401k Plan data: BEE EMPLOYEE 401K PLAN plan

BEE EMPLOYEE 401K PLAN 401k Plan overview

Plan Name	BEE EMPLOYEE 401K PLAN
Plan identification number	001

BEE EMPLOYEE 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BLACK ELK ENERGY OFFSHORE OPERATIONS, LLC has sponsored the creation of one or more 401k plans.

Company Name: BLACK ELK ENERGY OFFSHORE OPERATIONS, LLC

Employer identification number (EIN): 383769404

NAIC Classification: 211110
NAIC Description: Oil and Gas Extraction, Oil

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BEE EMPLOYEE 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 HILARY MCVAY
001 2013-01-01 HILARY MCVAY
001 2012-01-01 HILARY MCVAY
001 2011-01-01 HILARY MCVAY 2012-08-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2014-01-01	HILARY MCVAY
001	2013-01-01	HILARY MCVAY
001	2012-01-01	HILARY MCVAY
001	2011-01-01	HILARY MCVAY	2012-08-09

Plan Statistics for BEE EMPLOYEE 401K PLAN

401k plan membership statisitcs for BEE EMPLOYEE 401K PLAN

Measure Date Value
2014: BEE EMPLOYEE 401K PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 298
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 48
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 86
Total of all active and inactive participants 2014-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 134
Number of participants with account balances 2014-01-01 134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 123
2013: BEE EMPLOYEE 401K PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 200
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 179
Number of retired or separated participants receiving benefits 2013-01-01 49
Number of other retired or separated participants entitled to future benefits 2013-01-01 69
Total of all active and inactive participants 2013-01-01 297
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 297
Number of participants with account balances 2013-01-01 271
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 57
2012: BEE EMPLOYEE 401K PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 142
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 54
Total of all active and inactive participants 2012-01-01 196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 196
Number of participants with account balances 2012-01-01 194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 10

Measure	Date	Value
2014: BEE EMPLOYEE 401K PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	298
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	48
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	86
Total of all active and inactive participants	2014-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	134
Number of participants with account balances	2014-01-01	134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	123
2013: BEE EMPLOYEE 401K PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	200
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	179
Number of retired or separated participants receiving benefits	2013-01-01	49
Number of other retired or separated participants entitled to future benefits	2013-01-01	69
Total of all active and inactive participants	2013-01-01	297
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	297
Number of participants with account balances	2013-01-01	271
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	57
2012: BEE EMPLOYEE 401K PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	142
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	54
Total of all active and inactive participants	2012-01-01	196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	196
Number of participants with account balances	2012-01-01	194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	10

Financial Data on BEE EMPLOYEE 401K PLAN

Measure	Date	Value
2014 : BEE EMPLOYEE 401K PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$1,585,118
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$4,650,181
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$4,616,412
Value of total corrective distributions	2014-12-31	$9,960
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,271,893
Value of total assets at end of year	2014-12-31	$4,730,872
Value of total assets at beginning of year	2014-12-31	$7,795,935
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$23,809
Total interest from all sources	2014-12-31	$6,782
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$805,013
Participant contributions at end of year	2014-12-31	$86,065
Participant contributions at beginning of year	2014-12-31	$130,169
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$44,872
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$17,986
Total non interest bearing cash at end of year	2014-12-31	$44,049
Total non interest bearing cash at beginning of year	2014-12-31	$24,621
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-3,065,063
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$4,730,872
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$7,795,935
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$4,600,758
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$7,553,074
Income. Interest from loans (other than to participants)	2014-12-31	$6,782
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$306,443
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$448,894
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$43,199
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$4,616,412
Contract administrator fees	2014-12-31	$23,809
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	WEAVER AND TIDWELL LLP
Accountancy firm EIN	2014-12-31	750786316
2013 : BEE EMPLOYEE 401K PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$3,862,002
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$779,332
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$773,951
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$2,750,837
Value of total assets at end of year	2013-12-31	$7,707,864
Value of total assets at beginning of year	2013-12-31	$4,625,194
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$5,381
Total interest from all sources	2013-12-31	$4,032
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$1,550,920
Participant contributions at end of year	2013-12-31	$130,169
Participant contributions at beginning of year	2013-12-31	$71,117
Participant contributions at end of year	2013-12-31	$44,872
Participant contributions at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$357,660
Total non interest bearing cash at end of year	2013-12-31	$24,621
Total non interest bearing cash at beginning of year	2013-12-31	$273
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$3,082,670
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$7,707,864
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$4,625,194
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$7,553,074
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$4,508,787
Interest on participant loans	2013-12-31	$4,032
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,107,133
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$842,257
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$45,017
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$773,951
Contract administrator fees	2013-12-31	$5,381
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	ROBERTSON & ROBERTSON, PLLC
Accountancy firm EIN	2013-12-31	261631123
2012 : BEE EMPLOYEE 401K PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$2,527,133
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$251,861
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$244,242
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$2,131,295
Value of total assets at end of year	2012-12-31	$4,579,903
Value of total assets at beginning of year	2012-12-31	$2,304,631
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$7,619
Total interest from all sources	2012-12-31	$2,117
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$1,251,216
Participant contributions at end of year	2012-12-31	$71,117
Participant contributions at beginning of year	2012-12-31	$40,785
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$123,474
Total non interest bearing cash at end of year	2012-12-31	$0
Total non interest bearing cash at beginning of year	2012-12-31	$2,122
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$2,275,272
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$4,579,903
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,304,631
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$4,508,786
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,261,724
Income. Interest from loans (other than to participants)	2012-12-31	$2,117
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$393,721
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$756,605
Employer contributions (assets) at end of year	2012-12-31	$45,017
Employer contributions (assets) at beginning of year	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$244,242
Contract administrator fees	2012-12-31	$7,619
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	ROBERTSON & ROBERTSON, PLLC
Accountancy firm EIN	2012-12-31	261631123

Form 5500 Responses for BEE EMPLOYEE 401K PLAN

2014: BEE EMPLOYEE 401K PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
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 funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: BEE EMPLOYEE 401K PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: BEE EMPLOYEE 401K PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

87473

Policy instance

Insurance contract or identification number	87473
Number of Individuals Covered	150
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $31,319
Total amount of fees paid to insurance company	USD $21,232
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	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?	No
Commission paid to Insurance Broker	USD $31,319
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	NOVA 401(K) ASSOCIATES

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

87473

Policy instance

Insurance contract or identification number	87473
Number of Individuals Covered	297
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $28,977
Total amount of fees paid to insurance company	USD $10,542
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	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?	No
Commission paid to Insurance Broker	USD $28,977
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	NOVA 401(K) ASSOCIATES

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

87473

Policy instance

Insurance contract or identification number	87473
Number of Individuals Covered	194
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $15,935
Total amount of fees paid to insurance company	USD $6,234
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	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?	No
Commission paid to Insurance Broker	USD $15,935
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	NOVA 401(K) ASSOCIATES

Potentially related plans

BEE EMPLOYEE 401K PLAN [EIN = 306454594]

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Company Name:	BLACK ELK ENERGY OFFSHORE OPERATIONS, LLC
Employer identification number (EIN):	383769404
NAIC Classification:	211110
NAIC Description:	Oil and Gas Extraction, Oil