0001813960-22-000001.txt : 20220404 0001813960-22-000001.hdr.sgml : 20220404 20220404115014 ACCESSION NUMBER: 0001813960-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220404 DATE AS OF CHANGE: 20220404 EFFECTIVENESS DATE: 20220404 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Pacific Insurance Network Systems, Inc. CENTRAL INDEX KEY: 0001813960 IRS NUMBER: 851233830 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-440187 FILM NUMBER: 22800995 BUSINESS ADDRESS: STREET 1: PO BOX 120662 CITY: SAN DIEGO STATE: CA ZIP: 92112 BUSINESS PHONE: 626.844.1838 MAIL ADDRESS: STREET 1: PO BOX 120662 CITY: SAN DIEGO STATE: CA ZIP: 92112 D 1 primary_doc.xml X0708 D LIVE 0001813960 Pacific Insurance Network Systems, Inc. 973 W Laurel St SAN DIEGO CA CALIFORNIA 92101 626.844.1838 DELAWARE None None Corporation true 2020 Kathryn McKenzie Rose PO BOX 120662 SAN DIEGO CA CALIFORNIA 92112 Executive Officer Director Marshall William Rose PO BOX 120662 SAN DIEGO CA CALIFORNIA 92112 Executive Officer Director Jon Woodruff PO BOX 120662 SAN DIEGO CA CALIFORNIA 92112 Director Benjamin Bisconti PO BOX 120662 SAN DIEGO CA CALIFORNIA 92112 Director Other Technology Decline to Disclose 06b false 2022-03-17 false true true false 0 700000 350000 350000 false 2 0 0 0 false Pacific Insurance Network Systems, Inc. /s/ Kathryn McKenzie Rose Kathryn McKenzie Rose CEO 2022-04-03