401k Plan data: KAIZEN RESOURCES, INC. WRAP PLAN plan

KAIZEN RESOURCES, INC. WRAP PLAN 401k Plan overview

Plan Name	KAIZEN RESOURCES, INC. WRAP PLAN
Plan identification number	501

KAIZEN RESOURCES, INC. WRAP PLAN 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 Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

KAIZEN RESOURCES, INC. has sponsored the creation of one or more 401k plans.

Company Name: KAIZEN RESOURCES, INC.

Employer identification number (EIN): 822474379

NAIC Classification: 441110
NAIC Description: New Car Dealers

Additional information about KAIZEN RESOURCES, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2017-05-01

Company Identification Number: 0802710320

Legal Registered Office Address: 3413 LAWRENCE AVE. NEDERLAND

United States of America (USA)
77627

More information about KAIZEN RESOURCES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KAIZEN RESOURCES, INC. WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-12-01 FRANCISCO GALLEGOS 2024-03-06
501 2021-12-01 FRANCISCO GALLEGOS 2023-04-24
501 2019-12-01 FRANCISCO GALLEGOS 2023-04-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-12-01	FRANCISCO GALLEGOS	2024-03-06
501	2021-12-01	FRANCISCO GALLEGOS	2023-04-24
501	2019-12-01	FRANCISCO GALLEGOS	2023-04-24

Form 5500 Responses for KAIZEN RESOURCES, INC. WRAP PLAN

2022: KAIZEN RESOURCES, INC. WRAP PLAN 2022 form 5500 responses
2022-12-01	Type of plan entity	Single employer plan
2022-12-01	Plan funding arrangement – Insurance	Yes
2022-12-01	Plan benefit arrangement – Insurance	Yes
2021: KAIZEN RESOURCES, INC. WRAP PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2019: KAIZEN RESOURCES, INC. WRAP PLAN 2019 form 5500 responses
2019-12-01	Type of plan entity	Single employer plan
2019-12-01	First time form 5500 has been submitted	Yes
2019-12-01	Plan funding arrangement – Insurance	Yes
2019-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

49503

Policy instance

CALIFORNIA DENTAL NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2832

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1051219

Policy instance

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 95567 )

Policy contract number

146794

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

235253

Policy instance

CALIFORNIA DENTAL NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2832

Policy instance

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

832396

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1051219

Policy instance

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 95567 )

Policy contract number

146794

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

235253

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1051219

Policy instance

Insurance contract or identification number	1051219
Number of Individuals Covered	183
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,463
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $10,918
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CALIFORNIA DENTAL NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

2832

Policy instance

Insurance contract or identification number	2832
Number of Individuals Covered	23
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $524
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 95567 )

Policy contract number

146794

Policy instance

Insurance contract or identification number	146794
Number of Individuals Covered	113
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $22,382
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $458,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	KAIZEN RESOURCES, INC.
Employer identification number (EIN):	822474379
NAIC Classification:	441110
NAIC Description:	New Car Dealers

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2017-05-01
Company Identification Number:	0802710320
Legal Registered Office Address:	3413 LAWRENCE AVE. NEDERLAND United States of America (USA) 77627