401k Plan data: ENERGY PRODUCTS HEALTH CARE PLAN plan

ENERGY PRODUCTS HEALTH CARE PLAN 401k Plan overview

Plan Name	ENERGY PRODUCTS HEALTH CARE PLAN
Plan identification number	501

ENERGY PRODUCTS HEALTH CARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ENERGY PRODUCTS, LLC has sponsored the creation of one or more 401k plans.

Company Name: ENERGY PRODUCTS, LLC

Employer identification number (EIN): 462215677

NAIC Classification: 423800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ENERGY PRODUCTS HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-01-01 CAROL WHETZEL

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2014-01-01	CAROL WHETZEL

Plan Statistics for ENERGY PRODUCTS HEALTH CARE PLAN

401k plan membership statisitcs for ENERGY PRODUCTS HEALTH CARE PLAN

Measure Date Value
2014: ENERGY PRODUCTS HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 121
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 121

Measure	Date	Value
2014: ENERGY PRODUCTS HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	121
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	121

Form 5500 Responses for ENERGY PRODUCTS HEALTH CARE PLAN

2014: ENERGY PRODUCTS HEALTH CARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

590059

Policy instance

Insurance contract or identification number	590059
Number of Individuals Covered	210
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $51,019
Total amount of fees paid to insurance company	USD $516
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $805,765
Commission paid to Insurance Broker	USD $39,875
Insurance broker organization code?	3
Amount paid for insurance broker fees	516
Additional information about fees paid to insurance broker	BONUS COMMISSION
Insurance broker name	ROGERTS BENEFIT GROUP INC - OKLAHOM

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

395993

Policy instance

Insurance contract or identification number	395993
Number of Individuals Covered	121
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,783
Total amount of fees paid to insurance company	USD $404
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ADD
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 $49,702
Commission paid to Insurance Broker	USD $10,783
Amount paid for insurance broker fees	404
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	GEORGE F BASHAW III

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Company Name:	ENERGY PRODUCTS, LLC
Employer identification number (EIN):	462215677
NAIC Classification:	423800