401k Plan data: PACIFIC GROUP RESORTS, INC. plan

PACIFIC GROUP RESORTS, INC. 401k Plan overview

Plan Name	PACIFIC GROUP RESORTS, INC.
Plan identification number	501

PACIFIC GROUP RESORTS, INC. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

PACIFIC GROUP RESORTS, INC. has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC GROUP RESORTS, INC.

Employer identification number (EIN): 364778076

NAIC Classification: 713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC GROUP RESORTS, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-05-01
501 2023-05-01 TRACE HUBBARD
501 2021-05-01
501 2021-05-01 TRACE HUBBARD

Form 5500 Responses for PACIFIC GROUP RESORTS, INC.

2023: PACIFIC GROUP RESORTS, INC. 2023 form 5500 responses
2023-05-01	Type of plan entity	Single employer plan
2023-05-01	Submission has been amended	No
2023-05-01	This submission is the final filing	No
2023-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-05-01	Plan is a collectively bargained plan	No
2023-05-01	Plan funding arrangement – Insurance	Yes
2023-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-05-01	Plan benefit arrangement – Insurance	Yes
2023-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: PACIFIC GROUP RESORTS, INC. 2021 form 5500 responses
2021-05-01	Type of plan entity	Single employer plan
2021-05-01	First time form 5500 has been submitted	Yes
2021-05-01	Submission has been amended	No
2021-05-01	This submission is the final filing	No
2021-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-05-01	Plan is a collectively bargained plan	No
2021-05-01	Plan funding arrangement – Insurance	Yes
2021-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-05-01	Plan benefit arrangement – Insurance	Yes
2021-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00650167

Policy instance

Insurance contract or identification number	00650167
Number of Individuals Covered	301
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $648,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00020737

Policy instance

Insurance contract or identification number	00020737
Number of Individuals Covered	536
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $36,077
Total amount of fees paid to insurance company	USD $21,338
Are there contracts with allocated funds for individual policies?	0
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $580,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00020737

Policy instance

REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 )

Policy contract number

100000112

Policy instance

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Company Name:	PACIFIC GROUP RESORTS, INC.
Employer identification number (EIN):	364778076
NAIC Classification:	713900

Plan id#	Filing Submission Date	Name of Administrator
501	2023-05-01
501	2023-05-01	TRACE HUBBARD
501	2021-05-01
501	2021-05-01	TRACE HUBBARD