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| Plan Name | ARLINGTON COAL & LUMBER CO. MEDICAL PLAN |
| Plan identification number | 506 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ARLINGTON COAL & LUMBER COMPANY |
| Employer identification number (EIN): | 041040820 |
| NAIC Classification: | 444190 |
| NAIC Description: | Other Building Material Dealers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 506 | 2023-06-15 | JOHN P. BURKE | 2024-10-15 | ||
| 506 | 2022-06-15 | JOHN BURKE | 2023-12-03 | ||
| 506 | 2021-06-15 | JOHN BURKE | 2022-10-25 |
| 2023: ARLINGTON COAL & LUMBER CO. MEDICAL PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-06-15 | Type of plan entity | Single employer plan |
| 2023-06-15 | Plan funding arrangement – Insurance | Yes |
| 2023-06-15 | Plan benefit arrangement – Insurance | Yes |
| 2022: ARLINGTON COAL & LUMBER CO. MEDICAL PLAN 2022 form 5500 responses | ||
| 2022-06-15 | Type of plan entity | Single employer plan |
| 2022-06-15 | Plan funding arrangement – Insurance | Yes |
| 2022-06-15 | Plan benefit arrangement – Insurance | Yes |
| 2021: ARLINGTON COAL & LUMBER CO. MEDICAL PLAN 2021 form 5500 responses | ||
| 2021-06-15 | Type of plan entity | Single employer plan |
| 2021-06-15 | First time form 5500 has been submitted | Yes |
| 2021-06-15 | Plan funding arrangement – Insurance | Yes |
| 2021-06-15 | Plan benefit arrangement – Insurance | Yes |
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) | |||||||||||||||||||
| Policy contract number | 55337000 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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| TUFTS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60117 ) | |||||||||||||||||||
| Policy contract number | 11799000 | ||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||
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| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) | |||||||||||||||||||
| Policy contract number | 55337000 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) | |||||||||||||||||||
| Policy contract number | 55337000 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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