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BLACKBRUSH OIL & GAS L.P. LIFE PLAN 401k Plan overview

Plan NameBLACKBRUSH OIL & GAS L.P. LIFE PLAN
Plan identification number 501

BLACKBRUSH OIL & GAS L.P. LIFE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • 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

BLACKBRUSH OIL & GAS L.P. has sponsored the creation of one or more 401k plans.

Company Name:BLACKBRUSH OIL & GAS L.P.
Employer identification number (EIN):411524551
NAIC Classification:111100
NAIC Description:Oilseed and Grain Farming

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLACKBRUSH OIL & GAS L.P. LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-11-01ERIC FRIEDRICH

Plan Statistics for BLACKBRUSH OIL & GAS L.P. LIFE PLAN

401k plan membership statisitcs for BLACKBRUSH OIL & GAS L.P. LIFE PLAN

Measure Date Value
2015: BLACKBRUSH OIL & GAS L.P. LIFE PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01112
Total number of active participants reported on line 7a of the Form 55002015-11-01107
Number of retired or separated participants receiving benefits2015-11-010
Number of other retired or separated participants entitled to future benefits2015-11-010
Total of all active and inactive participants2015-11-01107

Form 5500 Responses for BLACKBRUSH OIL & GAS L.P. LIFE PLAN

2015: BLACKBRUSH OIL & GAS L.P. LIFE PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01First time form 5500 has been submittedYes
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberGFZ02137
Policy instance 1
Insurance contract or identification numberGFZ02137
Number of Individuals Covered107
Insurance policy start date2015-11-01
Insurance policy end date2016-10-31
Total amount of commissions paid to insurance brokerUSD $7,664
Total amount of fees paid to insurance companyUSD $2,555
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $51,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,664
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INSURANCE & FINANCIAL

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