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| Plan Name | SC PRODUCTS SELF FUNDED MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SILVER CREEK PRODUCTS LTD |
| Employer identification number (EIN): | 931021566 |
| NAIC Classification: | 325100 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-01-01 | JENNIFER CZARNICK |
| 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 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 |
| 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 |
| ALLIED NATIONAL COMPANIES (National Association of Insurance Commissioners NAIC id number: 60739 ) | |
| Policy contract number | 281067 |
| Policy instance | 1 |
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