401k Plan data: LEGACY OFFSHORE VISION PLAN plan

LEGACY OFFSHORE VISION PLAN 401k Plan overview

Plan Name	LEGACY OFFSHORE VISION PLAN
Plan identification number	503

LEGACY OFFSHORE VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision 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

LEGACY OFFSHORE, LLC has sponsored the creation of one or more 401k plans.

Company Name: LEGACY OFFSHORE, LLC

Employer identification number (EIN): 300450130

NAIC Classification: 238900

Additional information about LEGACY OFFSHORE, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2008-08-18

Company Identification Number: 0801018553

Legal Registered Office Address: 1122 HIGHBORNE CAY CT

TEXAS CITY
United States of America (USA)
77590

More information about LEGACY OFFSHORE, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEGACY OFFSHORE VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-03-15 CHARLES ZARNOVA
503 2014-03-15 CHARLES ZAMORA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2015-03-15	CHARLES ZARNOVA
503	2014-03-15	CHARLES ZAMORA

Plan Statistics for LEGACY OFFSHORE VISION PLAN

401k plan membership statisitcs for LEGACY OFFSHORE VISION PLAN

Measure Date Value
2015: LEGACY OFFSHORE VISION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-03-15 100
Total number of active participants reported on line 7a of the Form 5500 2015-03-15 32
Number of retired or separated participants receiving benefits 2015-03-15 0
Number of other retired or separated participants entitled to future benefits 2015-03-15 0
Total of all active and inactive participants 2015-03-15 32
2014: LEGACY OFFSHORE VISION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-03-15 100
Total number of active participants reported on line 7a of the Form 5500 2014-03-15 100
Number of retired or separated participants receiving benefits 2014-03-15 0
Number of other retired or separated participants entitled to future benefits 2014-03-15 0
Total of all active and inactive participants 2014-03-15 100

Measure	Date	Value
2015: LEGACY OFFSHORE VISION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-03-15	100
Total number of active participants reported on line 7a of the Form 5500	2015-03-15	32
Number of retired or separated participants receiving benefits	2015-03-15	0
Number of other retired or separated participants entitled to future benefits	2015-03-15	0
Total of all active and inactive participants	2015-03-15	32
2014: LEGACY OFFSHORE VISION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-03-15	100
Total number of active participants reported on line 7a of the Form 5500	2014-03-15	100
Number of retired or separated participants receiving benefits	2014-03-15	0
Number of other retired or separated participants entitled to future benefits	2014-03-15	0
Total of all active and inactive participants	2014-03-15	100

Form 5500 Responses for LEGACY OFFSHORE VISION PLAN

2015: LEGACY OFFSHORE VISION PLAN 2015 form 5500 responses
2015-03-15	Type of plan entity	Single employer plan
2015-03-15	Submission has been amended	No
2015-03-15	This submission is the final filing	No
2015-03-15	This return/report is a short plan year return/report (less than 12 months)	No
2015-03-15	Plan is a collectively bargained plan	No
2015-03-15	Plan funding arrangement – Insurance	Yes
2015-03-15	Plan benefit arrangement – Insurance	Yes
2014: LEGACY OFFSHORE VISION PLAN 2014 form 5500 responses
2014-03-15	Type of plan entity	Single employer plan
2014-03-15	First time form 5500 has been submitted	Yes
2014-03-15	Submission has been amended	No
2014-03-15	This submission is the final filing	No
2014-03-15	This return/report is a short plan year return/report (less than 12 months)	No
2014-03-15	Plan is a collectively bargained plan	No
2014-03-15	Plan funding arrangement – Insurance	Yes
2014-03-15	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5475598

Policy instance

Insurance contract or identification number	5475598
Number of Individuals Covered	32
Insurance policy start date	2015-03-15
Insurance policy end date	2016-03-14
Total amount of commissions paid to insurance broker	USD $89
Total amount of fees paid to insurance company	USD $369
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	Yes
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 $7,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $89
Amount paid for insurance broker fees	369
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION PRODUCER BONUS PROGRAM PAYMENT
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES, LLC

MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

D4371/9671215

Policy instance

Insurance contract or identification number	D4371/9671215
Number of Individuals Covered	100
Insurance policy start date	2014-03-15
Insurance policy end date	2015-03-14
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	LEGACY OFFSHORE, LLC
Employer identification number (EIN):	300450130
NAIC Classification:	238900

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2008-08-18
Company Identification Number:	0801018553
Legal Registered Office Address:	1122 HIGHBORNE CAY CT TEXAS CITY United States of America (USA) 77590