED HOLDINGS has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC CONSOLIDATED HOLDINGS

Employer identification number (EIN): 850824680

NAIC Classification: 551112
NAIC Description: Offices of Other Holding Companies

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-03-01 SANDY TAO 2023-12-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-03-01	SANDY TAO	2023-12-07

Plan Statistics for PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN

401k plan membership statisitcs for PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN

Measure Date Value
2022: PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN 2022 401k membership
Total participants, beginning-of-year 2022-03-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 59
Number of retired or separated participants receiving benefits 2022-03-01 0
Number of other retired or separated participants entitled to future benefits 2022-03-01 0
Total of all active and inactive participants 2022-03-01 59
Number of employers contributing to the scheme 2022-03-01 0

Measure	Date	Value
2022: PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN 2022 401k membership
Total participants, beginning-of-year	2022-03-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	59
Number of retired or separated participants receiving benefits	2022-03-01	0
Number of other retired or separated participants entitled to future benefits	2022-03-01	0
Total of all active and inactive participants	2022-03-01	59
Number of employers contributing to the scheme	2022-03-01	0

Form 5500 Responses for PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN

2022: PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	First time form 5500 has been submitted	Yes
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )

Policy contract number

W8001444

Policy instance

Insurance contract or identification number	W8001444
Number of Individuals Covered	80
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $21,953
Total amount of fees paid to insurance company	USD $29,358
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $642,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,508
Amount paid for insurance broker fees	29358
Additional information about fees paid to insurance broker	PRODUCER SERVICE FEES
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

235731

Policy instance

Insurance contract or identification number	235731
Number of Individuals Covered	25
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $8,878
Total amount of fees paid to insurance company	USD $10,700
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $166,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,878
Amount paid for insurance broker fees	10700
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

G43625

Policy instance

Insurance contract or identification number	G43625
Number of Individuals Covered	59
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $891
Total amount of fees paid to insurance company	USD $365
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $891
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

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Company Name:	PACIFIC CONSOLIDATED HOLDINGS
Employer identification number (EIN):	850824680
NAIC Classification:	551112
NAIC Description:	Offices of Other Holding Companies