401k Plan data: ZOTEFOAMS EMPLOYEE BENEFIT PLAN plan

ZOTEFOAMS EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	ZOTEFOAMS EMPLOYEE BENEFIT PLAN
Plan identification number	501

ZOTEFOAMS EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ZOTEFOAMS INC. has sponsored the creation of one or more 401k plans.

Company Name: ZOTEFOAMS INC.

Employer identification number (EIN): 223187795

NAIC Classification: 423990
NAIC Description: Other Miscellaneous Durable Goods Merchant Wholesalers

Additional information about ZOTEFOAMS INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 2307858

More information about ZOTEFOAMS INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ZOTEFOAMS EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 MELISSA OWNBEY 2024-09-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	MELISSA OWNBEY	2024-09-27

Form 5500 Responses for ZOTEFOAMS EMPLOYEE BENEFIT PLAN

2023: ZOTEFOAMS EMPLOYEE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

W26562

Policy instance

Insurance contract or identification number	W26562
Number of Individuals Covered	176
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $23,702
Total amount of fees paid to insurance company	USD $1,066
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $883,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

446686

Policy instance

Insurance contract or identification number	446686
Number of Individuals Covered	0
Insurance policy start date	2023-01-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $958
Total amount of fees paid to insurance company	USD $395
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10274515

Policy instance

Insurance contract or identification number	10274515
Number of Individuals Covered	107
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,365
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $39,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ZOTEFOAMS INC.
Employer identification number (EIN):	223187795
NAIC Classification:	423990
NAIC Description:	Other Miscellaneous Durable Goods Merchant Wholesalers

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	2307858