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| Plan Name | ANTHEM BLUE CROSS/BLUE SHIELD DENTAL PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | WINDHAM COMMUNITY MEMORIAL HOSPITAL INC |
| Employer identification number (EIN): | 060646966 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2009-10-01 | MARTIN LEVINE | |||
| 504 | 2008-10-01 | MARTIN LEVINE |
| Measure | Date | Value |
|---|---|---|
| 2009: ANTHEM BLUE CROSS/BLUE SHIELD DENTAL PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-10-01 | 632 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 521 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 107 |
| Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 0 |
| Total of all active and inactive participants | 2009-10-01 | 628 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-10-01 | 0 |
| Total participants | 2009-10-01 | 628 |
| 2008: ANTHEM BLUE CROSS/BLUE SHIELD DENTAL PLAN 2008 401k membership | ||
| Total participants, beginning-of-year | 2008-10-01 | 610 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-10-01 | 523 |
| Number of retired or separated participants receiving benefits | 2008-10-01 | 109 |
| Number of other retired or separated participants entitled to future benefits | 2008-10-01 | 0 |
| Total of all active and inactive participants | 2008-10-01 | 632 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2008-10-01 | 0 |
| Total participants | 2008-10-01 | 632 |
| 2009: ANTHEM BLUE CROSS/BLUE SHIELD DENTAL PLAN 2009 form 5500 responses | ||
|---|---|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Submission has been amended | Yes |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-10-01 | Plan is a collectively bargained plan | Yes |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: ANTHEM BLUE CROSS/BLUE SHIELD DENTAL PLAN 2008 form 5500 responses | ||
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | Yes |
| 2008-10-01 | Plan funding arrangement – Insurance | Yes |
| 2008-10-01 | Plan benefit arrangement – Insurance | Yes |
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