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| Plan Name | BLUEGRASS NATURAL RESOURCES LLC HEALTH AND WELFARE BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BLUEGRASS NATURAL RESOURCES, LLC |
| Employer identification number (EIN): | 881711423 |
| NAIC Classification: | 212110 |
| NAIC Description: | Coal Mining |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-03-01 | TONY HARRIS | 2024-09-26 |
| Measure | Date | Value |
|---|---|---|
| 2023: BLUEGRASS NATURAL RESOURCES LLC HEALTH AND WELFARE BENEFITS PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-03-01 | 363 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-03-01 | 336 |
| Number of retired or separated participants receiving benefits | 2023-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-03-01 | 0 |
| Total of all active and inactive participants | 2023-03-01 | 336 |
| Number of employers contributing to the scheme | 2023-03-01 | 0 |
| 2023: BLUEGRASS NATURAL RESOURCES LLC HEALTH AND WELFARE BENEFITS PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-03-01 | Type of plan entity | Single employer plan |
| 2023-03-01 | Plan funding arrangement – Insurance | Yes |
| 2023-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 123924 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 606382 | ||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 5983177 | ||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||
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