0001813960-23-000001.txt : 20230921 0001813960-23-000001.hdr.sgml : 20230921 20230921163838 ACCESSION NUMBER: 0001813960-23-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20230921 DATE AS OF CHANGE: 20230921 EFFECTIVENESS DATE: 20230921 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: 021-492741 FILM NUMBER: 231269504 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 2023-08-10 false true true false 0 500000 96667 403333 false 3 0 0 0 false Pacific Insurance Network Systems, Inc. /s/ Kathryn Rose Kathryn Rose CEO 2023-09-21