401k Plan data: ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN plan

ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN
Plan identification number	501

ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ARMSTRONG TECHNOLOGY, INC. has sponsored the creation of one or more 401k plans.

Company Name: ARMSTRONG TECHNOLOGY, INC.

Employer identification number (EIN): 941754041

NAIC Classification: 333510

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-11-01

Plan Statistics for ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN

401k plan membership statisitcs for ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN

Measure Date Value
2018: ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-11-01 119
Total number of active participants reported on line 7a of the Form 5500 2018-11-01 123
Number of retired or separated participants receiving benefits 2018-11-01 0
Number of other retired or separated participants entitled to future benefits 2018-11-01 0
Total of all active and inactive participants 2018-11-01 123

Measure	Date	Value
2018: ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-11-01	119
Total number of active participants reported on line 7a of the Form 5500	2018-11-01	123
Number of retired or separated participants receiving benefits	2018-11-01	0
Number of other retired or separated participants entitled to future benefits	2018-11-01	0
Total of all active and inactive participants	2018-11-01	123

Form 5500 Responses for ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN

2018: ARMSTRONG TECHNOLOGY WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-11-01	Type of plan entity	Single employer plan
2018-11-01	Submission has been amended	No
2018-11-01	This submission is the final filing	No
2018-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-11-01	Plan is a collectively bargained plan	No
2018-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-11-01	Plan benefit arrangement – Insurance	Yes
2018-11-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 )

Policy contract number

W0002314

Policy instance

Insurance contract or identification number	W0002314
Number of Individuals Covered	123
Insurance policy start date	2018-11-01
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $3,065
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
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $30,645
Commission paid to Insurance Broker	USD $3,065
Insurance broker organization code?	3

CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )

Policy contract number

W0002314

Policy instance

Insurance contract or identification number	W0002314
Number of Individuals Covered	59
Insurance policy start date	2018-11-01
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $11,792
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $378,552
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	11792
Additional information about fees paid to insurance broker	PRODUCE SERVICE FEES
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

600175

Policy instance

Insurance contract or identification number	600175
Number of Individuals Covered	120
Insurance policy start date	2018-11-01
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $24,138
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $708,958
Commission paid to Insurance Broker	USD $24,138
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3338250

Policy instance

Insurance contract or identification number	3338250
Number of Individuals Covered	109
Insurance policy start date	2018-11-01
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $13,850
Total amount of fees paid to insurance company	USD $6,925
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
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $139,449
Commission paid to Insurance Broker	USD $13,850
Insurance broker organization code?	3
Amount paid for insurance broker fees	6925
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS

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Company Name:	ARMSTRONG TECHNOLOGY, INC.
Employer identification number (EIN):	941754041
NAIC Classification:	333510