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| Plan Name | CHRIST COMMUNITY HEALTH SERVICES, INC. MEDICAL AND DENTAL PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CHRIST COMMUNITY HEALTH SERVICES, INC. |
| Employer identification number (EIN): | 621583270 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2012-04-01 | DAVID WAGNER | 2019-07-21 | ||
| 504 | 2011-04-01 | DAVID WAGNER | 2019-07-21 | ||
| 504 | 2010-04-01 | DAVID WAGNER | 2019-07-21 | ||
| 504 | 2009-04-01 | DAVID WAGNER | 2019-07-21 | ||
| 504 | 2008-04-01 | DAVID WAGNER | 2019-07-21 | ||
| 504 | 2007-04-01 | DAVID WAGNER | 2019-07-21 |
| 2012: CHRIST COMMUNITY HEALTH SERVICES, INC. MEDICAL AND DENTAL PLAN 2012 form 5500 responses | ||
|---|---|---|
| 2012-04-01 | Type of plan entity | Single employer plan |
| 2012-04-01 | This submission is the final filing | Yes |
| 2012-04-01 | Plan funding arrangement – Insurance | Yes |
| 2012-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: CHRIST COMMUNITY HEALTH SERVICES, INC. MEDICAL AND DENTAL PLAN 2011 form 5500 responses | ||
| 2011-04-01 | Type of plan entity | Single employer plan |
| 2011-04-01 | Plan funding arrangement – Insurance | Yes |
| 2011-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: CHRIST COMMUNITY HEALTH SERVICES, INC. MEDICAL AND DENTAL PLAN 2010 form 5500 responses | ||
| 2010-04-01 | Type of plan entity | Single employer plan |
| 2010-04-01 | Plan funding arrangement – Insurance | Yes |
| 2010-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: CHRIST COMMUNITY HEALTH SERVICES, INC. MEDICAL AND DENTAL PLAN 2009 form 5500 responses | ||
| 2009-04-01 | Type of plan entity | Single employer plan |
| 2009-04-01 | Plan funding arrangement – Insurance | Yes |
| 2009-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: CHRIST COMMUNITY HEALTH SERVICES, INC. MEDICAL AND DENTAL PLAN 2008 form 5500 responses | ||
| 2008-04-01 | Type of plan entity | Single employer plan |
| 2008-04-01 | Plan funding arrangement – Insurance | Yes |
| 2008-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: CHRIST COMMUNITY HEALTH SERVICES, INC. MEDICAL AND DENTAL PLAN 2007 form 5500 responses | ||
| 2007-04-01 | Type of plan entity | Single employer plan |
| 2007-04-01 | First time form 5500 has been submitted | Yes |
| 2007-04-01 | Plan funding arrangement – Insurance | Yes |
| 2007-04-01 | Plan benefit arrangement – Insurance | Yes |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 110310 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 110310 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 110310 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 110310 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 110310 |
| Policy instance | 1 |
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 ) | |
| Policy contract number | 110310 |
| Policy instance | 1 |
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