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CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 401k Plan overview

Plan NameCHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM
Plan identification number 004

CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM Benefits

401k Plan TypeDefined 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.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • 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.

401k Sponsoring company profile

CHAMPION ENERGY, LLC has sponsored the creation of one or more 401k plans.

Company Name:CHAMPION ENERGY, LLC
Employer identification number (EIN):823130338
NAIC Classification:424700

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0042019-01-01
0042018-01-01
0042017-01-01JOSEPH MELFI

Plan Statistics for CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM

401k plan membership statisitcs for CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM

Measure Date Value
2019: CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 2019 401k membership
Total participants, beginning-of-year2019-01-01225
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-010
Number of participants with account balances2019-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 2018 401k membership
Total participants, beginning-of-year2018-01-01224
Total number of active participants reported on line 7a of the Form 55002018-01-01141
Number of retired or separated participants receiving benefits2018-01-018
Number of other retired or separated participants entitled to future benefits2018-01-0173
Total of all active and inactive participants2018-01-01222
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-013
Total participants2018-01-01225
Number of participants with account balances2018-01-01209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 2017 401k membership
Total participants, beginning-of-year2017-01-01245
Total number of active participants reported on line 7a of the Form 55002017-01-01199
Number of retired or separated participants receiving benefits2017-01-018
Number of other retired or separated participants entitled to future benefits2017-01-0160
Total of all active and inactive participants2017-01-01267
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-013
Total participants2017-01-01270
Number of participants with account balances2017-01-01232
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-0191

Financial Data on CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM

Measure Date Value
2019 : CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-09-30$0
Total transfer of assets from this plan2019-09-30$16,441,867
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$0
Total income from all sources (including contributions)2019-09-30$2,316,950
Total loss/gain on sale of assets2019-09-30$0
Total of all expenses incurred2019-09-30$1,315,700
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-09-30$1,315,674
Expenses. Certain deemed distributions of participant loans2019-09-30$-2,324
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-09-30$355,257
Value of total assets at end of year2019-09-30$0
Value of total assets at beginning of year2019-09-30$15,440,617
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-09-30$2,350
Total interest from all sources2019-09-30$432,529
Total dividends received (eg from common stock, registered investment company shares)2019-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-09-30Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2019-09-30$0
Was this plan covered by a fidelity bond2019-09-30Yes
Value of fidelity bond cover2019-09-30$500,000
If this is an individual account plan, was there a blackout period2019-09-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-09-30$0
Were there any nonexempt tranactions with any party-in-interest2019-09-30No
Contributions received from participants2019-09-30$240,637
Participant contributions at end of year2019-09-30$0
Participant contributions at beginning of year2019-09-30$377,206
Assets. Other investments not covered elsewhere at beginning of year2019-09-30$0
Administrative expenses (other) incurred2019-09-30$2,350
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Value of net income/loss2019-09-30$1,001,250
Value of net assets at end of year (total assets less liabilities)2019-09-30$0
Value of net assets at beginning of year (total assets less liabilities)2019-09-30$15,440,617
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-09-30No
Were any leases to which the plan was party in default or uncollectible2019-09-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-09-30$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-09-30$9,962,682
Value of interest in pooled separate accounts at beginning of year2019-09-30$0
Interest on participant loans2019-09-30$11,761
Interest earned on other investments2019-09-30$420,768
Value of interest in common/collective trusts at beginning of year2019-09-30$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-09-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-09-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-09-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-09-30$5,100,729
Net investment gain/loss from pooled separate accounts2019-09-30$1,529,164
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-09-30No
Was there a failure to transmit to the plan any participant contributions2019-09-30No
Has the plan failed to provide any benefit when due under the plan2019-09-30No
Assets. Invements in employer securities at beginning of year2019-09-30$0
Contributions received in cash from employer2019-09-30$114,620
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-09-30$1,315,674
Asset. Corporate debt instrument debt (other) at beginning of year2019-09-30$0
Assets. Corporate common stocks other than exployer securities at beginning of year2019-09-30$0
Did the plan have assets held for investment2019-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-09-30Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-09-30Yes
Opinion of an independent qualified public accountant for this plan2019-09-30Disclaimer
Accountancy firm name2019-09-30CHARLES HEAVEN & COMPANY
Accountancy firm EIN2019-09-30060666222
2018 : CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$0
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total transfer of assets to this plan2018-12-31$0
Total transfer of assets from this plan2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$-75,719
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$2,324,901
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$2,316,979
Expenses. Certain deemed distributions of participant loans2018-12-31$5,527
Value of total corrective distributions2018-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$508,951
Value of total assets at end of year2018-12-31$15,440,617
Value of total assets at beginning of year2018-12-31$17,841,237
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$2,395
Total interest from all sources2018-12-31$163,852
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$339,741
Participant contributions at end of year2018-12-31$377,206
Participant contributions at beginning of year2018-12-31$330,952
Assets. Other investments not covered elsewhere at end of year2018-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$24,511
Other income not declared elsewhere2018-12-31$0
Administrative expenses (other) incurred2018-12-31$2,395
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-2,400,620
Value of net assets at end of year (total assets less liabilities)2018-12-31$15,440,617
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$17,841,237
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$9,962,682
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$12,579,029
Value of interest in pooled separate accounts at end of year2018-12-31$0
Value of interest in pooled separate accounts at beginning of year2018-12-31$0
Interest on participant loans2018-12-31$13,702
Interest earned on other investments2018-12-31$150,150
Value of interest in common/collective trusts at end of year2018-12-31$0
Value of interest in common/collective trusts at beginning of year2018-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$5,100,729
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$4,931,256
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$0
Net investment gain/loss from pooled separate accounts2018-12-31$-748,522
Net investment gain or loss from common/collective trusts2018-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Assets. Invements in employer securities at end of year2018-12-31$0
Assets. Invements in employer securities at beginning of year2018-12-31$0
Contributions received in cash from employer2018-12-31$144,699
Income. Dividends from common stock2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$2,316,979
Asset. Corporate debt instrument debt (other) at end of year2018-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2018-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2018-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2018-12-31$0
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31CHARLES HEAVEN & COMPANY
Accountancy firm EIN2018-12-31060666222
2017 : CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$0
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total transfer of assets to this plan2017-12-31$0
Total transfer of assets from this plan2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$2,752,103
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,064,159
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$1,061,145
Expenses. Certain deemed distributions of participant loans2017-12-31$0
Value of total corrective distributions2017-12-31$1,614
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$785,115
Value of total assets at end of year2017-12-31$17,841,237
Value of total assets at beginning of year2017-12-31$16,153,293
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$1,400
Total interest from all sources2017-12-31$175,218
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$586,149
Participant contributions at end of year2017-12-31$330,952
Participant contributions at beginning of year2017-12-31$286,982
Assets. Other investments not covered elsewhere at end of year2017-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$3,755
Other income not declared elsewhere2017-12-31$764
Administrative expenses (other) incurred2017-12-31$1,400
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$1,687,944
Value of net assets at end of year (total assets less liabilities)2017-12-31$17,841,237
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$16,153,293
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$12,579,029
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$10,347,641
Value of interest in pooled separate accounts at end of year2017-12-31$0
Value of interest in pooled separate accounts at beginning of year2017-12-31$0
Interest on participant loans2017-12-31$11,712
Interest earned on other investments2017-12-31$163,506
Value of interest in common/collective trusts at end of year2017-12-31$0
Value of interest in common/collective trusts at beginning of year2017-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$4,931,256
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$5,518,670
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$0
Net investment gain/loss from pooled separate accounts2017-12-31$1,791,006
Net investment gain or loss from common/collective trusts2017-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Assets. Invements in employer securities at end of year2017-12-31$0
Assets. Invements in employer securities at beginning of year2017-12-31$0
Contributions received in cash from employer2017-12-31$195,211
Income. Dividends from common stock2017-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$1,061,145
Asset. Corporate debt instrument debt (other) at end of year2017-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2017-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2017-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2017-12-31$0
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31CHARLES HEAVEN & COMPANY
Accountancy firm EIN2017-12-31060666222

Form 5500 Responses for CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM

2019: CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingYes
2019-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: CHAMPION ENERGY 401K EMPLOYEES AND INVESTMENT RETIREMENT PROGRAM 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-018554
Policy instance 1
Insurance contract or identification numberGA-018554
Number of Individuals Covered0
Insurance policy start date2019-01-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $23,596
Total amount of fees paid to insurance companyUSD $0
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,596
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-018554
Policy instance 1
Insurance contract or identification numberGA-018554
Number of Individuals Covered209
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $34,531
Total amount of fees paid to insurance companyUSD $0
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,531
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number
Policy instance 1
Number of Individuals Covered232
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $41,077
Total amount of fees paid to insurance companyUSD $0
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,077
Insurance broker organization code?3
Insurance broker nameWELLS FARGO ADVISORS INS AGENCY, LL

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