401k Plan data: DCI INC EMPLOYEE DENTAL PLAN plan

DCI INC EMPLOYEE DENTAL PLAN 401k Plan overview

Plan Name	DCI INC EMPLOYEE DENTAL PLAN
Plan identification number	504

DCI INC EMPLOYEE DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name: DCI, INC.

Employer identification number (EIN): 410754368

NAIC Classification: 332900

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2020-01-01 ALLISON WAGGONER 2021-08-02
504 2019-01-01 ALLISON WAGGONER 2020-10-06
504 2017-01-01 ALLISON WAGGONER
504 2016-01-01 HEIDI WEIKERT
504 2016-01-01
504 2015-01-01 HEIDI WEIKERT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
504	2020-01-01	ALLISON WAGGONER	2021-08-02
504	2019-01-01	ALLISON WAGGONER	2020-10-06
504	2017-01-01	ALLISON WAGGONER
504	2016-01-01	HEIDI WEIKERT
504	2016-01-01
504	2015-01-01	HEIDI WEIKERT

Plan Statistics for DCI INC EMPLOYEE DENTAL PLAN

401k plan membership statisitcs for DCI INC EMPLOYEE DENTAL PLAN

Measure Date Value
2020: DCI INC EMPLOYEE DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 86
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 86
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 86
2019: DCI INC EMPLOYEE DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 86
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 86
2017: DCI INC EMPLOYEE DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 95
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 95
2016: DCI INC EMPLOYEE DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 102
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 102
2015: DCI INC EMPLOYEE DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 107
Total of all active and inactive participants 2015-01-01 107

Measure	Date	Value
2020: DCI INC EMPLOYEE DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	86
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	86
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	86
2019: DCI INC EMPLOYEE DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	86
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	86
2017: DCI INC EMPLOYEE DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	95
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	95
2016: DCI INC EMPLOYEE DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	102
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	102
2015: DCI INC EMPLOYEE DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	107
Total of all active and inactive participants	2015-01-01	107

Form 5500 Responses for DCI INC EMPLOYEE DENTAL PLAN

2020: DCI INC EMPLOYEE DENTAL PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: DCI INC EMPLOYEE DENTAL PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2017: DCI INC EMPLOYEE DENTAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
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
2016: DCI INC EMPLOYEE DENTAL PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: DCI INC EMPLOYEE DENTAL 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

HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )

Policy contract number

25490

Policy instance

Insurance contract or identification number	25490
Number of Individuals Covered	171
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,381
Total amount of fees paid to insurance company	USD $46
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 $74,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,381
Amount paid for insurance broker fees	46
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3

HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )

Policy contract number

25490

Policy instance

Insurance contract or identification number	25490
Number of Individuals Covered	161
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,410
Total amount of fees paid to insurance company	USD $43
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 $72,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,410
Amount paid for insurance broker fees	43
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3

HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )

Policy contract number

25490

Policy instance

Insurance contract or identification number	25490
Number of Individuals Covered	204
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,621
Total amount of fees paid to insurance company	USD $0
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 $86,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,621
Insurance broker organization code?	3
Insurance broker name	HAYS COMPANIES

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Company Name:	DCI, INC.
Employer identification number (EIN):	410754368
NAIC Classification:	332900