401k Plan data: CENOVUS ENERGY 401(K) PLAN plan

CENOVUS ENERGY 401(K) PLAN 401k Plan overview

Plan Name	CENOVUS ENERGY 401(K) PLAN
Plan identification number	001

CENOVUS ENERGY 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

CENOVUS DOWNSTREAM SERVICES LLC has sponsored the creation of one or more 401k plans.

Company Name: CENOVUS DOWNSTREAM SERVICES LLC

Employer identification number (EIN): 981020836

NAIC Classification: 324110
NAIC Description: Petroleum Refineries

Additional information about CENOVUS DOWNSTREAM SERVICES LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5051760

More information about CENOVUS DOWNSTREAM SERVICES LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENOVUS ENERGY 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2018-01-01
001 2017-01-01 CORINNE ROZON
001 2016-01-01 CORINNE ROZON
001 2015-01-01 CORINNE ROZON
001 2014-01-01 TRIXY SASYNIUK-WALT
001 2013-01-01 RENNICK WALKER
001 2012-01-01 RENNICK WALKER 2013-10-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2018-01-01
001	2017-01-01	CORINNE ROZON
001	2016-01-01	CORINNE ROZON
001	2015-01-01	CORINNE ROZON
001	2014-01-01	TRIXY SASYNIUK-WALT
001	2013-01-01	RENNICK WALKER
001	2012-01-01	RENNICK WALKER	2013-10-03

Plan Statistics for CENOVUS ENERGY 401(K) PLAN

401k plan membership statisitcs for CENOVUS ENERGY 401(K) PLAN

Measure Date Value
2018: CENOVUS ENERGY 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 7
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 4
Total of all active and inactive participants 2018-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 11
Number of participants with account balances 2018-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CENOVUS ENERGY 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 9
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 2
Total of all active and inactive participants 2017-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 11
Number of participants with account balances 2017-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 1
2016: CENOVUS ENERGY 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 12
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 1
Total of all active and inactive participants 2016-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 13
Number of participants with account balances 2016-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CENOVUS ENERGY 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 7
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 1
Total of all active and inactive participants 2015-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 8
Number of participants with account balances 2015-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CENOVUS ENERGY 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 7
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 1
Total of all active and inactive participants 2014-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 8
Number of participants with account balances 2014-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CENOVUS ENERGY 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 5
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 1
Total of all active and inactive participants 2013-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 6
Number of participants with account balances 2013-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2018: CENOVUS ENERGY 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	7
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	4
Total of all active and inactive participants	2018-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	11
Number of participants with account balances	2018-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CENOVUS ENERGY 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	9
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	2
Total of all active and inactive participants	2017-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	11
Number of participants with account balances	2017-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1
2016: CENOVUS ENERGY 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	12
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	1
Total of all active and inactive participants	2016-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	13
Number of participants with account balances	2016-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CENOVUS ENERGY 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	7
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	1
Total of all active and inactive participants	2015-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	8
Number of participants with account balances	2015-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CENOVUS ENERGY 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	7
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	1
Total of all active and inactive participants	2014-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	8
Number of participants with account balances	2014-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CENOVUS ENERGY 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	5
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	1
Total of all active and inactive participants	2013-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	6
Number of participants with account balances	2013-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on CENOVUS ENERGY 401(K) PLAN

Measure	Date	Value
2018 : CENOVUS ENERGY 401(K) PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$700,078
Expenses. Total of all expenses incurred	2018-12-31	$2,475
Benefits paid (including direct rollovers)	2018-12-31	$0
Total plan assets at end of year	2018-12-31	$2,771,770
Total plan assets at beginning of year	2018-12-31	$2,074,167
Value of fidelity bond covering the plan	2018-12-31	$1,000,000
Total contributions received or receivable from participants	2018-12-31	$143,519
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$611,703
Other income received	2018-12-31	$-231,957
Net income (gross income less expenses)	2018-12-31	$697,603
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$2,771,770
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$2,074,167
Assets. Value of participant loans	2018-12-31	$81,087
Assets. Value of employer securities	2018-12-31	$163,496
Total contributions received or receivable from employer(s)	2018-12-31	$176,813
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$2,475
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : CENOVUS ENERGY 401(K) PLAN 2017 401k financial data
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$521,418
Expenses. Total of all expenses incurred	2017-12-31	$342,078
Benefits paid (including direct rollovers)	2017-12-31	$341,025
Total plan assets at end of year	2017-12-31	$2,074,167
Total plan assets at beginning of year	2017-12-31	$1,894,827
Value of fidelity bond covering the plan	2017-12-31	$1,000,000
Total contributions received or receivable from participants	2017-12-31	$146,222
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$194,130
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$179,340
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$2,074,167
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,894,827
Assets. Value of participant loans	2017-12-31	$19,743
Assets. Value of employer securities	2017-12-31	$164,520
Total contributions received or receivable from employer(s)	2017-12-31	$181,066
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$1,053
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : CENOVUS ENERGY 401(K) PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$507,769
Expenses. Total of all expenses incurred	2016-12-31	$537
Benefits paid (including direct rollovers)	2016-12-31	$0
Total plan assets at end of year	2016-12-31	$1,894,827
Total plan assets at beginning of year	2016-12-31	$1,387,595
Value of fidelity bond covering the plan	2016-12-31	$200,000
Total contributions received or receivable from participants	2016-12-31	$161,202
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$120,006
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$507,232
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,894,827
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,387,595
Assets. Value of participant loans	2016-12-31	$26,704
Assets. Value of employer securities	2016-12-31	$194,819
Total contributions received or receivable from employer(s)	2016-12-31	$226,561
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$537
2015 : CENOVUS ENERGY 401(K) PLAN 2015 401k financial data
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$251,950
Expenses. Total of all expenses incurred	2015-12-31	$502
Benefits paid (including direct rollovers)	2015-12-31	$0
Total plan assets at end of year	2015-12-31	$1,387,595
Total plan assets at beginning of year	2015-12-31	$1,136,147
Value of fidelity bond covering the plan	2015-12-31	$100,000
Total contributions received or receivable from participants	2015-12-31	$124,338
Other income received	2015-12-31	$-43,884
Net income (gross income less expenses)	2015-12-31	$251,448
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,387,595
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,136,147
Assets. Value of participant loans	2015-12-31	$33,376
Assets. Value of employer securities	2015-12-31	$107,966
Total contributions received or receivable from employer(s)	2015-12-31	$171,496
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$502
2014 : CENOVUS ENERGY 401(K) PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$283,529
Expenses. Total of all expenses incurred	2014-12-31	$120,281
Benefits paid (including direct rollovers)	2014-12-31	$119,950
Total plan assets at end of year	2014-12-31	$1,136,147
Total plan assets at beginning of year	2014-12-31	$972,899
Value of fidelity bond covering the plan	2014-12-31	$50,000,000
Total contributions received or receivable from participants	2014-12-31	$106,731
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$35,310
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$163,248
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,136,147
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$972,899
Assets. Value of participant loans	2014-12-31	$12,185
Assets. Value of employer securities	2014-12-31	$57,875
Total contributions received or receivable from employer(s)	2014-12-31	$141,488
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$331
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : CENOVUS ENERGY 401(K) PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$329,162
Expenses. Total of all expenses incurred	2013-12-31	$70
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$972,899
Total plan assets at beginning of year	2013-12-31	$643,807
Value of fidelity bond covering the plan	2013-12-31	$50,000,000
Total contributions received or receivable from participants	2013-12-31	$85,175
Expenses. Other expenses not covered elsewhere	2013-12-31	$70
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$143,090
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$329,092
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$972,899
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$643,807
Assets. Value of participant loans	2013-12-31	$18,297
Assets. Value of employer securities	2013-12-31	$49,475
Total contributions received or receivable from employer(s)	2013-12-31	$100,897
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0

Form 5500 Responses for CENOVUS ENERGY 401(K) PLAN

2018: CENOVUS ENERGY 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: CENOVUS ENERGY 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: CENOVUS ENERGY 401(K) PLAN 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)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: CENOVUS ENERGY 401(K) PLAN 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 benefit arrangement – Insurance	Yes
2014: CENOVUS ENERGY 401(K) 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 benefit arrangement – Insurance	Yes
2013: CENOVUS ENERGY 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942664-01

Policy instance

Insurance contract or identification number	942664-01
Number of Individuals Covered	11
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942664-01

Policy instance

Insurance contract or identification number	942664-01
Number of Individuals Covered	11
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942664-01

Policy instance

Insurance contract or identification number	942664-01
Number of Individuals Covered	7
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942664-01

Policy instance

Insurance contract or identification number	942664-01
Number of Individuals Covered	7
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

942664-01

Policy instance

Insurance contract or identification number	942664-01
Number of Individuals Covered	6
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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?	Yes
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

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Company Name:	CENOVUS DOWNSTREAM SERVICES LLC
Employer identification number (EIN):	981020836
NAIC Classification:	324110
NAIC Description:	Petroleum Refineries

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5051760