401k Plan data: MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN plan

MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN 401k Plan overview

Plan Name	MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN
Plan identification number	508

MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN Benefits

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

401k Sponsoring company profile

MEWBOURNE OIL COMPANY has sponsored the creation of one or more 401k plans.

Company Name: MEWBOURNE OIL COMPANY

Employer identification number (EIN): 751254872

NAIC Classification: 211120
NAIC Description: Crude Petroleum Extraction

Additional information about MEWBOURNE OIL COMPANY

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 1991-05-13

Company Identification Number: 0008758306

Legal Registered Office Address: PO BOX 7698

TYLER
United States of America (USA)
75711

More information about MEWBOURNE OIL COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2023-01-01 CHAD BAIRD 2024-05-14
508 2022-07-01 CHAD BAIRD 2023-07-26
508 2021-07-01 CHAD BAIRD 2022-12-16
508 2020-07-01 CHAD BAIRD 2021-12-14
508 2019-07-01 GILBERT R. HEARN 2021-01-19
508 2018-07-01 GILBERT R. HEARN 2019-12-11
508 2018-07-01 GILBERT R. HEARN 2021-01-26
508 2017-07-01
508 2016-07-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
508	2023-01-01	CHAD BAIRD	2024-05-14
508	2022-07-01	CHAD BAIRD	2023-07-26
508	2021-07-01	CHAD BAIRD	2022-12-16
508	2020-07-01	CHAD BAIRD	2021-12-14
508	2019-07-01	GILBERT R. HEARN	2021-01-19
508	2018-07-01	GILBERT R. HEARN	2019-12-11
508	2018-07-01	GILBERT R. HEARN	2021-01-26
508	2017-07-01
508	2016-07-01

Form 5500 Responses for MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN

2023: MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Submission has been amended	Yes
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MEWBOURNE OIL COMPANY GROUP MEDICAL INSURANCE PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	First time form 5500 has been submitted	Yes
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

281561

Policy instance

Insurance contract or identification number	281561
Number of Individuals Covered	1592
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $19,597
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $230,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30090988

Policy instance

Insurance contract or identification number	30090988
Number of Individuals Covered	552
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $72,781
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

ETB-012675

Policy instance

Insurance contract or identification number	ETB-012675
Number of Individuals Covered	701
Insurance policy start date	2022-09-01
Insurance policy end date	2023-08-31
Total amount of commissions paid to insurance broker	USD $1,873
Total amount of fees paid to insurance company	USD $2,591
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $12,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

62220

Policy instance

Insurance contract or identification number	62220
Number of Individuals Covered	701
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $42,763
Total amount of fees paid to insurance company	USD $19,692
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $467,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

62220

Policy instance

Insurance contract or identification number	62220
Number of Individuals Covered	632
Insurance policy start date	2022-07-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $22,200
Total amount of fees paid to insurance company	USD $20,208
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $290,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE HARTFORD INS (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB012675

Policy instance

Insurance contract or identification number	ETB012675
Number of Individuals Covered	636
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $130
Total amount of fees paid to insurance company	USD $154
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30090988

Policy instance

Insurance contract or identification number	30090988
Number of Individuals Covered	471
Insurance policy start date	2022-07-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

343024

Policy instance

Insurance contract or identification number	343024
Number of Individuals Covered	636
Insurance policy start date	2022-07-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	Yes

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

Policy contract number

922422-009

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30090988

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB012675

Policy instance

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

62220

Policy instance

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

Policy contract number

922422-009

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30090988

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB012675

Policy instance

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

62220

Policy instance

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

62220

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB012675

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30090988

Policy instance

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

Policy contract number

922422 ET AL

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5372121

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB012675

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

ETB012675

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TS05372121

Policy instance

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Company Name:	MEWBOURNE OIL COMPANY
Employer identification number (EIN):	751254872
NAIC Classification:	211120
NAIC Description:	Crude Petroleum Extraction

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1991-05-13
Company Identification Number:	0008758306
Legal Registered Office Address:	PO BOX 7698 TYLER United States of America (USA) 75711