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| Plan Name | BLOODCENTER BASIC DENTAL PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BLOODCENTER OF WISCONSIN, INC |
| Employer identification number (EIN): | 390807235 |
| NAIC Classification: | 621510 |
| NAIC Description: | Medical and Diagnostic Laboratories |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2011-01-01 | CAROL TILLMAN | CARA OLSON | 2012-10-02 | |
| 504 | 2009-01-01 | JAMES SIMARAS |
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