2015-10-09T12:16:35-05:00 2014-12-31 550526247 WILSON KOZICKI & GWYNN PLLC 32 TWENTIETH STREET SUITE 300 WHEELING WV 26003 990 2014-01-01 300002072 WV-OH SUPPLEMENTAL HEALTH PLAN WV-O 3045250331 3150 US ROUTE 60 ONA WV 25545 JOHN D GALLOWAY CPA ADMINISTRATOR 3047813928 2015-10-08 NANCY J GWYNN CPA P01447261 3042322280 2015-10-08 2014 2016-02-25 16:41:14Z DANA JOE SAMPLES 800 INDIANA AVENUE CHARLESTON WV 25302 2787759 0 X NA X 2001 WV PROVIDING SUPPLEMENTAL HEALTH PREMIUMS AND WEEKLY DISABILITY BENEFITS TO ELIGIBLE MEMBERS 12 12 45 12 0 0 0 0 844183 997579 203759 151546 0 0 1047942 1149125 0 0 779582 1010773 0 0 0 0 0 50105 57535 829687 1068308 218255 80817 3998982 4073627 15251 19245 3983731 4054382 TO PROVIDE SUPPLEMENTAL HEALTH PREMIUMS & WEEKLY DISABILITY BENEFITS TO ELIGIBLE MEMBERS OF PARTICIPATING INTERNATIONAL BROTHERHOOD OF ELECTRICAL WORKERS (IBEW) UNIONS 0 0 913889 THE PROVISION OF SUPPLEMENTAL HEALTH INSURANCE PREMIUMS FOR ELIGIBLE MEMBERS OF THE PARTICIPATING LOCAL IBEW UNIONS 96884 THE PROVISION OF SUPPLEMENTAL DISABILITY BENEFITS TO ELIGIBLE MEMBERS OF PARTICIPATING IBEW LOCAL UNIONS 1010773 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 45 1 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X AMERICAN BENEFIT CORPORATION 3045250331 3150 US ROUTE 60 ONA WV 25545 X TROY FERRELL TRUSTEE 1.00 X 0 0 0 SHANE FERGUSON TRUSTEE 1.00 X 0 0 0 THOMAS CONNER TRUSTEE 1.00 X 0 0 0 LYNFORD LOVELL TRUSTEE 1.00 X 0 0 0 WILLIAM HAMILTON TRUSTEE 1.00 X 0 0 0 ROBERT A KUBOVICZ TRUSTEE 1.00 X 0 0 0 STEVEN ALLRED TRUSTEE 1.00 X 0 0 0 JEFF WILLIAMSON TRUSTEE 1.00 X 0 0 0 JAMES BANE TRUSTEE 1.00 X 0 0 0 BRIAN DAMANT TRUSTEE 1.00 X 0 0 0 DANA JOE SAMPLES BOARD CHAIRMAN 1.00 X 0 0 0 DAVID K ROGERS SECRETARY / TREASURER 1.00 X 0 0 0 0 0 0 0 0 0 0 0 EMPLOYER CONTRIBUTIONS 525100 997579 997579 997579 146992 146992 1643188 1638634 4554 4554 4554 1149125 1149125 0 0 1010773 19200 3228 11040 14982 4500 1481 3104 1068308 159046 247138 94173 89196 68640 77160 3663303 3650053 5929 2476 7891 7604 3998982 4073627 15251 19245 15251 19245 X 0 0 0 0 3983731 4054382 3983731 4054382 3998982 4073627 80817 -10166 0 X 0 1 X 1 0 0 1123975 -10168 -10168 1134143 14982 14982 1149125 1053326 0 1053326 14982 14982 1068308 Form 990, Part VI, Section A, line 3 THE TRUSTEES FOR THE FUND ENGAGED AMERICAN BENEFIT CORPORATION TO PROVIDE ADMINISTRATIVE SERVICES FOR THE PLAN EFFECTIVE 1/1/2007. Form 990, Part VI, Section B, line 11 THE ORGANIZATION'S FORM 990 IS PREPARED ANNUALLY BY AN INDEPENDENT ACCOUNTING FIRM. THE FIRM SENDS A DRAFT TO THE ONE OR MORE MEMBERS OF THE GOVERNING BODY TO BE DISTRIBUTED TO THE REMAINING MEMBERS BEFORE THE FORM IS SIGNED BY AN AUTHORIZED MEMBER AND FILED WITH THE APPROPRIATE TAX AUTHORITIES. Form 990, Part VI, Section C, line 19 THIS 990 IS ALWAYS PUBLICALLY AVAILABLE THROUGH GUIDESTAR.COM; HOWEVER, THE PLAN'S GOVERNING DOCUMENTS AND AUDITED FINANCIAL STATEMENTS ARE ONLY AVAILABLE UPON REQUEST TO INTERESTED PARTIES. SCHEDULE R, PART II, III & IV SCHEDULE R, PARTS II- IV. CONTRIBUTING EMPLOYERS AND ALL OTHER NECESSARY INFORMATION IS MAINTAINED WITHIN THE ORGANIZATION AND IS AVAILABLE UPON REQUEST FOR ANY INTERESTED PARTY. SEE SCHEDULE O SEE SCHEDULE O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0