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| Plan Name | APPALACHIAN WOOD FLOORS, INC. EMPLOYEE HEALTH BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | APPALACHIAN WOOD FLOORS INC. |
| Employer identification number (EIN): | 311588140 |
| NAIC Classification: | 238300 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-11-01 |
| Measure | Date | Value |
|---|---|---|
| 2021: APPALACHIAN WOOD FLOORS, INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-11-01 | 54 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 53 |
| Number of retired or separated participants receiving benefits | 2021-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-11-01 | 0 |
| Total of all active and inactive participants | 2021-11-01 | 53 |
| Total participants | 2021-11-01 | 53 |
| Measure | Date | Value |
|---|---|---|
| 2022 : APPALACHIAN WOOD FLOORS, INC. EMPLOYEE HEALTH BENEFIT PLAN 2022 401k financial data | ||
| Total income from all sources | 2022-10-31 | $398,957 |
| Expenses. Total of all expenses incurred | 2022-10-31 | $394,340 |
| Benefits paid (including direct rollovers) | 2022-10-31 | $176,527 |
| Total plan assets at end of year | 2022-10-31 | $4,617 |
| Total plan assets at beginning of year | 2022-10-31 | $0 |
| Total contributions received or receivable from participants | 2022-10-31 | $218,317 |
| Expenses. Other expenses not covered elsewhere | 2022-10-31 | $194,018 |
| Net income (gross income less expenses) | 2022-10-31 | $4,617 |
| Net plan assets at end of year (total assets less liabilities) | 2022-10-31 | $4,617 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-10-31 | $0 |
| Total contributions received or receivable from employer(s) | 2022-10-31 | $180,640 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-10-31 | $23,795 |
| 2021: APPALACHIAN WOOD FLOORS, INC. EMPLOYEE HEALTH BENEFIT PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | First time form 5500 has been submitted | Yes |
| 2021-11-01 | Submission has been amended | No |
| 2021-11-01 | This submission is the final filing | No |
| 2021-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-11-01 | Plan is a collectively bargained plan | No |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 10559 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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