SOURCEGAS LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY
401k plan membership statisitcs for SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY
| Measure | Date | Value |
|---|
| 2016: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 20 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 19 |
| Total of all active and inactive participants | 2016-01-01 | 19 |
| 2015: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 21 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 20 |
| Total of all active and inactive participants | 2015-01-01 | 20 |
| 2014: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 34 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,108 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 50 |
| Total of all active and inactive participants | 2014-01-01 | 1,158 |
| 2013: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 33 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 34 |
| Total of all active and inactive participants | 2013-01-01 | 34 |
| Total participants | 2013-01-01 | 0 |
| 2012: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 53 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 33 |
| Total of all active and inactive participants | 2012-01-01 | 33 |
| Total participants | 2012-01-01 | 0 |
| 2011: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 57 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 53 |
| Total of all active and inactive participants | 2011-01-01 | 53 |
| Total participants | 2011-01-01 | 53 |
| Measure | Date | Value |
|---|
| 2016 : SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2016 401k financial data |
|---|
| Total income from all sources | 2016-02-29 | $36,278 |
| Expenses. Total of all expenses incurred | 2016-02-29 | $49,391 |
| Total plan assets at end of year | 2016-02-29 | $3,378,632 |
| Total plan assets at beginning of year | 2016-02-29 | $3,391,745 |
| Value of fidelity bond covering the plan | 2016-02-29 | $5,000,000 |
| Total contributions received or receivable from participants | 2016-02-29 | $46,918 |
| Expenses. Other expenses not covered elsewhere | 2016-02-29 | $15,375 |
| Other income received | 2016-02-29 | $-30,364 |
| Net income (gross income less expenses) | 2016-02-29 | $-13,113 |
| Net plan assets at end of year (total assets less liabilities) | 2016-02-29 | $3,378,632 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-02-29 | $3,391,745 |
| Total contributions received or receivable from employer(s) | 2016-02-29 | $19,724 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-02-29 | $34,016 |
| 2015 : SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $568,022 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $483,161 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $241,114 |
| Total plan assets at end of year | 2015-12-31 | $3,391,745 |
| Total plan assets at beginning of year | 2015-12-31 | $3,306,884 |
| Value of fidelity bond covering the plan | 2015-12-31 | $5,000,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $127,417 |
| Other income received | 2015-12-31 | $34,631 |
| Net income (gross income less expenses) | 2015-12-31 | $84,861 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $3,391,745 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $3,306,884 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $405,974 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $242,047 |
| 2014 : SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2014 401k financial data |
|---|
| Transfers to/from the plan | 2014-12-31 | $8,887 |
| Total income from all sources | 2014-12-31 | $656,577 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $369,389 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $147,009 |
| Total plan assets at end of year | 2014-12-31 | $3,306,884 |
| Total plan assets at beginning of year | 2014-12-31 | $3,010,809 |
| Value of fidelity bond covering the plan | 2014-12-31 | $5,000,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $93,678 |
| Other income received | 2014-12-31 | $198,099 |
| Net income (gross income less expenses) | 2014-12-31 | $287,188 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $3,306,884 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $3,010,809 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $364,800 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $222,380 |
| 2013 : SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2013 401k financial data |
|---|
| Transfers to/from the plan | 2013-12-31 | $14,351 |
| Total income from all sources | 2013-12-31 | $703,521 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $311,097 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $252,127 |
| Total plan assets at end of year | 2013-12-31 | $3,010,809 |
| Total plan assets at beginning of year | 2013-12-31 | $2,604,034 |
| Value of fidelity bond covering the plan | 2013-12-31 | $5,000,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $86,453 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $10,748 |
| Other income received | 2013-12-31 | $252,268 |
| Net income (gross income less expenses) | 2013-12-31 | $392,424 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $3,010,809 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $2,604,034 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $364,800 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $48,222 |
| 2012 : SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-12-31 | $89 |
| Total income from all sources | 2012-12-31 | $583,848 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $272,222 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $237,924 |
| Total plan assets at end of year | 2012-12-31 | $2,604,034 |
| Total plan assets at beginning of year | 2012-12-31 | $2,292,319 |
| Value of fidelity bond covering the plan | 2012-12-31 | $5,000,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $104,225 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $34,298 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $4,826 |
| Other income received | 2012-12-31 | $89,001 |
| Net income (gross income less expenses) | 2012-12-31 | $311,626 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $2,604,034 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $2,292,319 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $385,796 |
| 2011 : SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-12-31 | $2,335,434 |
| Total income from all sources | 2011-12-31 | $493,855 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $536,970 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $519,299 |
| Total plan assets at end of year | 2011-12-31 | $2,292,319 |
| Value of fidelity bond covering the plan | 2011-12-31 | $5,000,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $128,354 |
| Other income received | 2011-12-31 | $701 |
| Net income (gross income less expenses) | 2011-12-31 | $-43,115 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $2,292,319 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $364,800 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $17,671 |
| 2016: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 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 – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: SOURCEGAS POST-RETIREMENT EMPLOYEE BENEFITS PLAN FOR FORMER EMPLOYEES OR ARKANSAS WESTERN GAS COMPANY 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | First time form 5500 has been submitted | Yes |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ETB-130007 |
| Policy instance | 3 |
| Insurance contract or identification number | ETB-130007 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-02-29 | | 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 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | 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 $-1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL16772 |
| Policy instance | 2 |
| Insurance contract or identification number | HCL16772 | | Number of Individuals Covered | 2261 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-02-29 | | 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 | | Other welfare benefits provided | STOP LOSS | | 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 $178,596 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 67493-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 67493-1 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-02-29 | | 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 | 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 $1,273 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 67493-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 67493-1 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 | 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 $9,119 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL16772 |
| Policy instance | 2 |
| Insurance contract or identification number | HCL16772 | | Number of Individuals Covered | 1122 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 $928,986 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 67493-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 67493-1 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | 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 $10,292 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL16772 |
| Policy instance | 2 |
| Insurance contract or identification number | HCL16772 | | Number of Individuals Covered | 1105 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 | 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 $908,650 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 67493-1 |
| Policy instance | 1 |
| Insurance contract or identification number | 67493-1 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $274 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,972 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $274 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker name | THE HAYS BENEFIT GROUP, LLC |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL16772 |
| Policy instance | 2 |
| Insurance contract or identification number | HCL16772 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $27,446 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL16772 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL16772 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $26,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 67493-1 |
| Policy instance | 2 |
| Insurance contract or identification number | 67493-1 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL16772 |
| Policy instance | 1 |
| Insurance contract or identification number | HCL16772 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $29,707 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 677082G |
| Policy instance | 2 |
| Insurance contract or identification number | 677082G | | Number of Individuals Covered | 27 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of fees paid to insurance company | USD $274 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,063 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
