401k Plan data: KAWASAKI TENNESSEE INC. 401K PLAN plan

KAWASAKI TENNESSEE INC. 401K PLAN 401k Plan overview

Plan Name	KAWASAKI TENNESSEE INC. 401K PLAN
Plan identification number	001

KAWASAKI TENNESSEE INC. 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

KAWASAKI TENNESSEE, INC. has sponsored the creation of one or more 401k plans.

Company Name: KAWASAKI TENNESSEE, INC.

Employer identification number (EIN): 760719404

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KAWASAKI TENNESSEE INC. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 SUSIE WOODS-IPOCK 2024-09-10
001 2022-01-01 SUSIE WOODS-IPOCK 2023-09-12
001 2021-01-01 SUSIE WOODS-IPOCK 2022-09-11
001 2020-01-01 SUSIE WOODS-IPOCK 2021-08-31
001 2019-01-01
001 2018-01-01 SUSIE WOODS-IPOCK
001 2017-01-01 SUSIE WOODS-IPOCK 2018-07-11
001 2016-01-01 SUSIE WOODS-IPOCK 2017-05-09
001 2015-01-01 SUSIE WOODS-IPOCK 2016-03-11
001 2014-01-01 SUSIE WOODS-IPOCK 2015-05-29
001 2013-01-01 SUSIE HUSKEY 2014-06-18
001 2012-01-01 SUSIE HUSKEY 2013-09-11
001 2011-01-01 SUSIE HUSKEY 2012-09-20
001 2010-01-01 SUSIE HUSKEY 2011-08-18

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2023-01-01	SUSIE WOODS-IPOCK	2024-09-10
001	2022-01-01	SUSIE WOODS-IPOCK	2023-09-12
001	2021-01-01	SUSIE WOODS-IPOCK	2022-09-11
001	2020-01-01	SUSIE WOODS-IPOCK	2021-08-31
001	2019-01-01
001	2018-01-01	SUSIE WOODS-IPOCK
001	2017-01-01	SUSIE WOODS-IPOCK	2018-07-11
001	2016-01-01	SUSIE WOODS-IPOCK	2017-05-09
001	2015-01-01	SUSIE WOODS-IPOCK	2016-03-11
001	2014-01-01	SUSIE WOODS-IPOCK	2015-05-29
001	2013-01-01	SUSIE HUSKEY	2014-06-18
001	2012-01-01	SUSIE HUSKEY	2013-09-11
001	2011-01-01	SUSIE HUSKEY	2012-09-20
001	2010-01-01	SUSIE HUSKEY	2011-08-18

Plan Statistics for KAWASAKI TENNESSEE INC. 401K PLAN

401k plan membership statisitcs for KAWASAKI TENNESSEE INC. 401K PLAN

Measure Date Value
2023: KAWASAKI TENNESSEE INC. 401K PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 281
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 240
Number of retired or separated participants receiving benefits 2023-01-01 3
Number of other retired or separated participants entitled to future benefits 2023-01-01 8
Total of all active and inactive participants 2023-01-01 251
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 251
Number of participants with account balances 2023-01-01 135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 9
2022: KAWASAKI TENNESSEE INC. 401K PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 305
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 249
Number of retired or separated participants receiving benefits 2022-01-01 3
Number of other retired or separated participants entitled to future benefits 2022-01-01 21
Total of all active and inactive participants 2022-01-01 273
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 273
Number of participants with account balances 2022-01-01 145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 14
2021: KAWASAKI TENNESSEE INC. 401K PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 282
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 250
Number of retired or separated participants receiving benefits 2021-01-01 6
Number of other retired or separated participants entitled to future benefits 2021-01-01 36
Total of all active and inactive participants 2021-01-01 292
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 292
Number of participants with account balances 2021-01-01 155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 21
2020: KAWASAKI TENNESSEE INC. 401K PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 259
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 245
Number of retired or separated participants receiving benefits 2020-01-01 5
Number of other retired or separated participants entitled to future benefits 2020-01-01 15
Total of all active and inactive participants 2020-01-01 265
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 265
Number of participants with account balances 2020-01-01 127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 12
2019: KAWASAKI TENNESSEE INC. 401K PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 226
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 238
Number of retired or separated participants receiving benefits 2019-01-01 4
Number of other retired or separated participants entitled to future benefits 2019-01-01 7
Total of all active and inactive participants 2019-01-01 249
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 249
Number of participants with account balances 2019-01-01 108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 10
2018: KAWASAKI TENNESSEE INC. 401K PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 191
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 8
Total of all active and inactive participants 2018-01-01 200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 200
Number of participants with account balances 2018-01-01 79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 4

Measure	Date	Value
2023: KAWASAKI TENNESSEE INC. 401K PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	281
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	240
Number of retired or separated participants receiving benefits	2023-01-01	3
Number of other retired or separated participants entitled to future benefits	2023-01-01	8
Total of all active and inactive participants	2023-01-01	251
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	251
Number of participants with account balances	2023-01-01	135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	9
2022: KAWASAKI TENNESSEE INC. 401K PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	305
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	249
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	21
Total of all active and inactive participants	2022-01-01	273
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	273
Number of participants with account balances	2022-01-01	145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	14
2021: KAWASAKI TENNESSEE INC. 401K PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	282
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	250
Number of retired or separated participants receiving benefits	2021-01-01	6
Number of other retired or separated participants entitled to future benefits	2021-01-01	36
Total of all active and inactive participants	2021-01-01	292
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	292
Number of participants with account balances	2021-01-01	155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	21
2020: KAWASAKI TENNESSEE INC. 401K PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	259
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	245
Number of retired or separated participants receiving benefits	2020-01-01	5
Number of other retired or separated participants entitled to future benefits	2020-01-01	15
Total of all active and inactive participants	2020-01-01	265
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	265
Number of participants with account balances	2020-01-01	127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	12
2019: KAWASAKI TENNESSEE INC. 401K PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	226
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	238
Number of retired or separated participants receiving benefits	2019-01-01	4
Number of other retired or separated participants entitled to future benefits	2019-01-01	7
Total of all active and inactive participants	2019-01-01	249
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	249
Number of participants with account balances	2019-01-01	108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	10
2018: KAWASAKI TENNESSEE INC. 401K PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	191
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	8
Total of all active and inactive participants	2018-01-01	200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	200
Number of participants with account balances	2018-01-01	79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	4

Financial Data on KAWASAKI TENNESSEE INC. 401K PLAN

Measure	Date	Value
2023 : KAWASAKI TENNESSEE INC. 401K PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total income from all sources (including contributions)	2023-12-31	$951,215
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$241,606
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$221,478
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$506,190
Value of total assets at end of year	2023-12-31	$3,517,404
Value of total assets at beginning of year	2023-12-31	$2,807,795
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$20,128
Total interest from all sources	2023-12-31	$12,670
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$3,710
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2023-12-31	$3,710
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$300,015
Participant contributions at end of year	2023-12-31	$211,749
Participant contributions at beginning of year	2023-12-31	$156,239
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$709,609
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$3,517,404
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$2,807,795
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Investment advisory and management fees	2023-12-31	$5,092
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$2,956,679
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$2,375,678
Interest on participant loans	2023-12-31	$12,670
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-12-31	$348,976
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-12-31	$275,878
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$428,645
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	No
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$206,175
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$221,478
Contract administrator fees	2023-12-31	$8,036
Did the plan have assets held for investment	2023-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	KRUGGEL LAWTON & COMPANY, LLC
Accountancy firm EIN	2023-12-31	351307701
2022 : KAWASAKI TENNESSEE INC. 401K PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-87,113
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$240,888
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$225,368
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$476,691
Value of total assets at end of year	2022-12-31	$2,807,795
Value of total assets at beginning of year	2022-12-31	$3,135,796
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$15,520
Total interest from all sources	2022-12-31	$5,554
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$2,428
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$2,428
Administrative expenses professional fees incurred	2022-12-31	$8,365
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$288,906
Participant contributions at end of year	2022-12-31	$156,239
Participant contributions at beginning of year	2022-12-31	$97,938
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$154
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-328,001
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$2,807,795
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$3,135,796
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$4,405
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$2,375,678
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$2,781,131
Interest on participant loans	2022-12-31	$5,554
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$275,878
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$256,518
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-571,786
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$187,785
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$55
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$225,368
Contract administrator fees	2022-12-31	$2,750
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	KRUGGEL LAWTON & COMPANY, LLC
Accountancy firm EIN	2022-12-31	351307701
2021 : KAWASAKI TENNESSEE INC. 401K PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$793,645
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$185,911
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$178,027
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$481,340
Value of total assets at end of year	2021-12-31	$3,135,796
Value of total assets at beginning of year	2021-12-31	$2,528,062
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$7,884
Total interest from all sources	2021-12-31	$4,508
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$2,315
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$2,315
Administrative expenses professional fees incurred	2021-12-31	$2,500
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$271,181
Participant contributions at end of year	2021-12-31	$97,938
Participant contributions at beginning of year	2021-12-31	$94,236
Participant contributions at end of year	2021-12-31	$154
Participant contributions at beginning of year	2021-12-31	$9,335
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$30,398
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$607,734
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,135,796
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$2,528,062
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$3,134
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$2,781,131
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,166,275
Interest on participant loans	2021-12-31	$4,508
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$256,518
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$252,506
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$305,482
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$179,761
Employer contributions (assets) at end of year	2021-12-31	$55
Employer contributions (assets) at beginning of year	2021-12-31	$5,710
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$178,027
Contract administrator fees	2021-12-31	$2,250
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	KRUGGEL LAWTON & COMPANY, LLC
Accountancy firm EIN	2021-12-31	351307701
2020 : KAWASAKI TENNESSEE INC. 401K PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$683,772
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$165,901
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$159,109
Expenses. Certain deemed distributions of participant loans	2020-12-31	$-4,491
Value of total corrective distributions	2020-12-31	$1,046
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$396,986
Value of total assets at end of year	2020-12-31	$2,528,062
Value of total assets at beginning of year	2020-12-31	$2,010,191
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$10,237
Total interest from all sources	2020-12-31	$5,051
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$2,456
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$2,456
Administrative expenses professional fees incurred	2020-12-31	$5,500
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$250,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$234,601
Participant contributions at end of year	2020-12-31	$94,236
Participant contributions at beginning of year	2020-12-31	$97,080
Participant contributions at end of year	2020-12-31	$9,335
Participant contributions at beginning of year	2020-12-31	$295
Other income not declared elsewhere	2020-12-31	$23
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$517,871
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,528,062
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,010,191
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$2,162
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,166,275
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,679,521
Interest on participant loans	2020-12-31	$5,051
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$252,506
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$233,194
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$279,256
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$162,385
Employer contributions (assets) at end of year	2020-12-31	$5,710
Employer contributions (assets) at beginning of year	2020-12-31	$101
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$159,109
Contract administrator fees	2020-12-31	$2,575
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	KRUGGEL LAWTON & COMPANY, LLC
Accountancy firm EIN	2020-12-31	351307701
2019 : KAWASAKI TENNESSEE INC. 401K PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$636,453
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$172,692
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$158,777
Expenses. Certain deemed distributions of participant loans	2019-12-31	$10,801
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$339,387
Value of total assets at end of year	2019-12-31	$2,010,191
Value of total assets at beginning of year	2019-12-31	$1,546,430
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$3,114
Total interest from all sources	2019-12-31	$7,404
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$250,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$213,020
Participant contributions at end of year	2019-12-31	$97,080
Participant contributions at beginning of year	2019-12-31	$112,847
Participant contributions at end of year	2019-12-31	$295
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$463,761
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,010,191
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,546,430
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,679,521
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,258,289
Income. Interest from loans (other than to participants)	2019-12-31	$5,025
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$2,379
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$233,194
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$175,294
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$289,662
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$126,367
Employer contributions (assets) at end of year	2019-12-31	$101
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$158,777
Contract administrator fees	2019-12-31	$3,114
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	KRUGGEL LAWTON & COMPANY, LLC
Accountancy firm EIN	2019-12-31	351307701
2018 : KAWASAKI TENNESSEE INC. 401K PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$198,826
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$782,708
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$765,796
Expenses. Certain deemed distributions of participant loans	2018-12-31	$14,523
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$324,919
Value of total assets at end of year	2018-12-31	$1,546,430
Value of total assets at beginning of year	2018-12-31	$2,130,312
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$2,389
Total interest from all sources	2018-12-31	$6,747
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$250,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$145,393
Participant contributions at end of year	2018-12-31	$112,847
Participant contributions at beginning of year	2018-12-31	$99,947
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$82,570
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-583,882
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,546,430
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,130,312
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$1,258,289
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$1,837,165
Interest on participant loans	2018-12-31	$4,882
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$1,865
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$175,294
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$193,200
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-132,840
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$96,956
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$765,796
Contract administrator fees	2018-12-31	$2,389
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	KRUGGEL LAWTON & COMPANY, LLC
Accountancy firm EIN	2018-12-31	351307701

Form 5500 Responses for KAWASAKI TENNESSEE INC. 401K PLAN

2023: KAWASAKI TENNESSEE INC. 401K PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: KAWASAKI TENNESSEE INC. 401K PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: KAWASAKI TENNESSEE INC. 401K PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: KAWASAKI TENNESSEE INC. 401K PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: KAWASAKI TENNESSEE INC. 401K PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: KAWASAKI TENNESSEE INC. 401K PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

937944-01

Policy instance

Insurance contract or identification number	937944-01
Number of Individuals Covered	136
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,945
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?	Yes
Health Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

937944-01

Policy instance

Insurance contract or identification number	937944-01
Number of Individuals Covered	146
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $12,007
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?	Yes
Health Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,007
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

937944-01

Policy instance

Insurance contract or identification number	937944-01
Number of Individuals Covered	154
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12,358
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?	Yes
Health Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,358
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

937944-01

Policy instance

Insurance contract or identification number	937944-01
Number of Individuals Covered	127
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,715
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?	Yes
Health Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,715
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

937944-01

Policy instance

Insurance contract or identification number	937944-01
Number of Individuals Covered	105
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,533
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	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,533
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

937944-01

Policy instance

Insurance contract or identification number	937944-01
Number of Individuals Covered	79
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,339
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	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,339
Insurance broker organization code?	3

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Company Name:	KAWASAKI TENNESSEE, INC.
Employer identification number (EIN):	760719404
NAIC Classification:	332900