401k Plan data: BLACK STONE MINERALS HEALTH & WELFARE PLAN plan

BLACK STONE MINERALS HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	BLACK STONE MINERALS HEALTH & WELFARE PLAN
Plan identification number	501

BLACK STONE MINERALS HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

BLACK STONE NATURAL RESOURCES MANAGEMENT COMPANY has sponsored the creation of one or more 401k plans.

Company Name: BLACK STONE NATURAL RESOURCES MANAGEMENT COMPANY

Employer identification number (EIN): 760499297

NAIC Classification: 551112
NAIC Description: Offices of Other Holding Companies

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLACK STONE MINERALS HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-10-01 STEVE PUTMAN STEVE PUTMAN 2016-04-19
501 2013-10-01 SAMUEL CRABB
501 2012-10-01 SAMUEL CRABB

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2014-10-01	STEVE PUTMAN	STEVE PUTMAN	2016-04-19
501	2013-10-01	SAMUEL CRABB
501	2012-10-01	SAMUEL CRABB

Plan Statistics for BLACK STONE MINERALS HEALTH & WELFARE PLAN

401k plan membership statisitcs for BLACK STONE MINERALS HEALTH & WELFARE PLAN

Measure Date Value
2014: BLACK STONE MINERALS HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 118
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 0
Total of all active and inactive participants 2014-10-01 0
Total participants 2014-10-01 0
2013: BLACK STONE MINERALS HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 103
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 118
Total of all active and inactive participants 2013-10-01 118
Total participants 2013-10-01 118
2012: BLACK STONE MINERALS HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 103
Total of all active and inactive participants 2012-10-01 103
Total participants 2012-10-01 103

Measure	Date	Value
2014: BLACK STONE MINERALS HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	118
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	0
Total of all active and inactive participants	2014-10-01	0
Total participants	2014-10-01	0
2013: BLACK STONE MINERALS HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	103
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	118
Total of all active and inactive participants	2013-10-01	118
Total participants	2013-10-01	118
2012: BLACK STONE MINERALS HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	103
Total of all active and inactive participants	2012-10-01	103
Total participants	2012-10-01	103

Form 5500 Responses for BLACK STONE MINERALS HEALTH & WELFARE PLAN

2014: BLACK STONE MINERALS HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	Yes
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2013: BLACK STONE MINERALS HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2012: BLACK STONE MINERALS HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	First time form 5500 has been submitted	Yes
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

594159

Policy instance

Insurance contract or identification number	594159
Number of Individuals Covered	118
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $84,685
Total amount of fees paid to insurance company	USD $797
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	Yes
Vision Insurance Welfare Benefit	Yes
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 $1,704,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $84,685
Amount paid for insurance broker fees	797
Additional information about fees paid to insurance broker	VOLUME INCENTIVES AND NON-MONETARY
Insurance broker organization code?	3
Insurance broker name	BOWEN MICLETTE & BRITT INS AGEN

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

K101013

Policy instance

Insurance contract or identification number	K101013
Number of Individuals Covered	104
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $13,428
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	Yes
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 $68,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,428
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	BOWEN MICLETTE & BRITT INS AGENCY

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

594159

Policy instance

Insurance contract or identification number	594159
Number of Individuals Covered	105
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $83,929
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	Yes
Vision Insurance Welfare Benefit	Yes
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 $1,539,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $83,929
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	BOWEN MICLETTE & BRITT INS AGENCY

Potentially related plans

BLACK STONE HEALTH PC 401 K PROFIT SHARING PLAN TRUST [EIN = 465078872]

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Company Name:	BLACK STONE NATURAL RESOURCES MANAGEMENT COMPANY
Employer identification number (EIN):	760499297
NAIC Classification:	551112
NAIC Description:	Offices of Other Holding Companies