401k Plan data: CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN plan

CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN
Plan identification number	505

CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT 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

CPS PERFORMANCE MATERIALS CORP. has sponsored the creation of one or more 401k plans.

Company Name: CPS PERFORMANCE MATERIALS CORP.

Employer identification number (EIN): 822576396

NAIC Classification: 339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2019-01-01 KAREN L. MCFETRIDGE 2020-10-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2019-01-01	KAREN L. MCFETRIDGE	2020-10-01

Plan Statistics for CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN

Measure Date Value
2019: CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 125
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 0
Total of all active and inactive participants 2019-01-01 129
Number of employers contributing to the scheme 2019-01-01 0

Measure	Date	Value
2019: CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	125
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	0
Total of all active and inactive participants	2019-01-01	129
Number of employers contributing to the scheme	2019-01-01	0

Form 5500 Responses for CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN

2019: CPS PERFORMANCE MATERIALS CORP. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98351741001

Policy instance

Insurance contract or identification number	98351741001
Number of Individuals Covered	86
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $541
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $541
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4957923

Policy instance

Insurance contract or identification number	4957923
Number of Individuals Covered	144
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $24,052
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $830,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,052
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

165087

Policy instance

Insurance contract or identification number	165087
Number of Individuals Covered	125
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,848
Total amount of fees paid to insurance company	USD $2,300
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,848
Amount paid for insurance broker fees	2300
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

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Company Name:	CPS PERFORMANCE MATERIALS CORP.
Employer identification number (EIN):	822576396
NAIC Classification:	339900