401k Plan data: SC PRODUCTS SELF FUNDED MEDICAL PLAN plan

SC PRODUCTS SELF FUNDED MEDICAL PLAN 401k Plan overview

Plan Name	SC PRODUCTS SELF FUNDED MEDICAL PLAN
Plan identification number	501

SC PRODUCTS SELF FUNDED MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

SILVER CREEK PRODUCTS LTD has sponsored the creation of one or more 401k plans.

Company Name: SILVER CREEK PRODUCTS LTD

Employer identification number (EIN): 931021566

NAIC Classification: 325100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SC PRODUCTS SELF FUNDED MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 JENNIFER CZARNICK

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2017-01-01	JENNIFER CZARNICK

Plan Statistics for SC PRODUCTS SELF FUNDED MEDICAL PLAN

401k plan membership statisitcs for SC PRODUCTS SELF FUNDED MEDICAL PLAN

Measure Date Value
2017: SC PRODUCTS SELF FUNDED MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 3
Total of all active and inactive participants 2017-01-01 3
Total participants 2017-01-01 3

Measure	Date	Value
2017: SC PRODUCTS SELF FUNDED MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3
Total of all active and inactive participants	2017-01-01	3
Total participants	2017-01-01	3

Financial Data on SC PRODUCTS SELF FUNDED MEDICAL PLAN

Measure	Date	Value
2017 : SC PRODUCTS SELF FUNDED MEDICAL PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$48,024
Expenses. Total of all expenses incurred	2017-12-31	$46,440
Benefits paid (including direct rollovers)	2017-12-31	$10,031
Total plan assets at end of year	2017-12-31	$6,823
Total plan assets at beginning of year	2017-12-31	$5,239
Expenses. Other expenses not covered elsewhere	2017-12-31	$25,267
Net income (gross income less expenses)	2017-12-31	$1,584
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$6,823
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$5,239
Total contributions received or receivable from employer(s)	2017-12-31	$48,024
Value of corrective distributions	2017-12-31	$1,078
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$10,064

Form 5500 Responses for SC PRODUCTS SELF FUNDED MEDICAL PLAN

2017: SC PRODUCTS SELF FUNDED MEDICAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

ALLIED NATIONAL COMPANIES (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

281067

Policy instance

Insurance contract or identification number	281067
Number of Individuals Covered	3
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $5,807
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	Yes
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 $2,834
Insurance broker name	GRESS INSURANCE & INVESTMENTS INC

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Company Name:	SILVER CREEK PRODUCTS LTD
Employer identification number (EIN):	931021566
NAIC Classification:	325100