UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 15
CERTIFICATION AND NOTICE OF TERMINATION OF REGISTRATION UNDER
SECTION 12(g) OF THE SECURITIES EXCHANGE ACT OF 1934 OR SUSPENSION OF
DUTY TO FILE REPORTS UNDER SECTIONS 13 AND 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934.
Commission File Number 001-16751
Employees 401(k) Thrift Plan
of Trigon Insurance Company
and
Trigon Insurance Company 401(k) Restoration Plan
(Exact name of registrant as specified in its charter)
120 Monument Circle
Indianapolis, Indiana 46204
(317) 488-6000
(Address, including zip code, and telephone number,
including area code, of registrants principal executive offices)
Plan Interests in the Employees 401(k) Thrift Plan
of Trigon Insurance Company
and
Plan Interests in the Trigon Insurance Company 401(k) Restoration Plan
(Title of each class of securities covered by this Form)
None
(Titles of all other classes of securities for which
a duty to file reports under section 13(a) or 15(d) remains)
Please place an X in the box(es) to designate the appropriate rule provision(s) relied upon to terminate or suspend the duty to file reports:
Rule 12g-4(a)(1)(i) |
[ ] |
Rule 12h-3(b)(1)(i) | [X] | |||||
Rule 12g-4(a)(1)(ii) |
[ ] |
Rule 12h-3(b)(1)(ii) | [ ] | |||||
Rule 12g-4(a)(2)(i) |
[ ] |
Rule 12h-3(b)(2)(i) | [ ] | |||||
Rule 12g-4(a)(2)(ii) |
[ ] |
Rule 12h-3(b)(2)(ii) | [ ] | |||||
Rule 15d-6 [ ] |
Approximate number of holders of record as of the certification or notice date: 38
*Effective January 31, 2004, the Employees 401(k) Thrift Plan of Trigon Insurance Company was merged into the Anthem 401(k) Long Term Savings Investment Plan.
Pursuant to the requirements of the Securities Exchange Act of 1934, the Employees 401(k) Thrift Plan of Trigon Insurance Company and the Trigon Insurance Company 401(k) Restoration Plan have caused this certification/notice to be signed on their behalf by the undersigned duly authorized person.
Date: February 23, 2004
ANTHEM 401(K) LONG TERM SAVINGS INVESTMENT PLAN, Successor by Plan Merger to the Employees 401(k) Thrift Plan of Trigon Insurance Company
| ||
By: | /s/ David R. Frick | |
David R. Frick Chairman of the Pension Committee of Anthem Insurance Companies, Inc. |
TRIGON INSURANCE COMPANY 401(K) RESTORATION PLAN
| ||
By: | /s/ David R. Frick | |
David R. Frick Chairman of the Pension Committee of Anthem Insurance Companies, Inc. |