401k Plan data: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS plan

USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 401k Plan overview

Plan Name	USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS
Plan identification number	503

USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS Benefits

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

401k Sponsoring company profile

USCA MANAGEMENT LLC has sponsored the creation of one or more 401k plans.

Company Name: USCA MANAGEMENT LLC

Employer identification number (EIN): 900889322

NAIC Classification: 523900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2018-09-01
503 2017-09-01
503 2016-09-01

Plan Statistics for USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS

401k plan membership statisitcs for USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS

Measure Date Value
2018: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 2018 401k membership
Total participants, beginning-of-year 2018-09-01 113
Total number of active participants reported on line 7a of the Form 5500 2018-09-01 0
Number of retired or separated participants receiving benefits 2018-09-01 0
Number of other retired or separated participants entitled to future benefits 2018-09-01 0
Total of all active and inactive participants 2018-09-01 0
2017: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 2017 401k membership
Total participants, beginning-of-year 2017-09-01 107
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 263
Number of retired or separated participants receiving benefits 2017-09-01 0
Number of other retired or separated participants entitled to future benefits 2017-09-01 0
Total of all active and inactive participants 2017-09-01 263
Number of employers contributing to the scheme 2017-09-01 0
2016: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 2016 401k membership
Total participants, beginning-of-year 2016-09-01 111
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 107
Number of retired or separated participants receiving benefits 2016-09-01 0
Number of other retired or separated participants entitled to future benefits 2016-09-01 0
Total of all active and inactive participants 2016-09-01 107

Measure	Date	Value
2018: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 2018 401k membership
Total participants, beginning-of-year	2018-09-01	113
Total number of active participants reported on line 7a of the Form 5500	2018-09-01	0
Number of retired or separated participants receiving benefits	2018-09-01	0
Number of other retired or separated participants entitled to future benefits	2018-09-01	0
Total of all active and inactive participants	2018-09-01	0
2017: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 2017 401k membership
Total participants, beginning-of-year	2017-09-01	107
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	263
Number of retired or separated participants receiving benefits	2017-09-01	0
Number of other retired or separated participants entitled to future benefits	2017-09-01	0
Total of all active and inactive participants	2017-09-01	263
Number of employers contributing to the scheme	2017-09-01	0
2016: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 2016 401k membership
Total participants, beginning-of-year	2016-09-01	111
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	107
Number of retired or separated participants receiving benefits	2016-09-01	0
Number of other retired or separated participants entitled to future benefits	2016-09-01	0
Total of all active and inactive participants	2016-09-01	107

Form 5500 Responses for USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS

2018: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 2018 form 5500 responses
2018-09-01	Type of plan entity	Single employer plan
2018-09-01	Submission has been amended	No
2018-09-01	This submission is the final filing	Yes
2018-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-09-01	Plan is a collectively bargained plan	No
2018-09-01	Plan funding arrangement – Insurance	Yes
2018-09-01	Plan benefit arrangement – Insurance	Yes
2017: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: USCA MANAGEMENT COMPANY LLC MEDICAL BENEFITS 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	First time form 5500 has been submitted	Yes
2016-09-01	Submission has been amended	No
2016-09-01	This submission is the final filing	No
2016-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-09-01	Plan is a collectively bargained plan	No
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

106566

Policy instance

Insurance contract or identification number	106566
Number of Individuals Covered	273
Insurance policy start date	2018-09-01
Insurance policy end date	2019-08-31
Total amount of commissions paid to insurance broker	USD $94,096
Total amount of fees paid to insurance company	USD $663
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 $2,114,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $70,824
Amount paid for insurance broker fees	663
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

106566

Policy instance

Insurance contract or identification number	106566
Number of Individuals Covered	263
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $91,506
Total amount of fees paid to insurance company	USD $990
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,059,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	USCA MANAGEMENT LLC
Employer identification number (EIN):	900889322
NAIC Classification:	523900