401k Plan data: IOGA WV INSURANCE PROGRAM plan

IOGA WV INSURANCE PROGRAM 401k Plan overview

Plan Name	IOGA WV INSURANCE PROGRAM
Plan identification number	501

IOGA WV INSURANCE PROGRAM Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

INDEPENDENT OIL & GAS ASSOCIATION OF WEST VIRGINIA has sponsored the creation of one or more 401k plans.

Company Name: INDEPENDENT OIL & GAS ASSOCIATION OF WEST VIRGINIA

Employer identification number (EIN): 310894437

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IOGA WV INSURANCE PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 ROBERT HANSEN
501 2016-01-01 STANLEY MASONER
501 2015-01-01 STANLEY MASONER
501 2014-01-01 STANLEY MASONER

Plan id#	Filing Submission Date	Name of Administrator
501	2017-01-01	ROBERT HANSEN
501	2016-01-01	STANLEY MASONER
501	2015-01-01	STANLEY MASONER
501	2014-01-01	STANLEY MASONER

Plan Statistics for IOGA WV INSURANCE PROGRAM

401k plan membership statisitcs for IOGA WV INSURANCE PROGRAM

Measure Date Value
2017: IOGA WV INSURANCE PROGRAM 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,130
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,236
Total of all active and inactive participants 2017-01-01 1,236
2016: IOGA WV INSURANCE PROGRAM 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,312
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,130
Total of all active and inactive participants 2016-01-01 1,130
2015: IOGA WV INSURANCE PROGRAM 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,670
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,312
Total of all active and inactive participants 2015-01-01 1,312
2014: IOGA WV INSURANCE PROGRAM 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,551
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,670
Total of all active and inactive participants 2014-01-01 1,670

Measure	Date	Value
2017: IOGA WV INSURANCE PROGRAM 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,130
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,236
Total of all active and inactive participants	2017-01-01	1,236
2016: IOGA WV INSURANCE PROGRAM 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,312
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,130
Total of all active and inactive participants	2016-01-01	1,130
2015: IOGA WV INSURANCE PROGRAM 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,670
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,312
Total of all active and inactive participants	2015-01-01	1,312
2014: IOGA WV INSURANCE PROGRAM 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,551
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,670
Total of all active and inactive participants	2014-01-01	1,670

Form 5500 Responses for IOGA WV INSURANCE PROGRAM

2017: IOGA WV INSURANCE PROGRAM 2017 form 5500 responses
2017-01-01	Type of plan entity	Mulitple employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: IOGA WV INSURANCE PROGRAM 2016 form 5500 responses
2016-01-01	Type of plan entity	Mulitple employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: IOGA WV INSURANCE PROGRAM 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: IOGA WV INSURANCE PROGRAM 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

YL1-001

Policy instance

Insurance contract or identification number	YL1-001
Number of Individuals Covered	1638
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,204
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,204
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

MIOGA000

Policy instance

Insurance contract or identification number	MIOGA000
Number of Individuals Covered	155
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,069
Total amount of fees paid to insurance company	USD $565
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $36,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,069
Insurance broker organization code?	3
Amount paid for insurance broker fees	565
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	PARKER BENEFITS, INC

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

0257240

Policy instance

Insurance contract or identification number	0257240
Number of Individuals Covered	1531
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,945
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,945
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

0310

Policy instance

Insurance contract or identification number	0310
Number of Individuals Covered	1932
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $598,880
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,350,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $596,313
Insurance broker organization code?	3
Insurance broker name	CHRISTOPHE ALLEN

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

MIOGA000

Policy instance

Insurance contract or identification number	MIOGA000
Number of Individuals Covered	176
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,194
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $40,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,538
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC WV

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

0257240

Policy instance

Insurance contract or identification number	0257240
Number of Individuals Covered	1827
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,125
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,125
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 )

Policy contract number

0310

Policy instance

Insurance contract or identification number	0310
Number of Individuals Covered	2417
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $293,303
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,581,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $380,695
Insurance broker organization code?	3
Insurance broker name	CHRISTOPHE ALLEN

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

MIOGA000

Policy instance

Insurance contract or identification number	MIOGA000
Number of Individuals Covered	188
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,326
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $45,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,326
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES OF W

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

450440-036

Policy instance

Insurance contract or identification number	450440-036
Number of Individuals Covered	920
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,754
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,621
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES

HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 )

Policy contract number

0310

Policy instance

Insurance contract or identification number	0310
Number of Individuals Covered	3447
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $868,903
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,114,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $866,696
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

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Company Name:	INDEPENDENT OIL & GAS ASSOCIATION OF WEST VIRGINIA
Employer identification number (EIN):	310894437
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations