401k Plan data: OCCK, INC. HEALTH AND DENTAL INSURANCE PLAN plan

OCCK, INC. HEALTH AND DENTAL INSURANCE PLAN 401k Plan overview

Plan Name	OCCK, INC. HEALTH AND DENTAL INSURANCE PLAN
Plan identification number	502

OCCK, INC. HEALTH AND DENTAL INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	SELECT distinct(Description) AS Description FROM 401k_benefit_codes LEFT JOIN 401k_benefit_code_description ON BenefitCode=Code COLLATE utf8_unicode_ci WHERE EIN='481251313' AND PlanID='502'

401k Sponsoring company profile

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

Company Name: OCCK, INC.

Employer identification number (EIN): 481251313

NAIC Classification: 624310
NAIC Description: Vocational Rehabilitation Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OCCK, INC. HEALTH AND DENTAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-01-01 CARRIE FREE 2024-07-23 SHEILA NELSON-STOUT 2024-07-23
502 2022-01-01 CONNIE SMITH 2023-06-27 PATRICK WALLERIUS 2023-06-27
502 2021-01-01
502 2021-01-01 ERIN MURRAY
502 2020-01-01
502 2019-01-01
502 2018-01-01
502 2017-01-01 DEANNA L. LAMER
502 2016-01-01 DEANNA L. LAMER
502 2015-01-01 DEANNA L. LAMER
502 2014-01-01 DEANNA L. LAMER
502 2013-01-01 DEANNA L. LAMER
502 2012-01-01 DEANNA L. LAMER
502 2011-01-01 DEANNA L. LAMER
502 2010-01-01 DEANNA L. LAMER
502 2009-01-01 DEANNA L. LAMER DEANNA L. LAMER 2010-07-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2023-01-01	CARRIE FREE	2024-07-23	SHEILA NELSON-STOUT	2024-07-23
502	2022-01-01	CONNIE SMITH	2023-06-27	PATRICK WALLERIUS	2023-06-27
502	2021-01-01
502	2021-01-01	ERIN MURRAY
502	2020-01-01
502	2019-01-01
502	2018-01-01
502	2017-01-01	DEANNA L. LAMER
502	2016-01-01	DEANNA L. LAMER
502	2015-01-01	DEANNA L. LAMER
502	2014-01-01	DEANNA L. LAMER
502	2013-01-01	DEANNA L. LAMER
502	2012-01-01	DEANNA L. LAMER
502	2011-01-01	DEANNA L. LAMER
502	2010-01-01	DEANNA L. LAMER
502	2009-01-01	DEANNA L. LAMER		DEANNA L. LAMER	2010-07-27

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

07730

Policy instance

Insurance contract or identification number	07730
Number of Individuals Covered	189
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
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	No
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

07730

Policy instance

Insurance contract or identification number	07730
Number of Individuals Covered	178
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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	No
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

07730

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

07730

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

07730

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

09379

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

09379

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

09379

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

09379

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

09379

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

96358

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

96358

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

96358

Policy instance

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

96358

Policy instance

Potentially related plans

OCCK, INC. GROUP LIFE INSURANCE PLAN [EIN = 451251313]

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Company Name:	OCCK, INC.
Employer identification number (EIN):	481251313
NAIC Classification:	624310
NAIC Description:	Vocational Rehabilitation Services