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| Plan Name | PACIFIC CONSOLIDATED HOLDINGS 2022 WRAP PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PACIFIC CONSOLIDATED HOLDINGS |
| Employer identification number (EIN): | 850824680 |
| NAIC Classification: | 551112 |
| NAIC Description: | Offices of Other Holding Companies |
| 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 |
| 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 |
| CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 61557 ) | |
| Policy contract number | W8001444 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 235731 |
| Policy instance | 2 |
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |
| Policy contract number | G43625 |
| Policy instance | 3 |
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