401k Plan data: EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN plan

EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN 401k Plan overview

Plan Name	EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN
Plan identification number	501

EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Vision Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

EAGLE SPECIALTY MATERIALS, LLC DBA PRAIRIE EAGLE MINING CO. has sponsored the creation of one or more 401k plans.

Company Name: EAGLE SPECIALTY MATERIALS, LLC DBA PRAIRIE EAGLE MINING CO.

Employer identification number (EIN): 843133021

NAIC Classification: 212110
NAIC Description: Coal Mining

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-01-01
501 2020-01-01

Plan Statistics for EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN

401k plan membership statisitcs for EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN

Measure Date Value
2020: EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 341
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 414
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 414

Measure	Date	Value
2020: EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	341
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	414
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	414

Form 5500 Responses for EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN

2020: EAGLE SPECIALTY MATERIALS, LLC MEDICAL PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	First time form 5500 has been submitted	Yes
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF WYOMING (National Association of Insurance Commissioners NAIC id number: 53767 )

Policy contract number

10502118 105021

Policy instance

Insurance contract or identification number	10502118 105021
Number of Individuals Covered	410
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
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	No
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 $9,090,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	EAGLE SPECIALTY MATERIALS, LLC DBA PRAIRIE EAGLE MINING CO.
Employer identification number (EIN):	843133021
NAIC Classification:	212110
NAIC Description:	Coal Mining