401k Plan data: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, plan

GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 401k Plan overview

Plan Name	GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION,
Plan identification number	502

GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Other welfare benefit cover

401k Sponsoring company profile

SURFACE COMBUSTION, INC. has sponsored the creation of one or more 401k plans.

Company Name: SURFACE COMBUSTION, INC.

Employer identification number (EIN): 341568193

NAIC Classification: 333900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION,

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01
502 2016-01-01
502 2015-01-01
502 2014-01-01

Plan Statistics for GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION,

401k plan membership statisitcs for GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION,

Measure Date Value
2017: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2017 401k membership
Total participants, beginning-of-year 2017-01-01 93
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 93
Total of all active and inactive participants 2017-01-01 93
2016: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2016 401k membership
Total participants, beginning-of-year 2016-01-01 99
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 93
Total of all active and inactive participants 2016-01-01 93
2015: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2015 401k membership
Total participants, beginning-of-year 2015-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 99
Total of all active and inactive participants 2015-01-01 99
2014: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2014 401k membership
Total participants, beginning-of-year 2014-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 114
Total of all active and inactive participants 2014-01-01 114

Measure	Date	Value
2017: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2017 401k membership
Total participants, beginning-of-year	2017-01-01	93
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	93
Total of all active and inactive participants	2017-01-01	93
2016: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2016 401k membership
Total participants, beginning-of-year	2016-01-01	99
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	93
Total of all active and inactive participants	2016-01-01	93
2015: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2015 401k membership
Total participants, beginning-of-year	2015-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	99
Total of all active and inactive participants	2015-01-01	99
2014: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2014 401k membership
Total participants, beginning-of-year	2014-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	114
Total of all active and inactive participants	2014-01-01	114

Form 5500 Responses for GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION,

2017: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: GROUP TRAVEL ACCIDENT PLAN FOR SURFACE COMBUSTION, 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB018928

Policy instance

Insurance contract or identification number	ETB018928
Number of Individuals Covered	93
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $250
Total amount of fees paid to insurance company	USD $38
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $250
Amount paid for insurance broker fees	38
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC.

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB018928

Policy instance

Insurance contract or identification number	ETB018928
Number of Individuals Covered	99
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $250
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $250
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC.

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB018928

Policy instance

Insurance contract or identification number	ETB018928
Number of Individuals Covered	114
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $250
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $250
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC.

Potentially related plans

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Company Name:	SURFACE COMBUSTION, INC.
Employer identification number (EIN):	341568193
NAIC Classification:	333900