0001813960-22-000002.txt : 20221018 0001813960-22-000002.hdr.sgml : 20221018 20221017190527 ACCESSION NUMBER: 0001813960-22-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20221018 DATE AS OF CHANGE: 20221017 EFFECTIVENESS DATE: 20221018 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: 021-462040 FILM NUMBER: 221314612 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 973 W Laurel St. SAN DIEGO CA CALIFORNIA 92101 Executive Officer Director Marshall William Rose 973 W Laurel St. SAN DIEGO CA CALIFORNIA 92101 Executive Officer Director Jon Woodruff 973 W Laurel St. SAN DIEGO CA CALIFORNIA 92101 Director Benjamin Bisconti 973 W Laurel St. SAN DIEGO CA CALIFORNIA 92101 Director Other Technology Decline to Disclose 06b false 2022-08-19 false true true false 0 935000 935000 0 false 6 0 0 0 false Pacific Insurance Network Systems, Inc. /s/ Kathryn Rose Kathryn Rose CEO 2022-09-26