401k Plan data: DCI INC EMPLOYEE MEDICAL CARE PLAN plan

DCI INC EMPLOYEE MEDICAL CARE PLAN 401k Plan overview

Plan Name	DCI INC EMPLOYEE MEDICAL CARE PLAN
Plan identification number	501

DCI INC EMPLOYEE MEDICAL CARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

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

Company Name: DCI, INC.

Employer identification number (EIN): 020353614

NAIC Classification: 337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DCI INC EMPLOYEE MEDICAL CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 WENDY SLICER
501 2015-01-01 WENDY SLICER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2017-01-01	WENDY SLICER
501	2015-01-01	WENDY SLICER

Plan Statistics for DCI INC EMPLOYEE MEDICAL CARE PLAN

401k plan membership statisitcs for DCI INC EMPLOYEE MEDICAL CARE PLAN

Measure Date Value
2017: DCI INC EMPLOYEE MEDICAL CARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 102
Total of all active and inactive participants 2017-01-01 102
Total participants 2017-01-01 102
2015: DCI INC EMPLOYEE MEDICAL CARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 85
Total of all active and inactive participants 2015-01-01 85
Total participants 2015-01-01 85

Measure	Date	Value
2017: DCI INC EMPLOYEE MEDICAL CARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	102
Total of all active and inactive participants	2017-01-01	102
Total participants	2017-01-01	102
2015: DCI INC EMPLOYEE MEDICAL CARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	85
Total of all active and inactive participants	2015-01-01	85
Total participants	2015-01-01	85

Form 5500 Responses for DCI INC EMPLOYEE MEDICAL CARE PLAN

2017: DCI INC EMPLOYEE MEDICAL CARE 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 – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2015: DCI INC EMPLOYEE MEDICAL CARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 26921 )

Policy contract number

A1009-2017

Policy instance

Insurance contract or identification number	A1009-2017
Number of Individuals Covered	99
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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	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
Welfare Benefit Premiums Paid to Carrier	USD $16,547,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Insurance broker name	ULTRABENEFITS

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL19215

Policy instance

Insurance contract or identification number	HCL19215
Number of Individuals Covered	85
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $214,883
Are there contracts with allocated funds for individual policies?	No
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

Potentially related plans

DCI INC EMPLOYEE DENTAL PLAN [EIN = 410754368]

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Company Name:	DCI, INC.
Employer identification number (EIN):	020353614
NAIC Classification:	337000