401k Plan data: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN plan

PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 401k Plan overview

Plan Name	PACIFICA HEALTH SERVICES, LLC 401(K) PLAN
Plan identification number	001

PACIFICA HEALTH SERVICES, LLC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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

PACIFICA HEALTH SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name: PACIFICA HEALTH SERVICES, LLC

Employer identification number (EIN): 470867368

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFICA HEALTH SERVICES, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2018-01-01
001 2017-01-01 JENNIFER CONNER JENNIFER CONNER 2018-10-15
001 2017-01-01 JENNIFER CONNER
001 2016-01-01 JENNIFER CONNER JENNIFER CONNER 2017-10-11
001 2015-01-01 JENNIFER CONNER
001 2014-01-01 ALLEN WOLNERMAN ALLEN WOLNERMAN 2015-10-14
001 2013-01-01 ALLEN WOLNERMAN
001 2012-01-01 ALLEN WOLNERMAN ALLEN WOLNERMAN 2013-10-11
001 2011-01-01 ALLEN WOLNERMAN
001 2009-01-01 ALLEN WOLLERMAN ALLEN WOLLERMAN 2010-11-10
001 2009-01-01 ALLEN WOLLERMAN ALLEN WOLLERMAN 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2018-01-01
001	2017-01-01	JENNIFER CONNER	JENNIFER CONNER	2018-10-15
001	2017-01-01	JENNIFER CONNER
001	2016-01-01	JENNIFER CONNER	JENNIFER CONNER	2017-10-11
001	2015-01-01	JENNIFER CONNER
001	2014-01-01	ALLEN WOLNERMAN	ALLEN WOLNERMAN	2015-10-14
001	2013-01-01	ALLEN WOLNERMAN
001	2012-01-01	ALLEN WOLNERMAN	ALLEN WOLNERMAN	2013-10-11
001	2011-01-01	ALLEN WOLNERMAN
001	2009-01-01	ALLEN WOLLERMAN	ALLEN WOLLERMAN	2010-11-10
001	2009-01-01	ALLEN WOLLERMAN	ALLEN WOLLERMAN	2010-10-15

Plan Statistics for PACIFICA HEALTH SERVICES, LLC 401(K) PLAN

401k plan membership statisitcs for PACIFICA HEALTH SERVICES, LLC 401(K) PLAN

Measure Date Value
2022: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 119
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 11
Total of all active and inactive participants 2022-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 130
Number of participants with account balances 2022-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 103
Number of retired or separated participants receiving benefits 2021-01-01 5
Number of other retired or separated participants entitled to future benefits 2021-01-01 18
Total of all active and inactive participants 2021-01-01 126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 126
Number of participants with account balances 2021-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 7
2020: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 194
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 116
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 20
Total of all active and inactive participants 2020-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 137
Number of participants with account balances 2020-01-01 54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 202
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 142
Number of retired or separated participants receiving benefits 2019-01-01 13
Number of other retired or separated participants entitled to future benefits 2019-01-01 14
Total of all active and inactive participants 2019-01-01 169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 169
Number of participants with account balances 2019-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 19
2018: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 217
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 152
Number of retired or separated participants receiving benefits 2018-01-01 6
Number of other retired or separated participants entitled to future benefits 2018-01-01 21
Total of all active and inactive participants 2018-01-01 179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 179
Number of participants with account balances 2018-01-01 93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 20
2017: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 244
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 173
Number of retired or separated participants receiving benefits 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 14
Total of all active and inactive participants 2017-01-01 189
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 189
Number of participants with account balances 2017-01-01 81
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 17
2016: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 256
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 185
Number of retired or separated participants receiving benefits 2016-01-01 2
Number of other retired or separated participants entitled to future benefits 2016-01-01 17
Total of all active and inactive participants 2016-01-01 204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 204
Number of participants with account balances 2016-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 17
2015: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 292
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 216
Number of retired or separated participants receiving benefits 2015-01-01 3
Number of other retired or separated participants entitled to future benefits 2015-01-01 16
Total of all active and inactive participants 2015-01-01 235
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 235
Number of participants with account balances 2015-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 18
2014: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 306
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 225
Number of retired or separated participants receiving benefits 2014-01-01 3
Number of other retired or separated participants entitled to future benefits 2014-01-01 15
Total of all active and inactive participants 2014-01-01 243
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 243
Number of participants with account balances 2014-01-01 111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 25
2013: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 272
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 247
Number of retired or separated participants receiving benefits 2013-01-01 5
Number of other retired or separated participants entitled to future benefits 2013-01-01 11
Total of all active and inactive participants 2013-01-01 263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 263
Number of participants with account balances 2013-01-01 130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 23
2012: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 235
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 206
Number of retired or separated participants receiving benefits 2012-01-01 9
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 215
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 2
Total participants 2012-01-01 217
Number of participants with account balances 2012-01-01 115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 11
2011: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 195
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 192
Number of retired or separated participants receiving benefits 2011-01-01 8
Number of other retired or separated participants entitled to future benefits 2011-01-01 9
Total of all active and inactive participants 2011-01-01 209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 210
Number of participants with account balances 2011-01-01 110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2009: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 150
Number of retired or separated participants receiving benefits 2009-01-01 15
Number of other retired or separated participants entitled to future benefits 2009-01-01 20
Total of all active and inactive participants 2009-01-01 185
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 185
Number of participants with account balances 2009-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 4

Measure	Date	Value
2022: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	119
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	11
Total of all active and inactive participants	2022-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	130
Number of participants with account balances	2022-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	103
Number of retired or separated participants receiving benefits	2021-01-01	5
Number of other retired or separated participants entitled to future benefits	2021-01-01	18
Total of all active and inactive participants	2021-01-01	126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	126
Number of participants with account balances	2021-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	7
2020: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	194
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	116
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	20
Total of all active and inactive participants	2020-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	137
Number of participants with account balances	2020-01-01	54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	202
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	142
Number of retired or separated participants receiving benefits	2019-01-01	13
Number of other retired or separated participants entitled to future benefits	2019-01-01	14
Total of all active and inactive participants	2019-01-01	169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	169
Number of participants with account balances	2019-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	19
2018: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	217
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	152
Number of retired or separated participants receiving benefits	2018-01-01	6
Number of other retired or separated participants entitled to future benefits	2018-01-01	21
Total of all active and inactive participants	2018-01-01	179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	179
Number of participants with account balances	2018-01-01	93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	20
2017: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	244
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	173
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	14
Total of all active and inactive participants	2017-01-01	189
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	189
Number of participants with account balances	2017-01-01	81
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	17
2016: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	256
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	185
Number of retired or separated participants receiving benefits	2016-01-01	2
Number of other retired or separated participants entitled to future benefits	2016-01-01	17
Total of all active and inactive participants	2016-01-01	204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	204
Number of participants with account balances	2016-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	17
2015: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	292
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	216
Number of retired or separated participants receiving benefits	2015-01-01	3
Number of other retired or separated participants entitled to future benefits	2015-01-01	16
Total of all active and inactive participants	2015-01-01	235
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	235
Number of participants with account balances	2015-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	18
2014: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	306
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	225
Number of retired or separated participants receiving benefits	2014-01-01	3
Number of other retired or separated participants entitled to future benefits	2014-01-01	15
Total of all active and inactive participants	2014-01-01	243
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	243
Number of participants with account balances	2014-01-01	111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	25
2013: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	272
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	247
Number of retired or separated participants receiving benefits	2013-01-01	5
Number of other retired or separated participants entitled to future benefits	2013-01-01	11
Total of all active and inactive participants	2013-01-01	263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	263
Number of participants with account balances	2013-01-01	130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	23
2012: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	235
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	206
Number of retired or separated participants receiving benefits	2012-01-01	9
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	215
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	2
Total participants	2012-01-01	217
Number of participants with account balances	2012-01-01	115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	11
2011: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	195
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	192
Number of retired or separated participants receiving benefits	2011-01-01	8
Number of other retired or separated participants entitled to future benefits	2011-01-01	9
Total of all active and inactive participants	2011-01-01	209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	210
Number of participants with account balances	2011-01-01	110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2009: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	150
Number of retired or separated participants receiving benefits	2009-01-01	15
Number of other retired or separated participants entitled to future benefits	2009-01-01	20
Total of all active and inactive participants	2009-01-01	185
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	185
Number of participants with account balances	2009-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on PACIFICA HEALTH SERVICES, LLC 401(K) PLAN

Measure	Date	Value
2022 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$4,234
Total income from all sources (including contributions)	2022-12-31	$-63,585
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$214,563
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$204,090
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$28,894
Value of total assets at end of year	2022-12-31	$386,782
Value of total assets at beginning of year	2022-12-31	$669,164
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$10,473
Total interest from all sources	2022-12-31	$31
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$11,092
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$11,092
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$250,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$24,260
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$0
Participant contributions at end of year	2022-12-31	$119
Participant contributions at beginning of year	2022-12-31	$50
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$4,234
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-278,148
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$386,782
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$664,930
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$372,555
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$633,354
Value of interest in common/collective trusts at end of year	2022-12-31	$13,708
Value of interest in common/collective trusts at beginning of year	2022-12-31	$35,760
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$31
Net investment gain/loss from pooled separate accounts	2022-12-31	$-103,356
Net investment gain or loss from common/collective trusts	2022-12-31	$-246
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$4,634
Employer contributions (assets) at end of year	2022-12-31	$400
Employer contributions (assets) at beginning of year	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$204,090
Contract administrator fees	2022-12-31	$10,473
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MARTENS & COMPANY, CPA. LLP
Accountancy firm EIN	2022-12-31	593823192
2021 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$4,234
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$128,769
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$240,647
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$239,706
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$39,602
Value of total assets at end of year	2021-12-31	$669,164
Value of total assets at beginning of year	2021-12-31	$776,808
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$941
Total interest from all sources	2021-12-31	$523
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$250,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$39,602
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$16,957
Participant contributions at end of year	2021-12-31	$50
Participant contributions at beginning of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$4,234
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$-111,878
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$664,930
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$776,808
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$633,354
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$714,814
Interest on participant loans	2021-12-31	$523
Value of interest in common/collective trusts at end of year	2021-12-31	$35,760
Value of interest in common/collective trusts at beginning of year	2021-12-31	$38,296
Net investment gain/loss from pooled separate accounts	2021-12-31	$89,026
Net investment gain or loss from common/collective trusts	2021-12-31	$-382
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$0
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$6,741
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$239,706
Contract administrator fees	2021-12-31	$941
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MARTENS & COMPANY, CPA. LLP
Accountancy firm EIN	2021-12-31	593823192
2020 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$156,651
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$34,363
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$29,703
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$81,253
Value of total assets at end of year	2020-12-31	$776,808
Value of total assets at beginning of year	2020-12-31	$654,520
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$4,660
Total interest from all sources	2020-12-31	$1,391
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$250,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$74,512
Participant contributions at end of year	2020-12-31	$16,957
Participant contributions at beginning of year	2020-12-31	$26,398
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$60
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$122,288
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$776,808
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$654,520
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$714,814
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$578,296
Interest on participant loans	2020-12-31	$1,391
Value of interest in common/collective trusts at end of year	2020-12-31	$38,296
Value of interest in common/collective trusts at beginning of year	2020-12-31	$37,137
Net investment gain/loss from pooled separate accounts	2020-12-31	$74,243
Net investment gain or loss from common/collective trusts	2020-12-31	$-236
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$6,741
Employer contributions (assets) at end of year	2020-12-31	$6,741
Employer contributions (assets) at beginning of year	2020-12-31	$12,629
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$29,703
Contract administrator fees	2020-12-31	$4,660
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	MARTENS & COMPANY, CPA. LLP
Accountancy firm EIN	2020-12-31	593823192
2019 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$193,965
Total income from all sources (including contributions)	2019-12-31	$193,965
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$122,539
Total of all expenses incurred	2019-12-31	$122,539
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$120,559
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$120,559
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$95,576
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$95,576
Value of total assets at end of year	2019-12-31	$654,520
Value of total assets at end of year	2019-12-31	$654,520
Value of total assets at beginning of year	2019-12-31	$583,094
Value of total assets at beginning of year	2019-12-31	$583,094
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,980
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,980
Total interest from all sources	2019-12-31	$2,290
Total interest from all sources	2019-12-31	$2,290
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$250,000
Value of fidelity bond cover	2019-12-31	$250,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$82,947
Contributions received from participants	2019-12-31	$82,947
Participant contributions at end of year	2019-12-31	$26,398
Participant contributions at end of year	2019-12-31	$26,398
Participant contributions at beginning of year	2019-12-31	$44,200
Participant contributions at beginning of year	2019-12-31	$44,200
Participant contributions at end of year	2019-12-31	$60
Participant contributions at end of year	2019-12-31	$60
Participant contributions at beginning of year	2019-12-31	$4,611
Participant contributions at beginning of year	2019-12-31	$4,611
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$803
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$803
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$71,426
Value of net income/loss	2019-12-31	$71,426
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$654,520
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$654,520
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$583,094
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$583,094
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$578,296
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$578,296
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$474,239
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$474,239
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$0
Interest on participant loans	2019-12-31	$2,290
Interest on participant loans	2019-12-31	$2,290
Value of interest in common/collective trusts at end of year	2019-12-31	$37,137
Value of interest in common/collective trusts at end of year	2019-12-31	$37,137
Value of interest in common/collective trusts at beginning of year	2019-12-31	$46,994
Value of interest in common/collective trusts at beginning of year	2019-12-31	$46,994
Net investment gain/loss from pooled separate accounts	2019-12-31	$96,222
Net investment gain/loss from pooled separate accounts	2019-12-31	$96,222
Net investment gain or loss from common/collective trusts	2019-12-31	$-123
Net investment gain or loss from common/collective trusts	2019-12-31	$-123
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$12,629
Contributions received in cash from employer	2019-12-31	$12,629
Employer contributions (assets) at end of year	2019-12-31	$12,629
Employer contributions (assets) at end of year	2019-12-31	$12,629
Employer contributions (assets) at beginning of year	2019-12-31	$12,247
Employer contributions (assets) at beginning of year	2019-12-31	$12,247
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$120,559
Contract administrator fees	2019-12-31	$1,980
Contract administrator fees	2019-12-31	$1,980
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MARTENS & COMPANY, CPA. LLP
Accountancy firm name	2019-12-31	MARTENS & COMPANY, CPA. LLP
Accountancy firm EIN	2019-12-31	593823192
Accountancy firm EIN	2019-12-31	593823192
2018 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$93,127
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$188,415
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$185,649
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$134,545
Value of total assets at end of year	2018-12-31	$583,094
Value of total assets at beginning of year	2018-12-31	$678,382
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$2,766
Total interest from all sources	2018-12-31	$2,298
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$250,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$122,298
Participant contributions at end of year	2018-12-31	$44,200
Participant contributions at beginning of year	2018-12-31	$40,663
Participant contributions at end of year	2018-12-31	$4,611
Participant contributions at beginning of year	2018-12-31	$4,990
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$803
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$899
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-95,288
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$583,094
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$678,382
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$474,239
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$545,537
Value of interest in pooled separate accounts at end of year	2018-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$0
Interest on participant loans	2018-12-31	$2,298
Value of interest in common/collective trusts at end of year	2018-12-31	$46,994
Value of interest in common/collective trusts at beginning of year	2018-12-31	$73,858
Net investment gain/loss from pooled separate accounts	2018-12-31	$-43,077
Net investment gain or loss from common/collective trusts	2018-12-31	$-639
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$12,247
Employer contributions (assets) at end of year	2018-12-31	$12,247
Employer contributions (assets) at beginning of year	2018-12-31	$12,435
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$185,649
Contract administrator fees	2018-12-31	$2,766
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	MARTENS & COMPANY, CPA. LLP
Accountancy firm EIN	2018-12-31	593823192
2017 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$246,772
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$161,554
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$158,206
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$173,620
Value of total assets at end of year	2017-12-31	$678,382
Value of total assets at beginning of year	2017-12-31	$593,164
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$3,348
Total interest from all sources	2017-12-31	$2,593
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$250,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$158,555
Participant contributions at end of year	2017-12-31	$40,663
Participant contributions at beginning of year	2017-12-31	$48,269
Participant contributions at end of year	2017-12-31	$4,990
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$2,630
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$899
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$85,218
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$678,382
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$593,164
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$545,537
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$471,829
Interest on participant loans	2017-12-31	$2,593
Value of interest in common/collective trusts at end of year	2017-12-31	$73,858
Value of interest in common/collective trusts at beginning of year	2017-12-31	$60,516
Net investment gain/loss from pooled separate accounts	2017-12-31	$71,414
Net investment gain or loss from common/collective trusts	2017-12-31	$-855
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$12,435
Employer contributions (assets) at end of year	2017-12-31	$12,435
Employer contributions (assets) at beginning of year	2017-12-31	$12,550
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$158,206
Contract administrator fees	2017-12-31	$3,348
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	BROOKS LODDEN, P.C.
Accountancy firm EIN	2017-12-31	421229486
2016 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$171,578
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$255,045
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$255,045
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$136,834
Value of total assets at end of year	2016-12-31	$593,164
Value of total assets at beginning of year	2016-12-31	$676,631
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$2,658
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$250,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$122,838
Participant contributions at end of year	2016-12-31	$48,269
Participant contributions at beginning of year	2016-12-31	$58,115
Participant contributions at beginning of year	2016-12-31	$1,091
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$1,446
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$599
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-83,467
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$593,164
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$676,631
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$471,829
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$550,093
Interest on participant loans	2016-12-31	$2,658
Value of interest in common/collective trusts at end of year	2016-12-31	$60,516
Value of interest in common/collective trusts at beginning of year	2016-12-31	$54,755
Net investment gain/loss from pooled separate accounts	2016-12-31	$33,122
Net investment gain or loss from common/collective trusts	2016-12-31	$-1,036
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$12,550
Employer contributions (assets) at end of year	2016-12-31	$12,550
Employer contributions (assets) at beginning of year	2016-12-31	$11,978
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$255,045
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	BROOKS LODDEN, P.C.
Accountancy firm EIN	2016-12-31	421229486
2015 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$100,844
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$80,495
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$80,495
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$122,015
Value of total assets at end of year	2015-12-31	$676,631
Value of total assets at beginning of year	2015-12-31	$656,282
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$3,040
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$69,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$92,424
Participant contributions at end of year	2015-12-31	$58,115
Participant contributions at beginning of year	2015-12-31	$49,956
Participant contributions at end of year	2015-12-31	$1,091
Participant contributions at beginning of year	2015-12-31	$2
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$15,524
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$599
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$20,349
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$676,631
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$656,282
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$550,093
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$538,319
Income. Interest from loans (other than to participants)	2015-12-31	$3,040
Value of interest in common/collective trusts at end of year	2015-12-31	$54,755
Value of interest in common/collective trusts at beginning of year	2015-12-31	$54,310
Net investment gain/loss from pooled separate accounts	2015-12-31	$-23,045
Net investment gain or loss from common/collective trusts	2015-12-31	$-1,166
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$14,067
Employer contributions (assets) at end of year	2015-12-31	$11,978
Employer contributions (assets) at beginning of year	2015-12-31	$13,695
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$80,495
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	BROOKS LODDEN, P.C.
Accountancy firm EIN	2015-12-31	421229486
2014 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$158,200
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$187,022
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$187,022
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$143,871
Value of total assets at end of year	2014-12-31	$656,282
Value of total assets at beginning of year	2014-12-31	$685,104
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$2,520
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$69,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$120,830
Participant contributions at end of year	2014-12-31	$49,956
Participant contributions at beginning of year	2014-12-31	$43,516
Participant contributions at end of year	2014-12-31	$2
Participant contributions at beginning of year	2014-12-31	$5,312
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$9,346
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$991
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-28,822
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$656,282
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$685,104
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$538,319
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$569,563
Interest on participant loans	2014-12-31	$2,520
Value of interest in common/collective trusts at end of year	2014-12-31	$54,310
Value of interest in common/collective trusts at beginning of year	2014-12-31	$49,715
Net investment gain/loss from pooled separate accounts	2014-12-31	$13,095
Net investment gain or loss from common/collective trusts	2014-12-31	$-1,286
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$13,695
Employer contributions (assets) at end of year	2014-12-31	$13,695
Employer contributions (assets) at beginning of year	2014-12-31	$16,007
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$187,022
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	BROOKS LODDEN, P.C.
Accountancy firm EIN	2014-12-31	421229486
2013 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$256,065
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$102,374
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$101,859
Value of total corrective distributions	2013-12-31	$515
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$156,015
Value of total assets at end of year	2013-12-31	$685,104
Value of total assets at beginning of year	2013-12-31	$531,413
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$1,810
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$55,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$123,096
Participant contributions at end of year	2013-12-31	$43,516
Participant contributions at beginning of year	2013-12-31	$26,954
Participant contributions at end of year	2013-12-31	$5,312
Participant contributions at beginning of year	2013-12-31	$4,309
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$16,912
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$991
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$783
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$153,691
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$685,104
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$531,413
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$569,563
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$442,368
Income. Interest from loans (other than to participants)	2013-12-31	$1,810
Value of interest in common/collective trusts at end of year	2013-12-31	$49,715
Value of interest in common/collective trusts at beginning of year	2013-12-31	$43,258
Net investment gain/loss from pooled separate accounts	2013-12-31	$99,183
Net investment gain or loss from common/collective trusts	2013-12-31	$-943
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$16,007
Employer contributions (assets) at end of year	2013-12-31	$16,007
Employer contributions (assets) at beginning of year	2013-12-31	$13,741
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$101,859
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	BROOKS LODDEN, P.C.
Accountancy firm EIN	2013-12-31	421229486
2012 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$162,921
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$152,453
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$152,453
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$117,797
Value of total assets at end of year	2012-12-31	$531,413
Value of total assets at beginning of year	2012-12-31	$520,945
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$1,393
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$54,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$101,901
Participant contributions at end of year	2012-12-31	$26,954
Participant contributions at beginning of year	2012-12-31	$36,428
Participant contributions at end of year	2012-12-31	$4,309
Participant contributions at beginning of year	2012-12-31	$4,140
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$783
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$560
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$10,468
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$531,413
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$520,945
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$442,368
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$466,244
Interest on participant loans	2012-12-31	$1,393
Value of interest in common/collective trusts at end of year	2012-12-31	$43,258
Value of interest in common/collective trusts at beginning of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Net investment gain/loss from pooled separate accounts	2012-12-31	$44,131
Net investment gain or loss from common/collective trusts	2012-12-31	$-400
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$15,896
Employer contributions (assets) at end of year	2012-12-31	$13,741
Employer contributions (assets) at beginning of year	2012-12-31	$13,573
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$152,453
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	DENMAN & COMPANY, LLP
Accountancy firm EIN	2012-12-31	420794029
2011 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$73,969
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$53,829
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$53,829
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$100,384
Value of total assets at end of year	2011-12-31	$520,945
Value of total assets at beginning of year	2011-12-31	$500,805
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$1,559
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$50,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$85,507
Participant contributions at end of year	2011-12-31	$36,428
Participant contributions at beginning of year	2011-12-31	$27,528
Participant contributions at end of year	2011-12-31	$4,140
Participant contributions at beginning of year	2011-12-31	$2,988
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$433
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$560
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$651
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$20,140
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$520,945
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$500,805
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$466,244
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$457,907
Interest on participant loans	2011-12-31	$1,559
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$-27,974
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$14,444
Employer contributions (assets) at end of year	2011-12-31	$13,573
Employer contributions (assets) at beginning of year	2011-12-31	$11,731
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$53,829
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	DENMAN & COMPANY, LLP
Accountancy firm EIN	2011-12-31	420794029
2010 : PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$133,971
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$99,952
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$99,952
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$92,560
Value of total assets at end of year	2010-12-31	$500,805
Value of total assets at beginning of year	2010-12-31	$466,786
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$1,181
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$50,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$80,829
Participant contributions at end of year	2010-12-31	$27,528
Participant contributions at beginning of year	2010-12-31	$28,785
Participant contributions at end of year	2010-12-31	$2,988
Participant contributions at beginning of year	2010-12-31	$1,435
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$651
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$675
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$34,019
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$500,805
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$466,786
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$457,907
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$420,752
Interest on participant loans	2010-12-31	$1,181
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$40,230
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$11,731
Employer contributions (assets) at end of year	2010-12-31	$11,731
Employer contributions (assets) at beginning of year	2010-12-31	$15,139
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$99,952
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	DENMAN & COMPANY, LLP
Accountancy firm EIN	2010-12-31	420794029

Form 5500 Responses for PACIFICA HEALTH SERVICES, LLC 401(K) PLAN

2022: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: PACIFICA HEALTH SERVICES, LLC 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-54-JK49

Policy instance

Insurance contract or identification number	GAP-54-JK49
Number of Individuals Covered	113
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,070
Total amount of fees paid to insurance company	USD $1,242
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $2,070
Insurance broker organization code?	3
Amount paid for insurance broker fees	1242
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	PARADIGM BENEFITS, LLC

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-54-JK49

Policy instance

Insurance contract or identification number	GAP-54-JK49
Number of Individuals Covered	113
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,806
Total amount of fees paid to insurance company	USD $1,083
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-54-JK49

Policy instance

Insurance contract or identification number	GAP-54-JK49
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,005
Total amount of fees paid to insurance company	USD $1,675
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	PACIFICA HEALTH SERVICES, LLC
Employer identification number (EIN):	470867368
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities