401k Plan data: PACIFIC ONESOURCE EMPLOYEE BENEFITS PLAN plan

PACIFIC ONESOURCE EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	PACIFIC ONESOURCE EMPLOYEE BENEFITS PLAN
Plan identification number	501

PACIFIC ONESOURCE EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

PACIFIC ONESOURCE, INC. DBA SCHOOL TECH SUPPLY has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC ONESOURCE, INC. DBA SCHOOL TECH SUPPLY

Employer identification number (EIN): 264053225

NAIC Classification: 423600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC ONESOURCE EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 CHRISTINE ANDERSON 2024-07-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	CHRISTINE ANDERSON	2024-07-08

Form 5500 Responses for PACIFIC ONESOURCE EMPLOYEE BENEFITS PLAN

2023: PACIFIC ONESOURCE EMPLOYEE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

L06953

Policy instance

Insurance contract or identification number	L06953
Number of Individuals Covered	112
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $41,087
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $833,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5398255

Policy instance

Insurance contract or identification number	5398255
Number of Individuals Covered	125
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,530
Total amount of fees paid to insurance company	USD $72
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

236150

Policy instance

Insurance contract or identification number	236150
Number of Individuals Covered	25
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $9,318
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $200,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	PACIFIC ONESOURCE, INC. DBA SCHOOL TECH SUPPLY
Employer identification number (EIN):	264053225
NAIC Classification:	423600