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DCCCA INC GROUP HEALTH PLAN 401k Plan overview

Plan NameDCCCA INC GROUP HEALTH PLAN
Plan identification number 550

DCCCA INC GROUP HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

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

Company Name:DCCCA, INC
Employer identification number (EIN):237368880
NAIC Classification:624100
NAIC Description: Individual and Family Services

Additional information about DCCCA, INC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1992-04-29
Company Identification Number: 0009140307
Legal Registered Office Address: 3312 CLINTON PKWY

LAWRENCE
United States of America (USA)
66047

More information about DCCCA, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DCCCA INC GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5502019-04-01
5502018-04-01KERYE JACKSON KERYE JACKSON2019-07-24
5502017-04-01KERYE JACKSON KERYE JACKSON2018-06-27
5502016-04-01KERYE JACKSON KERYE JACKSON2017-06-29
5502015-04-01KERYE JACKSON KERYE JACKSON2016-06-19
5502014-04-01KERYE JACKSON
5502013-04-01KERYE JACKSON KERYE JACKSON2014-06-27
5502012-04-01KERYE JACKSON
5502011-04-01KERYE JACKSON
5502010-04-01KERYE JACKSON
5502009-04-01KERYE JACKSON

Plan Statistics for DCCCA INC GROUP HEALTH PLAN

401k plan membership statisitcs for DCCCA INC GROUP HEALTH PLAN

Measure Date Value
2019: DCCCA INC GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01154
Total number of active participants reported on line 7a of the Form 55002019-04-010
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-010
2018: DCCCA INC GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01155
Total number of active participants reported on line 7a of the Form 55002018-04-01154
Total of all active and inactive participants2018-04-01154
Total participants2018-04-01154
2017: DCCCA INC GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01170
Total number of active participants reported on line 7a of the Form 55002017-04-01155
Total of all active and inactive participants2017-04-01155
Total participants2017-04-01155
2016: DCCCA INC GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01167
Total number of active participants reported on line 7a of the Form 55002016-04-01170
Total of all active and inactive participants2016-04-01170
Total participants2016-04-01170
2015: DCCCA INC GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01137
Total number of active participants reported on line 7a of the Form 55002015-04-01167
Total of all active and inactive participants2015-04-01167
Total participants2015-04-01167
2014: DCCCA INC GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01131
Total number of active participants reported on line 7a of the Form 55002014-04-01137
Total of all active and inactive participants2014-04-01137
Total participants2014-04-01137
2013: DCCCA INC GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01173
Total number of active participants reported on line 7a of the Form 55002013-04-01131
Total of all active and inactive participants2013-04-01131
Total participants2013-04-01131
2012: DCCCA INC GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01242
Total number of active participants reported on line 7a of the Form 55002012-04-01173
Total of all active and inactive participants2012-04-01173
Total participants2012-04-01173
2011: DCCCA INC GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-01200
Total number of active participants reported on line 7a of the Form 55002011-04-01242
Total of all active and inactive participants2011-04-01242
Total participants2011-04-01242
2010: DCCCA INC GROUP HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-04-01236
Total number of active participants reported on line 7a of the Form 55002010-04-01200
Number of retired or separated participants receiving benefits2010-04-010
Number of other retired or separated participants entitled to future benefits2010-04-010
Total of all active and inactive participants2010-04-01200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-04-010
Total participants2010-04-01200
2009: DCCCA INC GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-01354
Total number of active participants reported on line 7a of the Form 55002009-04-01236
Total of all active and inactive participants2009-04-01236
Total participants2009-04-01236

Financial Data on DCCCA INC GROUP HEALTH PLAN

Measure Date Value
2019 : DCCCA INC GROUP HEALTH PLAN 2019 401k financial data
Total plan liabilities at end of year2019-03-31$0
Total plan liabilities at beginning of year2019-03-31$0
Total income from all sources2019-03-31$1,562,350
Expenses. Total of all expenses incurred2019-03-31$1,562,350
Benefits paid (including direct rollovers)2019-03-31$1,204,703
Total plan assets at end of year2019-03-31$0
Total plan assets at beginning of year2019-03-31$0
Total contributions received or receivable from participants2019-03-31$188,045
Net income (gross income less expenses)2019-03-31$0
Net plan assets at end of year (total assets less liabilities)2019-03-31$0
Net plan assets at beginning of year (total assets less liabilities)2019-03-31$0
Total contributions received or receivable from employer(s)2019-03-31$1,374,305
Expenses. Administrative service providers (salaries,fees and commissions)2019-03-31$357,647
2018 : DCCCA INC GROUP HEALTH PLAN 2018 401k financial data
Total plan liabilities at end of year2018-03-31$0
Total plan liabilities at beginning of year2018-03-31$0
Total income from all sources2018-03-31$1,414,310
Expenses. Total of all expenses incurred2018-03-31$1,414,310
Benefits paid (including direct rollovers)2018-03-31$1,141,705
Total plan assets at end of year2018-03-31$0
Total plan assets at beginning of year2018-03-31$0
Total contributions received or receivable from participants2018-03-31$116,915
Net income (gross income less expenses)2018-03-31$0
Net plan assets at end of year (total assets less liabilities)2018-03-31$0
Net plan assets at beginning of year (total assets less liabilities)2018-03-31$0
Total contributions received or receivable from employer(s)2018-03-31$1,297,395
Expenses. Administrative service providers (salaries,fees and commissions)2018-03-31$272,605
2017 : DCCCA INC GROUP HEALTH PLAN 2017 401k financial data
Total plan liabilities at beginning of year2017-03-31$0
Total income from all sources2017-03-31$1,317,390
Expenses. Total of all expenses incurred2017-03-31$1,317,390
Benefits paid (including direct rollovers)2017-03-31$1,055,366
Total plan assets at end of year2017-03-31$0
Total plan assets at beginning of year2017-03-31$0
Total contributions received or receivable from participants2017-03-31$130,083
Expenses. Other expenses not covered elsewhere2017-03-31$178,712
Net income (gross income less expenses)2017-03-31$0
Net plan assets at end of year (total assets less liabilities)2017-03-31$0
Net plan assets at beginning of year (total assets less liabilities)2017-03-31$0
Total contributions received or receivable from employer(s)2017-03-31$1,187,307
Expenses. Administrative service providers (salaries,fees and commissions)2017-03-31$83,312
2016 : DCCCA INC GROUP HEALTH PLAN 2016 401k financial data
Total income from all sources2016-03-31$1,114,599
Expenses. Total of all expenses incurred2016-03-31$1,114,599
Benefits paid (including direct rollovers)2016-03-31$875,031
Total contributions received or receivable from participants2016-03-31$126,524
Expenses. Other expenses not covered elsewhere2016-03-31$165,781
Net income (gross income less expenses)2016-03-31$0
Net plan assets at end of year (total assets less liabilities)2016-03-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-03-31$0
Total contributions received or receivable from employer(s)2016-03-31$988,075
Expenses. Administrative service providers (salaries,fees and commissions)2016-03-31$73,787
2015 : DCCCA INC GROUP HEALTH PLAN 2015 401k financial data
Total income from all sources2015-03-31$799,039
Expenses. Total of all expenses incurred2015-03-31$799,039
Benefits paid (including direct rollovers)2015-03-31$584,121
Total contributions received or receivable from participants2015-03-31$123,332
Expenses. Other expenses not covered elsewhere2015-03-31$154,066
Net income (gross income less expenses)2015-03-31$0
Total contributions received or receivable from employer(s)2015-03-31$675,707
Expenses. Administrative service providers (salaries,fees and commissions)2015-03-31$60,852
2014 : DCCCA INC GROUP HEALTH PLAN 2014 401k financial data
Total income from all sources2014-03-31$860,070
Expenses. Total of all expenses incurred2014-03-31$860,070
Benefits paid (including direct rollovers)2014-03-31$622,036
Total contributions received or receivable from participants2014-03-31$123,966
Expenses. Other expenses not covered elsewhere2014-03-31$167,320
Net income (gross income less expenses)2014-03-31$0
Total contributions received or receivable from employer(s)2014-03-31$736,104
Expenses. Administrative service providers (salaries,fees and commissions)2014-03-31$70,714
2013 : DCCCA INC GROUP HEALTH PLAN 2013 401k financial data
Total income from all sources (including contributions)2013-03-31$1,011,683
Total of all expenses incurred2013-03-31$1,011,683
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-03-31$935,215
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-03-31$1,011,683
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-03-31$76,468
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-03-31No
Administrative expenses professional fees incurred2013-03-31$2,182
Was this plan covered by a fidelity bond2013-03-31No
If this is an individual account plan, was there a blackout period2013-03-31No
Were there any nonexempt tranactions with any party-in-interest2013-03-31No
Contributions received from participants2013-03-31$123,334
Administrative expenses (other) incurred2013-03-31$31,171
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-03-31No
Value of net income/loss2013-03-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-03-31No
Were any leases to which the plan was party in default or uncollectible2013-03-31No
Expenses. Payments to insurance carriers foe the provision of benefits2013-03-31$215,628
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-03-31No
Was there a failure to transmit to the plan any participant contributions2013-03-31No
Has the plan failed to provide any benefit when due under the plan2013-03-31No
Contributions received in cash from employer2013-03-31$888,349
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-03-31$719,587
Contract administrator fees2013-03-31$43,115
Did the plan have assets held for investment2013-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-03-31No
2012 : DCCCA INC GROUP HEALTH PLAN 2012 401k financial data
Total income from all sources (including contributions)2012-03-31$543,992
Total of all expenses incurred2012-03-31$543,992
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-03-31$474,447
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-03-31$543,992
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-03-31$69,545
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-03-31No
Was this plan covered by a fidelity bond2012-03-31No
If this is an individual account plan, was there a blackout period2012-03-31No
Were there any nonexempt tranactions with any party-in-interest2012-03-31No
Contributions received from participants2012-03-31$124,157
Administrative expenses (other) incurred2012-03-31$21,407
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-03-31No
Value of net income/loss2012-03-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-03-31No
Were any leases to which the plan was party in default or uncollectible2012-03-31No
Expenses. Payments to insurance carriers foe the provision of benefits2012-03-31$207,271
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-03-31No
Was there a failure to transmit to the plan any participant contributions2012-03-31No
Has the plan failed to provide any benefit when due under the plan2012-03-31No
Contributions received in cash from employer2012-03-31$419,835
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-03-31$267,176
Contract administrator fees2012-03-31$48,138
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-03-31No
Did the plan have assets held for investment2012-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-03-31No
2011 : DCCCA INC GROUP HEALTH PLAN 2011 401k financial data
Total income from all sources (including contributions)2011-03-31$1,190,366
Total of all expenses incurred2011-03-31$1,190,366
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-03-31$1,134,020
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-03-31$1,190,366
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-03-31$56,346
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-03-31No
Was this plan covered by a fidelity bond2011-03-31No
If this is an individual account plan, was there a blackout period2011-03-31No
Were there any nonexempt tranactions with any party-in-interest2011-03-31No
Contributions received from participants2011-03-31$223,395
Administrative expenses (other) incurred2011-03-31$16,734
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-03-31No
Value of net income/loss2011-03-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-03-31No
Were any leases to which the plan was party in default or uncollectible2011-03-31No
Expenses. Payments to insurance carriers foe the provision of benefits2011-03-31$181,669
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-03-31No
Was there a failure to transmit to the plan any participant contributions2011-03-31No
Has the plan failed to provide any benefit when due under the plan2011-03-31No
Contributions received in cash from employer2011-03-31$966,971
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-03-31$952,351
Contract administrator fees2011-03-31$39,612
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-03-31No
Did the plan have assets held for investment2011-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-03-31No

Form 5500 Responses for DCCCA INC GROUP HEALTH PLAN

2019: DCCCA INC GROUP HEALTH PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingYes
2019-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: DCCCA INC GROUP HEALTH PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2017: DCCCA INC GROUP HEALTH PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: DCCCA INC GROUP HEALTH PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: DCCCA INC GROUP HEALTH PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: DCCCA INC GROUP HEALTH PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: DCCCA INC GROUP HEALTH PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: DCCCA INC GROUP HEALTH PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: DCCCA INC GROUP HEALTH PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan funding arrangement – General assets of the sponsorYes
2011-04-01Plan benefit arrangement – InsuranceYes
2010: DCCCA INC GROUP HEALTH PLAN 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Submission has been amendedNo
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan funding arrangement – General assets of the sponsorYes
2010-04-01Plan benefit arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – General assets of the sponsorYes
2009: DCCCA INC GROUP HEALTH PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan funding arrangement – General assets of the sponsorYes
2009-04-01Plan benefit arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL31055
Policy instance 1
Insurance contract or identification numberHCL31055
Number of Individuals Covered136
Insurance policy start date2019-04-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $30,451
Total amount of fees paid to insurance companyUSD $5,177
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $203,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,451
Amount paid for insurance broker fees5177
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number417003411432
Policy instance 1
Insurance contract or identification number417003411432
Number of Individuals Covered15
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $41,974
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $279,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,732
Additional information about fees paid to insurance brokerMANAGING PRODUCER FEE
Insurance broker organization code?3
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number417003411432
Policy instance 1
Insurance contract or identification number417003411432
Number of Individuals Covered155
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $29,024
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $193,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,024
Insurance broker organization code?3
Insurance broker nameWILLIS OF GREATER KANSAS CITY

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