Alabama Dental Association

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Three-digit plan number (PN)	501
Effective date of plan	2018-09-01
Business code	813000
Sponsor’s telephone number	3342651684
Plan sponsor’s mailing address	836 WASHINGTON AVE, MONTGOMERY, AL, 361043839
Plan sponsor’s address	836 WASHINGTON AVE, MONTGOMERY, AL, 361043839

Plan administrator’s name and address

Administrator’s EIN	204913990
Plan administrator’s name	ARSENAL INSURANCE MANAGEMENT
Plan administrator’s address	5151 HAMPSTEAD HIGH ST STE 200, MONTGOMERY, AL, 361166789
Administrator’s telephone number	3342607774

Number of participants as of the end of the plan year

Active participants

1143

Signature of

Role	Plan administrator
Date	2021-08-13
Name of individual signing	THOMAS TAYLOR
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2021-08-13
Name of individual signing	THOMAS TAYLOR
Valid signature	Filed with authorized/valid electronic signature