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| Plan Name | THE SHADOWFAX CORPORATION HEALTH INSURANCE BENEFIT |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | THE SHADOWFAX CORPORATION |
| Employer identification number (EIN): | 232368549 |
| NAIC Classification: | 624310 |
| NAIC Description: | Vocational Rehabilitation Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2009-03-01 | ||||
| 502 | 2009-03-01 | THERESA A. LINEBAUGH |
| 2009: THE SHADOWFAX CORPORATION HEALTH INSURANCE BENEFIT 2009 form 5500 responses | ||
|---|---|---|
| 2009-03-01 | Type of plan entity | Single employer plan |
| 2009-03-01 | Submission has been amended | Yes |
| 2009-03-01 | This submission is the final filing | Yes |
| 2009-03-01 | Plan funding arrangement – Insurance | Yes |
| 2009-03-01 | Plan benefit arrangement – Insurance | Yes |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) | |
| Policy contract number | 1133 |
| Policy instance | 1 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) | |
| Policy contract number | 02895960 |
| Policy instance | 2 |
| KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 ) | |
| Policy contract number | 02895960 |
| Policy instance | 3 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) | |
| Policy contract number | 2387 |
| Policy instance | 4 |
| TEACHERS PROTECTIVE MUTUAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69353 ) | |
| Policy contract number | GBQ-6040 |
| Policy instance | 5 |
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