<PAGE>
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 11-K
(Mark one)
[X] ANNUAL REPORT PURSUANT TO SECTION 15(d) OF THE SECURITIES EXCHANGE
ACT OF 1934 FOR THE FISCAL YEAR ENDED DECEMBER 31, 1997
OR
[__] TRANSITION REPORT PURSUANT TO SECTION 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934
FOR THE TRANSITION PERIOD FROM TO .
COMMISSION FILE NUMBER 0-20766
HCC INSURANCE HOLDINGS, INC.
HCC INSURANCE HOLDINGS, INC. 401(k) PLAN
(Name of Issuer of the securities held pursuant to the Plan)
13403 NORTHWEST FREEWAY
HOUSTON, TEXAS 77040
(Address of principal executive office)
(713) 690-7300
(Registrant's telephone number, including area code)
----------------------------
<PAGE>
REQUIRED INFORMATION
ITEM 1. Not applicable.
ITEM 2. Not applicable.
ITEM 3. Not applicable.
ITEM 4. 1997 Return - Report of Employee Benefit Plan (with fewer than 100
participants) prepared in accordance with Section 104(a)(2)(A) of
ERISA has been included as Exhibit 1 hereto.
EXHIBITS
1 -- 1997 Return - Report of Employee Benefit Plan (with fewer than
100 participants)
<PAGE>
SIGNATURES
THE PLAN Pursuant to the requirements of the Securities Exchange Act of 1934,
the HCC Insurance Holdings, Inc. 401(k) Plan has duly caused this
annual report to be signed on its behalf by the undersigned thereunto
duly authorized, in the City of Houston, State of Texas, on the 10th
day of December, 1998.
HCC INSURANCE HOLDINGS, INC. 401(k) PLAN
By: HCC Insurance Holdings, Inc.,
Administrator
By: /s/ John N. Molbeck, Jr.
------------------------------------
Name: John N. Molbeck, Jr.
-----------------------------------
Title: President
----------------------------------
<PAGE>
<TABLE>
<S><C>
EXHIBIT 1
Form 5500-C/R RETURN/REPORT OF EMPLOYEE BENEFIT PLAN OMB Nos. 1210-0016
Department of the Treasury (WITH FEWER THAN 100 PARTICIPANTS) 1210-0089
Internal Revenue Service THIS FORM IS REQUIRED TO BE FILED UNDER SECTIONS ----------------------------------
------------- 104 AND 4065 OF THE EMPLOYEE RETIREMENT
Department of Labor INCOME SECURITY ACT OF 1974 AND SECTIONS 6039D, 1997
Pension and Welfare Benefits Administration 6047(e), 6057(b), AND 6058(a) OF THE ----------------------------------
------------- INTERNAL REVENUE CODE THIS FORM IS OPEN
Pension Benefit Guaranty Corporation > See separate instructions. TO PUBLIC INSPECTION.
- ------------------------------------------------------------------------------------------------------------------------------------
FOR THE CALENDAR PLAN YEAR 1997 OR FISCAL PLAN YEAR BEGINNING , 1997, AND ENDING , 19
- ------------------------------------------------------------------------------------------------------------------------------------
If A(1) through A(4), B, C, and/or D do not apply to this year's FOR IRS USE ONLY
return/report, leave the boxes unmarked. EP-ID
You must check either box A(5) or A(6), whichever is applicable. ------------------------------------------------------------
See instructions. (5) FORM 5500-C FILER CHECK HERE....................... / /
A This return/report is: (Complete only pages 1 and 3 through 6.) (Code section
(1) / / the first return/report filed for the plan; 6039D filers see instructions on page 5.)
(2) / / an amended return/report; (6) FORM 5500-R FILER CHECK HERE....................... /X/
(3) / / the final return/report filed for the plan; or (Complete only pages 1 and 2. Detach pages 3 through
(4) / / a short plan year return/report (less than 12 months). 6 before filing.) If you checked box (1) or (3), you
must file Form 5500-C. (See page 6 of the instructions.)
IF ANY INFORMATION ON A PREPRINTED PAGE 1 IS INCORRECT, CORRECT IT. IF ANY INFORMATION IS MISSING, ADD IT. PLEASE USE RED INK
WHEN MAKING THESE CHANGES AND INCLUDE THE PREPRINTED PAGE 1 WITH YOUR COMPLETED RETURN/REPORT.
B Check here if any information reported in 1a, 2a, 2b, or 5a changed since the last return/report for this plan .......... > / /
C If your plan year changed since the last return/report, check here ...................................................... > / /
D If you filed for an extension of time to file this return/report, check here and attach a copy of the approved extension. > / /
- ------------------------------------------------------------------------------------------------------------------------------------
1a Name and address of plan sponsor (employer, if for a single-employer plan) 1b Employer identification number (EIN)
(Address should include room or suite no.) 76-0336636
------------------------------------------------
1c Sponsor's telephone number
HCC INSURANCE HOLDINGS, INC. 713-744-9673
------------------------------------------------
13403 NORTHWEST FWY, STE 200 1d Business code (see instructions, page 17)
6749
HOUSTON, TX 77040 ------------------------------------------------
1e CUSIP issuer number
404132102
- ------------------------------------------------------------------------------------------------------------------------------------
2a Name and address of plan administrator (if same as plan sponsor, enter "Same") 2b Administrator's EIN
SAME AS SPONSOR
------------------------------------------------
2c Administrator's telephone number
- ------------------------------------------------------------------------------------------------------------------------------------
3 If you are filing this page without the preprinted historical plan information and the name, address, and EIN of the plan
sponsor or plan administrator has changed since the last return/report filed for this plan, enter the information from the last
return/report on lines 3a and/or 3b and complete line 3c.
a Sponsor EIN Plan number
------------------------------------------------------------------- ----------------- ------------
b Administrator EIN
------------------------------------------------------------- -------------------------------------------
c If line 3a indicates a change in the sponsor's name, address, and EIN, is this a change in sponsorship only? (See line 3c on
page 8 of the instructions for the definition of sponsorship.) Enter "Yes" or "No." >
- ------------------------------------------------------------------------------------------------------------------------------------
4 ENTITY CODE. (If not shown, enter applicable code from page 8 of the instructions.) > B
- ------------------------------------------------------------------------------------------------------------------------------------
5a Name of plan > HCC INSURANCE HOLDINGS, INC. 401(k) PLAN 5b Effective date of plan (mo., day, yr.)
---------------------------------------------------------- 1/1/92
------------------------------------------------
- ----------------------------------------------------------------------------- 5c Three-digit
- --------------------------------------------------------------------------------- plan number > 002
ALL FILERS MUST COMPLETE 6a THROUGH 6d, AS APPLICABLE ------------------------------------------------
6a / / Welfare benefit plan 6b /X/ Pension benefit plan ) 2
(If the correct codes are not preprinted below, enter the applicable ) ------------------------------------------------
codes from page 8 of the instructions in the boxes.) )
------------------------------------------------
6c Pension plan features. (If the correct codes are not preprinted below, enter ------------------------------------------------
the applicable pension plan feature codes from page 9 of the instructions C,G
in the boxes.) ------------------------------------------------
6d / / Fringe benefits plan. Attach Schedule F (Form 5500). See instructions.
- ------------------------------------------------------------------------------------------------------------------------------------
CAUTION: A PENALTY FOR THE LATE OR INCOMPLETE FILING OF THIS RETURN/REPORT WILL BE ASSESSED UNLESS REASONABLE CAUSE IS ESTABLISHED.
- ------------------------------------------------------------------------------------------------------------------------------------
Under penalties of perjury and other penalties set forth in the instructions, I declare that I have examined this return/report,
including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature of employer/plan sponsor > /s/ L. EDWARD TUFFLY, SENIOR VP Date > 10/8/98
--------------------------------------------- -----------------------------------------
Type of print name of individual signing above L. EDWARD TUFFLY, SENIOR VP
------------------------------------------------------------------------------------
Signature of plan administrator > /s/ FRANK J. BRAMANTI Date > 10/8/98
------------------------------------------------ -----------------------------------------
Type of print name of individual signing above FRANK J. BRAMANTI, ADMINISTRATOR/TRUSTEE
- ------------------------------------------------------------------------------------------------------------------------------------
FOR PAPERWORK REDUCTION ACT NOTICE, SEE THE INSTRUCTIONS FOR FORM 5500-C/R. FORM 5500-C/R (1997)
</TABLE>
ISA
STF FED5761F.1
<PAGE>
<TABLE>
<S><C>
Form 5500-C/R (1997 FORM 5500-R FILERS, COMPLETE PAGES 1 AND 2 ONLY. FORM 5500-C FILERS, COMPLETE PAGE 1, SKIP PAGE 2, Page 2
AND COMPLETE PAGES 3 THROUGH 6.
- ------------------------------------------------------------------------------------------------------------------------------------
6e Check investment arrangement(s): (1) / / Master trust (2) / / Common/Collective trust (3) /X/ Pooled separate account Yes No
- ------------------------------------------------------------------------------------------------------------------------------------
7a Total participants: (1) At the beginning of plan year > 72 (2) At the end of plan year > 130
-------- ---------
b Enter number of participants with account balances at the end of the plan year (defined benefit plans do not
complete this item) > 104
---------
c (1) Were any participants in the pension benefit plan separated from service with a deferred vested benefit
for which a Schedule SSA (Form 5500) is required to be attached? (See instructions.) ...................... 7c(1) X
----------------
(2) If "Yes," enter the number of separated participants required to be reported > 2
- ------------------------------------------------------------------------------------------------------------------------------------
8a Was this plan terminated during this plan year or any prior plan year? If "Yes," enter the year > 8a X
------------- ----------------
b Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or
brought under the control of PBGC? ............................................................................ 8b N/A
----------------
c If line 8a is "Yes" and the plan is covered by PBGC, is the plan continuing to file PBGC Form 1 and pay
premiums until the end of the plan year in which assets are distributed or brought under the control of PBGC?.. 8c N/A
- ------------------------------------------------------------------------------------------------------------------------------------
9 Is this a plan established or maintained pursuant to one or more collective bargaining agreements? ............ 9 X
- ------------------------------------------------------------------------------------------------------------------------------------
10 If any benefits are provided by an insurance company, insurance service, or similar organization, enter the
number of Schedules A (Form 5500), Insurance information, that are attached. If none, enter -0-. > 1
- ------------------------------------------------------------------------------------------------------------------------------------
11a (1) Were any plan amendments adopted during this plan year? ................................................... 11a(1) X
----------------
(2) Enter the date the most recent amendment was adopted > Month 12 Day 31 Year 97
---------- ---------- ----------
b If line 11a is "Yes," did any amendment result in a retroactive reduction of accrued benefits for any
participant? .................................................................................................. 11b X
----------------
c If line 11a is "Yes," did any amendment change the information contained in the latest summary plan description
or summary description of modifications available at the time of the amendment? ............................... 11c X
----------------
d If line 11c is "Yes," has a summary plan description or summary description of modifications that reflects the
plan amendments referred to on line 11c been furnished to participants? (see instructions.) ................... 11d X
- ------------------------------------------------------------------------------------------------------------------------------------
12a If this is a pension benefit plan subject to the minimum funding standards, has the plan experienced a funding
deficiency for this plan year? (See instructions.) ............................................................ 12a N/A
----------------
b If line 12a is "Yes," have you filed Form 5330 to pay the excise tax? ......................................... 12b N/A
----------------
c Is the plan administrator making an election under section 412(c)(8) for an amendment adopted after the end of
the plan year? (See instructions.) ............................................................................ 12c X
----------------
d If a change in the actuarial funding method was made for the plan year pursuant to a Revenue Procedure
providing automatic approval for the change, indicate whether the plan sponsor/administrator agrees to
the change .................................................................................................... 12d N/A
- ------------------------------------------------------------------------------------------------------------------------------------
13a Total plan assets as of the beginning 1,417,101 and end 2,209,900 of the plan year
----------------- ---------------
b Total liabilities as of the beginning NONE and end NONE of the plan year
----------------- ---------------
c Net assets as of the beginning > 1,417,101 and end > 2,209,900 of the plan year
- ------------------------------------------------------------------------------------------------------------------------------------
14 For this plan year, enter: a Plan income 838,011 d Plan contributions 536,708
------------- -------------
b Expenses 45,212 e Total benefits paid 30,886
---------------- ------------
c Net income (loss)(subtract 14b from 14a) 792,799
----------
- ------------------------------------------------------------------------------------------------------------------------------------
15 You may NOT use N/A in response to lines 15a through 15o. If you check "Yes," you Yes No Amount
must enter a dollar amount in the amount column. DURING THIS PLAN YEAR: -----------------------------
a Was this plan covered by a fidelity bond? ..................................................... 15a X 5,000,000
-----------------------------
b If line 15a is "Yes," enter the name of the surety company > TEXAS PACIFIC INSURANCE CO.
---------------------------
c Was there any loss to the plan, whether or not reimbursed, caused by fraud or dishonesty? ..... 15c X
-----------------------------
d Was there any sale, exchange, or lease of any property between the plan and the employer, any
fiduciary, any of the five most highly paid employees of the employer, any owner of a 10% or
more interest in the employer, or relatives of any such persons? ............................. 15d X
-----------------------------
e Was there any loan or extension of credit by the plan to the employer, any fiduciary, any of
the five most highly paid employees of the employer, any owner of a 10% or more interest in
the employer, or relatives of any such persons? .............................................. 15e X
-----------------------------
f Did the plan acquire or hold any employer security or employer real property? ................ 15f X
-----------------------------
g Has the plan granted an extension on any delinquent loan owed to the plan? ................... 15g X
-----------------------------
h Were any participant contributions transmitted to the plan more than 31 days after receipt or
withholding by the employer? ................................................................. 15h X
-----------------------------
i Were any loans by the plan or fixed income obligations due the plan classified as
uncollectible or in default as of the close of the plan year? ................................ 15i X
-----------------------------
j Has any plan fiduciary had a financial interest in excess of 10% in any party providing
services to the plan or received anything of value from any such party? ...................... 15j X
-----------------------------
k Did the plan at any time hold 20% or more of its assets in any single security, debt,
mortgage, parcel of real estate, or partnership/joint venture interests? ..................... 15k X 910,035
-----------------------------
l Did the plan at any time engage in any transaction or series of related transactions involving
20% or more of the current value of plan assets? ............................................. 15l X
-----------------------------
m Were there any noncash contributions made to the plan the value of which was set without an
appraisal by an independent third party? ..................................................... 15m X
-----------------------------
n Were there any purchases of nonpublicly traded securities by the plan the value of which was
set without an appraisal by an independent third party? ...................................... 15n X
-----------------------------
o Has the plan reduced or failed to provide any benefit when due under the plan because of
insufficient assets? ......................................................................... 15o X
- ------------------------------------------------------------------------------------------------------------------------------------
16a Is the plan covered under the Pension Benefit Guaranty Corporation termination insurance
program? / / Yes /X/ No / / Not determined
b If line 16a is "Yes" or "Not determined," enter the employer identification number and the plan number used to identify it.
Employer identification number > N/A Plan number > N/A
- ------------------------------------------------------------------------------------------------------------------------------------
</TABLE>
STF FED5761F.2
<PAGE>
<TABLE>
<CAPTION>
<S><C>
SCHEDULE A
(FORM 5500)
Department of Treasury
Internal Revenue Service
---------
Department of Labor INSURANCE INFORMATION OMB No. 1210-0016
Pension and Welfare Benefits This Schedule is required to be filed under Section 104 of the -----------------
Administration Employee Retirement Income Security Act of 1974. 1997
--------- > File as an Attachment to Form 5500 or 5500-C/R -----------------
Pension Benefit Guaranty > Insurance companies are required to provide this information THIS FORM IS
Corporation as per ERISA section 103(a)(2). OPEN TO PUBLIC
INSPECTION
- -----------------------------------------------------------------------------------------------------------------------------------
For calendar year 1997 or fiscal plan year beginning , 1997, and ending , 19 .
- -----------------------------------------------------------------------------------------------------------------------------------
> PART I MUST BE COMPLETED FOR ALL PLANS REQUIRED TO FILE THIS SCHEDULE. > ENTER MASTER TRUST OR 103-12 IE NAME IN PLACE OF
> PART II MUST BE COMPLETED FOR ALL INSURED PENSION PLANS. "SPONSOR" AND SPECIFY INVESTMENT ACCOUNT OR
> PART III MUST BE COMPLETED FOR ALL INSURED WELFARE PLANS. 103-12 IE IN PLACE OF "PLAN" IF FILLING WITH DOL
FOR A MASTER TRUST OR 103-12 IE.
- -----------------------------------------------------------------------------------------------------------------------------------
Name of plan sponsor as shown on line 1a of Form 5500 or 5500-C/R Employer Identification Number
HCC INSURANCE HOLDINGS INC 76-0336636
- -----------------------------------------------------------------------------------------------------------------------------------
Name of plan Three-digit
HCC INSURANCE HOLDINGS, INC. 401(k) PLAN plan number > 002
- -----------------------------------------------------------------------------------------------------------------------------------
PART I SUMMARY OF ALL INSURANCE CONTRACTS INCLUDED IN PARTS II AND III
Group all contracts in the same manner as in Parts II and III.
- -----------------------------------------------------------------------------------------------------------------------------------
1 Check appropriate box: a / / Welfare Plan b /X/ Pension Plan c / / Combination pension and welfare plan
- -----------------------------------------------------------------------------------------------------------------------------------
2 Coverage: (b) Contract or (c) Approximate number of Policy or contract year
(a) Name of insurance carrier identification persons covered at end of ------------------------------
number policy or contract year (d) From (e) To
- -----------------------------------------------------------------------------------------------------------------------------------
CONNECTICUT GENERAL LIFE INS COMPANY 36182/000 110 1/01/97 12/31/97
- -----------------------------------------------------------------------------------------------------------------------------------
3 Insurance fees and commissions paid to agents or brokers: (d) Fees paid
(b) Name and address of (c) Amount of --------------------------------------------------------------
the agents or brokers to commissions paid
(a) Contract or whom commission or fees Amount Purpose
identification number were paid
- -----------------------------------------------------------------------------------------------------------------------------------
GA# 36182/000 0 0 N/A
- -----------------------------------------------------------------------------------------------------------------------------------
TOTAL 0.00 0.00
- -----------------------------------------------------------------------------------------------------------------------------------
4 Premiums due and unpaid at end of year > $ NONE : Contract or identification number >
- -----------------------------------------------------------------------------------------------------------------------------------
PART II INSURED PENSION PLANS Provide information for each contract on a separate Part II. Where individual contracts are
provided, the entire group of such individual contracts with each carrier may be treated as a unit for purpose of this
report
- -----------------------------------------------------------------------------------------------------------------------------------
> Contract or identification number >
- -----------------------------------------------------------------------------------------------------------------------------------
5 Contracts with allocated funds, (for example, individual policies or group deferred annuity contracts):
a State the basis of premium rates > N/A
-------------------------------------------------------------------------------------------
b Total premiums paid to carrier................................................................................ N/A
--------------
c If the carrier, service, or other organization incurred any specific costs in connection with this acquisition
or retention of the contract or policy, other than reported in 3 above, enter amount.......................... N/A
--------------
Specify nature of costs > N/A
- -----------------------------------------------------------------------------------------------------------------------------------
6 Contracts with unallocated funds, (for example, deposit administration or immediate participation guarantee
contracts). Do not include portions of these contracts maintained in separate accounts:
a Balance at the end of the previous year ...................................................................... 302,299
--------------
b Additions: (i) Contributions deposited during year.......................................... 86,379
--------------
(ii) Dividends and credits...............................................................
--------------
(iii) Interest credited during the year .................................................. 17,249
--------------
(iv) Transferred from separate account................................................... 22,735
--------------
(v) Other (specify) > FORFEITURES GENERATED FROM SEPARATE ACCT 8,906
----------------------------------------------------------------- --------------
(vi) Total additions....................................................................................... 135,269
--------------
c Total of balance and additions (add a and b(vi)).............................................................. 437,568
--------------
d Deductions:
(i) Disbursed from fund to pay benefits or purchase annuities during year .............. 1,194
--------------
(ii) Administration charge made by carrier...............................................
--------------
(iii) Transferred to separate account..................................................... 9,704
--------------
(iv) Other (specify) > FORFEIT-CREDIT-$ 12,511; PRIOR YR ADJ-$323 12,834
------------------------------------------------------------------ --------------
(v) Total deductions...................................................................................... 23,732.00
--------------
e Balance at end of current policy year (subtract d(v) from c).................................................. 413,836
- -----------------------------------------------------------------------------------------------------------------------------------
7 Separate accounts: Current value of plan's interest in separate accounts at year end ........................ 1,796,064
- -----------------------------------------------------------------------------------------------------------------------------------
For Paperwork Reduction Act Notice, see the instructions for Form 5500 or 5500 C/R. ISA Schedule A (Form 5500) 1997
</TABLE>
STF FED5727F.1
<PAGE>
<TABLE>
<C> <S> <C>
Schedule A (Form 5500) 1997 PART III IS NOT APPLICABLE Page 2
- ----------------------------------------------------------------------------------------------------------------------------------
Part III INSURED WELFARE PLANS
Provide information for each contract on a separate Part III. If more than one contract covers the same group of
employees of the same employer(s) or members of the same employee organization(s), the information may be combined for reporting
purposes if such contracts are experience-rated as a unit. Where individual contracts are provided, the entire group of such
individual contracts with each carrier may be treated as a unit for purposes of this report.
- ----------------------------------------------------------------------------------------------------------------------------------
8 (a) Contract or (b) Type of (c) List gross premium for (d) Premium rate or
identification number benefit each contract subscription charge
- ----------------------------------------------------------------------------------------------------------------------------------
- ----------------------------------------------------------------------------------------------------------------------------------
9 Experience-rated contracts: a Premiums: (i) Amount received . . . . . . . . . . . . . . . . . . . . . . . __________
(ii) Increase (decrease) in amount due but unpaid. . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(iii) Increase (decrease) in unearned premium reserve . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(iv) Premiums earned, add (i) and (ii), and subtract (iii) . . . . . . . . . . . . . . . . . . . . . . . __________
b Benefit charges: (i) Claims paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(ii) Increase (decrease) in claim reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(iii) Incurred claims (add (i) and (ii)). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(iv) Claims charged. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
c Remainder of premium: (i) Retention charges (on an accrual basis)--
(A) Commissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(B) Administrative service or other fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(C) Other specific acquisition costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(D) Other expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(E) Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(F) Charges for risks or contingencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(G) Other retention charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(H) Total retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(ii) Dividends or retroactive rate refunds. (These amounts were / / paid in cash, or / / credited.). . . . . . . . __________
d Status of policyholder reserves at end of year: (i) Amount held to provide benefits after retirement . . . . . . . __________
(ii) Claim reserves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
(iii) Other reserves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________
e Dividends or retroactive rate refunds due. (Do not include amount entered in c(ii).) . . . . . . . . . . . . . . .
- ----------------------------------------------------------------------------------------------------------------------------------
10 Nonexperience-rated contracts: a Total premiums or subscription charges paid to carrier . . . . . . . . . . . . . . __________
b If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or
retention of the contract or policy, other than reported in 3 above, report amount . . . . . . . . . . . . . . . . __________
Specify nature of costs ______________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
- ----------------------------------------------------------------------------------------------------------------------------------
IF MORE SPACE IS REQUIRED FOR ANY ITEM, ATTACH ADDITIONAL SHEETS THE SAME SIZE AS THIS FORM
- ----------------------------------------------------------------------------------------------------------------------------------
</TABLE>
GENERAL INSTRUCTIONS
This schedule must be attached to Form 5500 or 5500-C/R for every defined
benefit, defined contribution, and welfare benefit plan where any benefits
under the plan are provided by an insurance company, insurance service, or
other similar organization.
SPECIFIC INSTRUCTIONS
Information entered on Schedule A (Form 5500) should pertain to the insurance
contract or policy year ending with or within the plan year (for reporting
purposes, a year cannot exceed 12 months). For example, if an insurance
contract year begins on July 1 and ends on June 30, and the plan year begins
on January 1 and ends on December 31, the Schedule A information attached to
the 1997 Form 5500 should be for the insurance contract year ending on June
30, 1997.
EXCEPTION: If the insurance company maintains records on the basis of a plan
year rather than a policy or contract year, the information entered on
Schedule A (Form 5500) may pertain to the plan year instead of the policy or
contract year.
Include only the contracts issued to the plan for which this
return/report is being filed.
PLANS PARTICIPATING IN MASTER TRUST(S) AND 103-12IES. -- SEE INVESTMENT
ARRANGEMENTS FILING DIRECTLY WITH DOL on page 4 of the instructions for Form
5500 or 5500-C/R.
LINE 2(c). -- Since the plan coverage may fluctuate during the year, the
administrator should estimate the number of persons that were covered by the
plan at the end of the policy or contract year.
Where contracts covering individual employees are grouped, entries
should be determined as of the end of the plan year.
LINES 2(d) and (e). -- Enter the beginning and ending dates of the policy
year for each contract listed under column (b). Enter "N/A" in column (d) if
separate contracts covering individual employees are grouped.
LINE 3. -- Report all sales commissions in column (c) regardless of the
identity of the recipient. Do not report override commissions, salaries,
bonuses, etc., paid to a general agent or manager for managing an agency, or
for performing other administrative functions.
Fees to be reported in column (d) represent payments by insurance
carriers to agents and brokers for items other than commissions (e.g.,
service fees, consulting fees, and finders fees).
NOTE: FOR PURPOSES OF THIS ITEM, COMMISSIONS AND FEES INCLUDE AMOUNTS PAID BY
AN INSURANCE COMPANY ON THE BASIS OF THE AGGREGATE VALUE (E.G., POLICY
AMOUNTS, PREMIUMS) OF CONTRACTS OR POLICIES (OR CLASSES THEREOF) PLACED OR
RETAINED. THE AMOUNT (OR PRO RATA SHARE OF THE TOTAL) OF SUCH COMMISSIONS OR
FEES ATTRIBUTABLE TO THE CONTRACT OR POLICY PLACED WITH OR RETAINED BY THE
PLAN MUST BE REPORTED IN COLUMN (c) OR (d), AS APPROPRIATE.
Fees paid by insurance carriers to persons other than agents and brokers
should be reported in Parts II and III on Schedule A (Form 5500) as
acquisition costs, administrative charges, etc., as appropriate. For plans
with 100 or more participants, fees paid by employee benefit plans to agents,
brokers, and other persons are to be reported on Schedule C (Form 5500).
LINE 5a. -- The rate information called for here may be furnished by
attaching the appropriate schedules of current rates filed with the
appropriate state insurance departments or by providing a statement regarding
the basis of the rates.
LINE 6. -- Show deposit fund amounts rather than experience credit records
when both are maintained.
LINE 8(d). -- The rate information called for here may be furnished by
attaching the appropriate schedules of current rates or a statement as to the
basis of the rates.
- ------------------------------------------------------------------------------
<PAGE>
<TABLE>
<CAPTION>
<S><C>
SCHEDULE P ANNUAL RETURN OF FIDUCIARY OMB No. 1210-0016
(FORM 5500) OF EMPLOYEE BENEFIT TRUST ---------------------
Department of the Treasury > File as an attachment to Form 5500, 5500-C/R, or 5500-EZ 1997
Internal Revenue Service > For the Paperwork Reduction Notice, see the Form 5500 instructions ---------------------
THIS FORM IS OPEN TO
PUBLIC INSPECTION
- -----------------------------------------------------------------------------------------------------------------------------------
For trust calendar year 1997 or fiscal year beginning , 1997, and ending ,19 .
- -----------------------------------------------------------------------------------------------------------------------------------
1a Name of trustee or custodian
PETER B. SMITH & FRANK J. BRAMANTI, TRUSTEES
- -----------------------------------------------------------------------------------------------------------------------------------
b Number, street, and room or suite no. (if a P.O. box, see the instructions for Form 5500, 5500-C/R, or 5500-EZ.)
13403 NORTHWEST FREEWAY, STE 200
- -----------------------------------------------------------------------------------------------------------------------------------
c City or town, state, and ZIP code
HOUSTON, TEXAS 77040
- -----------------------------------------------------------------------------------------------------------------------------------
2a Name of trust b Trust's employer identification number
HCC INSURANCE HOLDINGS, INC. 401(k) PLAN 76-0540617
- -----------------------------------------------------------------------------------------------------------------------------------
3 Name of plan if different from name of trust
- -----------------------------------------------------------------------------------------------------------------------------------
4 Have you furnished the participating employee benefit plan(s) with the trust financial information
required to be reported by the plan(s)?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /X/ YES / / NO
- -----------------------------------------------------------------------------------------------------------------------------------
5 Enter the plan sponsor's employer identification number as
shown on Form 5500, 5500-C/R, or 5500-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . > 76-0336636
- -----------------------------------------------------------------------------------------------------------------------------------
Under penalties of perjury, I declare that I have examined this schedule, and to the best of my knowledge and belief it is true,
correct, and complete.
SIGNATURE OF FIDUCIARY > /s/ Frank J. Bramanti Date > 10/11/98
- -----------------------------------------------------------------------------------------------------------------------------------
</TABLE>
INSTRUCTIONS
SECTION REFERENCES ARE TO THE INTERNAL REVENUE CODE.
PURPOSE OF FORM
You may use this schedule to satisfy the requirements under section 6033(a)
for an annual information return from every section 401(a) organization
exempt from tax under section 501(a).
Filing this form will start the running of the statute of limitations
under section 6501(a) for any trust described in section 401(a), which is
exempt from tax under section 501(a).
WHO MAY FILE
1. Every trustee of a trust created as part of an employee benefit plan as
described in section 401(a).
2. Every custodian of a custodial account described in section 401(f).
HOW TO FILE
File Schedule P (Form 5500) for the trust year ending with or within any
participating plan's plan year. Attach it to the Form 5500, 5500-C/R, or
5500-EZ filed by the plan for that plan year. A separately filed Schedule P
(Form 5500) will not be accepted.
If the trust or custodial account is used by more than one plan, file one
Schedule P (Form 5500). If a plan uses more than one trust or custodial
account for its funds, file one Schedule P (Form 5500) for each trust or
custodial account.
TRUST'S EMPLOYER IDENTIFICATION NUMBER
Enter the trust employer identification number (EIN) assigned to the employee
benefit trust or custodial account, if one has been issued to you. The trust
EIN should be used for transactions conducted for the trust. If you do not
have a trust EIN, enter the EIN you would use on Form 1099-R to report
distributions from employee benefit plans and on Form 945 to report withheld
amounts of income tax from those payments.
NOTE: TRUSTEES WHO DO NOT HAVE AN EIN MAN APPLY FOR ONE ON FORM SS-4,
APPLICATION FOR EMPLOYER IDENTIFICATION NUMBER. YOU MUST BE CONSISTENT AND
USE THE SAME EIN FOR ALL TRUST REPORTING PURPOSES.
SIGNATURE
The fiduciary (trustee or custodian) must sign this schedule. If there is
more than one fiduciary, the fiduciary authorized by the others may sign.
OTHER RETURNS AND FORMS THAT MAY BE REQUIRED
- - FORM 990-T -- For trusts described in section 401(a), a tax is imposed on
income derived from business that is unrelated to the purpose for which the
trust received a tax exemption. Report this income and tax on FORM 990-T,
Exempt Organization Business Income Tax Return. (See sections 511 through 514
and the related regulations.)
- - FORM 1099-R -- If you made payments or distributions to individual
beneficiaries of a plan, report those payments on Form 1099-R (See the
instructions for Forms 1099, 1098, 5498, and W-2G.)
- - FORM 945 -- If you made payments or distributions to individual
beneficiaries of a plan, you may be required to withhold income tax from
those payments. Use FORM 945, Annual Return of Withheld Federal Income Tax,
to report taxes withheld from nonpayroll items. (See CIRCULAR E, Employer's
Tax Guide (Pub. 15), for more information.)
- -------------------------------------------------------------------------------
ISA SCHEDULE P (FORM 5500) 1997
STF FED5753F
<PAGE>
<TABLE>
<S><C>
SCHEDULE SSA ANNUAL REGISTRATION STATEMENT IDENTIFYING SEPARATED OMB No. 1210-0016
(FORM 5500) PARTICIPANTS WITH DEFERRED VESTED BENEFITS -----------------
UNDER SECTION 6057(a) OF THE INTERNAL REVENUE CODE 1997
> FILE AS AN ATTACHMENT TO FORM 5500 OR 500-C/R. -----------------
> FOR PAPERWORK REDUCTION ACT NOTICE, SEE THE INSTRUCTIONS FOR FORM 5500 OR 5500-C/R THIS FORM IS NOT
Department of the Treasury OPEN TO PUBLIC
Internal Revenue Service INSPECTION
- ------------------------------------------------------------------------------------------------------------------------------------
For the calendar year 1997 or fiscal plan year beginning , 1997, and ending , 19
- ------------------------------------------------------------------------------------------------------------------------------------
1a Name of plan sponsor (employer if for a single employer plan) 1b Sponsor's employer identification number (EIN)
HCC INSURANCE HOLDINGS INC 76-0336636
- ------------------------------------------------------------------------------------------------------------------------------------
2a Name of plan 2b Three digit
HCC INSURANCE HOLDINGS, INC. 401(k) PLAN plan number > 002
- ------------------------------------------------------------------------------------------------------------------------------------
3 Enter one of the following Entry Codes in column (a) for each separated participant with deferred vested benefits that:
CODE A -- has not previously been reported.
CODE B -- has previously been reported under the above plan number but requires revisions to the information previously
reported.
CODE C -- has previously been reported under ANOTHER plan number but will be receiving their benefits from the plan listed
above instead.
CODE D -- has previously been reported under the above plan number but is no longer entitled to those deferred vested benefits.
- ------------------------------------------------------------------------------------------------------------------------------------
USE WITH ENTRY CODE USE WITH ENTRY CODE USE WITH ENTRY CODE
"A", "B", "C", OR "D" "A" OR "B" "C"
- ------------------------------------------------------------------------------------------------------------------------------------
Enter code for Amount of vested benefit
nature and -------------------------------------
(a) (b) (c) form of (f) Defined (i) (j)
Entry Social security Name of participant benefit Defined benefit contribution plan Previous sponsor's Previous
Code number ------------------ plan -- periodic -------------------- employer plan
(d) (e) payment (g) (h) identification number
Type of Payment Units or Total number
annuity frequency shares value of
account
- ------------------------------------------------------------------------------------------------------------------------------------
A ###-##-#### MICHAEL P. ARMSTRONG A A 2,273
A ###-##-#### MICHAEL S. HODGES A A 1,077
- ------------------------------------------------------------------------------------------------------------------------------------
/ / Check here if additional participants are shown on attachments. All attachments must include the sponsor's name, EIN, name of
plan, plan number, and column identification letter for each column completed for line 3.
- ------------------------------------------------------------------------------------------------------------------------------------
/ / Check here if plan is a government, church or other plan that elects to voluntarily file Schedule SSA. If so, complete lines 4
through 5c, and the signature area. Otherwise, complete the signature area only.
- ------------------------------------------------------------------------------------------------------------------------------------
4 Plan sponsor's address (number, street, and room or suite no.) (If a P.O. box, see the instructions for line 4.)
- ------------------------------------------------------------------------------------------------------------------------------------
City or town, state, and ZIP code
- ------------------------------------------------------------------------------------------------------------------------------------
5a Name of plan administrator (if other than sponsor) 5b Administrator's EIN
- ------------------------------------------------------------------------------------------------------------------------------------
5c Number, street, and room or suite no. (If a P.O. box, see the instructions for line 4.)
- ------------------------------------------------------------------------------------------------------------------------------------
City or town, state, and ZIP code
- ------------------------------------------------------------------------------------------------------------------------------------
Under penalties of perjury, I declare that I have examined this report, and to the best of my knowledge and belief, it is true,
correct, and complete.
Signature of plan administrator > /s/ Frank J. Bramanti
-------------------------------------------------------------------------------------------------
Phone number of plan administrator > 713-744-9673 Date > 10/8/98
- ------------------------------------------------------------------------------------------------------------------------------------
ISA Schedule SSA (Form 5500) (1997)
STF FED5757F
</TABLE>
