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| Plan Name | UAHN EMPLOYER DENTAL SERVICE PLAN |
| Plan identification number | 510 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | THE UNIVERSITY OF ARIZONA HEALTH NETWORK |
| Employer identification number (EIN): | 272936985 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 510 | 2012-01-01 | JOHN MARQUES | MISTY HANSEN | 2013-07-26 |
| Measure | Date | Value |
|---|---|---|
| 2012: UAHN EMPLOYER DENTAL SERVICE PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-01-01 | 936 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 1,086 |
| Total of all active and inactive participants | 2012-01-01 | 1,086 |
| 2012: UAHN EMPLOYER DENTAL SERVICE PLAN 2012 form 5500 responses | ||
|---|---|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | First time form 5500 has been submitted | Yes |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | Yes |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| EMPLOYERS DENTAL SERVICES (National Association of Insurance Commissioners NAIC id number: 53090 ) | |||||||||||||||||||||||
| Policy contract number | 17750 9225 1867 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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