401k Plan data: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN plan

BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 401k Plan overview

Plan Name	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN
Plan identification number	001

BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021).
Plan covered by PBGC that was terminated and closed out for PBGC purposes - Before the end of the plan year (or a prior plan year), (1) the plan terminated in a standard (or distress) termination and completed the distribution of plan assets in satisfaction of all benefit liabilities (or all ERISA Title IV benefits for distress termination); or (2) a trustee was appointed for a terminated plan pursuant to ERISA section 4042.
Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).

401k Sponsoring company profile

BLUE CROSS & BLUE SHIELD OF RHODE ISLAND has sponsored the creation of one or more 401k plans.

Company Name: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND

Employer identification number (EIN): 050158952

NAIC Classification: 524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 SHANNON BROADBENT VISAEL RODRIGUEZ 2017-07-13
001 2015-01-01 SHANNON BROADBENT VISAEL RODRIGUEZ 2016-10-12
001 2014-01-01 SHANNON BROADBENT MICHELE LEDERBERG 2015-10-14
001 2013-01-01 SHANNON BROADBENT RICHARD KROPP 2014-10-15
001 2012-01-01 SHANNON BROADBENT ELLEN HARRISON 2013-10-15
001 2011-01-01 SHANNON BROADBENT ERIC GASBARRO 2012-10-16
001 2009-01-01 SHANNON BROADBENT ERIC GASBARRO 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	SHANNON BROADBENT	VISAEL RODRIGUEZ	2017-07-13
001	2015-01-01	SHANNON BROADBENT	VISAEL RODRIGUEZ	2016-10-12
001	2014-01-01	SHANNON BROADBENT	MICHELE LEDERBERG	2015-10-14
001	2013-01-01	SHANNON BROADBENT	RICHARD KROPP	2014-10-15
001	2012-01-01	SHANNON BROADBENT	ELLEN HARRISON	2013-10-15
001	2011-01-01	SHANNON BROADBENT	ERIC GASBARRO	2012-10-16
001	2009-01-01	SHANNON BROADBENT	ERIC GASBARRO	2010-10-14

Plan Statistics for BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN

401k plan membership statisitcs for BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN

Measure Date Value
2016: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,980
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,027
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 540
Number of retired or separated participants receiving benefits 2014-01-01 523
Number of other retired or separated participants entitled to future benefits 2014-01-01 878
Total of all active and inactive participants 2014-01-01 1,941
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 39
Total participants 2014-01-01 1,980
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2,090
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 597
Number of retired or separated participants receiving benefits 2013-01-01 506
Number of other retired or separated participants entitled to future benefits 2013-01-01 890
Total of all active and inactive participants 2013-01-01 1,993
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 34
Total participants 2013-01-01 2,027
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2,814
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 728
Number of retired or separated participants receiving benefits 2012-01-01 482
Number of other retired or separated participants entitled to future benefits 2012-01-01 848
Total of all active and inactive participants 2012-01-01 2,058
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 32
Total participants 2012-01-01 2,090
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 25
2011: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 3,039
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 850
Number of retired or separated participants receiving benefits 2011-01-01 438
Number of other retired or separated participants entitled to future benefits 2011-01-01 1,497
Total of all active and inactive participants 2011-01-01 2,785
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 29
Total participants 2011-01-01 2,814
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 15
2009: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 3,009
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 993
Number of retired or separated participants receiving benefits 2009-01-01 570
Number of other retired or separated participants entitled to future benefits 2009-01-01 1,401
Total of all active and inactive participants 2009-01-01 2,964
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 62
Total participants 2009-01-01 3,026
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 39

Measure	Date	Value
2016: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,980
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,027
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	540
Number of retired or separated participants receiving benefits	2014-01-01	523
Number of other retired or separated participants entitled to future benefits	2014-01-01	878
Total of all active and inactive participants	2014-01-01	1,941
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	39
Total participants	2014-01-01	1,980
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2,090
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	597
Number of retired or separated participants receiving benefits	2013-01-01	506
Number of other retired or separated participants entitled to future benefits	2013-01-01	890
Total of all active and inactive participants	2013-01-01	1,993
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	34
Total participants	2013-01-01	2,027
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2,814
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	728
Number of retired or separated participants receiving benefits	2012-01-01	482
Number of other retired or separated participants entitled to future benefits	2012-01-01	848
Total of all active and inactive participants	2012-01-01	2,058
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	32
Total participants	2012-01-01	2,090
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	25
2011: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3,039
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	850
Number of retired or separated participants receiving benefits	2011-01-01	438
Number of other retired or separated participants entitled to future benefits	2011-01-01	1,497
Total of all active and inactive participants	2011-01-01	2,785
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	29
Total participants	2011-01-01	2,814
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	15
2009: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	3,009
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	993
Number of retired or separated participants receiving benefits	2009-01-01	570
Number of other retired or separated participants entitled to future benefits	2009-01-01	1,401
Total of all active and inactive participants	2009-01-01	2,964
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	62
Total participants	2009-01-01	3,026
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	39

Financial Data on BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN

Measure	Date	Value
2016 : BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-23	$0
Total plan liabilities at end of year	2016-12-23	$0
Total plan liabilities at beginning of year	2016-12-23	$0
Total income from all sources	2016-12-23	$131,569
Expenses. Total of all expenses incurred	2016-12-23	$164,838
Total plan assets at end of year	2016-12-23	$0
Total plan assets at beginning of year	2016-12-23	$33,269
Value of fidelity bond covering the plan	2016-12-23	$5,000,000
Total contributions received or receivable from participants	2016-12-23	$0
Expenses. Other expenses not covered elsewhere	2016-12-23	$140,583
Contributions received from other sources (not participants or employers)	2016-12-23	$0
Other income received	2016-12-23	$131,569
Noncash contributions received	2016-12-23	$0
Net income (gross income less expenses)	2016-12-23	$-33,269
Net plan assets at end of year (total assets less liabilities)	2016-12-23	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-12-23	$33,269
Total contributions received or receivable from employer(s)	2016-12-23	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-23	$24,255
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-23	$0
2015 : BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$216,851
Total loss/gain on sale of assets	2015-12-31	$-3,547,974
Total of all expenses incurred	2015-12-31	$259,227,210
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$258,777,472
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$2,594,387
Value of total assets at end of year	2015-12-31	$33,269
Value of total assets at beginning of year	2015-12-31	$259,043,628
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$449,738
Total interest from all sources	2015-12-31	$138,916
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$468,388
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$468,388
Administrative expenses professional fees incurred	2015-12-31	$153,906
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$5,000,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$5,506,725
Other income not declared elsewhere	2015-12-31	$21,330
Administrative expenses (other) incurred	2015-12-31	$112,860
Total non interest bearing cash at end of year	2015-12-31	$23,220
Total non interest bearing cash at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-259,010,359
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$33,269
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$259,043,628
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$213,263,084
Value of interest in pooled separate accounts at end of year	2015-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$39,460,132
Interest earned on other investments	2015-12-31	$138,916
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$10,049
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$813,687
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$160,166,240
Net investment gain/loss from pooled separate accounts	2015-12-31	$541,804
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$2,594,387
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$98,611,232
Contract administrator fees	2015-12-31	$182,972
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Aggregate proceeds on sale of assets	2015-12-31	$220,898,392
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$224,446,366
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	LGC&D LLP
Accountancy firm EIN	2015-12-31	453994797
2014 : BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$2,634,630
Total unrealized appreciation/depreciation of assets	2014-12-31	$2,634,630
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$12,377,789
Total loss/gain on sale of assets	2014-12-31	$884,041
Total of all expenses incurred	2014-12-31	$12,734,011
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$12,370,716
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$0
Value of total assets at end of year	2014-12-31	$259,043,628
Value of total assets at beginning of year	2014-12-31	$259,399,850
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$363,295
Total interest from all sources	2014-12-31	$68,803
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$669,020
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$669,020
Administrative expenses professional fees incurred	2014-12-31	$100,755
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$5,000,000
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$5,506,725
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$35,531,146
Other income not declared elsewhere	2014-12-31	$1,617,066
Administrative expenses (other) incurred	2014-12-31	$96,509
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-356,222
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$259,043,628
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$259,399,850
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Assets. partnership/joint venture interests at beginning of year	2014-12-31	$15,148,240
Investment advisory and management fees	2014-12-31	$164,531
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$213,263,084
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$112,422,859
Value of interest in pooled separate accounts at end of year	2014-12-31	$39,460,132
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$95,552,722
Interest earned on other investments	2014-12-31	$68,803
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$813,687
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$744,883
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$1,166,284
Net investment gain/loss from pooled separate accounts	2014-12-31	$5,337,945
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$12,370,716
Contract administrator fees	2014-12-31	$1,500
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Aggregate proceeds on sale of assets	2014-12-31	$16,032,281
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$15,148,240
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	LGC&D LLP
Accountancy firm EIN	2014-12-31	453994797
2013 : BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$361,128
Total unrealized appreciation/depreciation of assets	2013-12-31	$361,128
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$40,932,837
Total loss/gain on sale of assets	2013-12-31	$-2,182,420
Total of all expenses incurred	2013-12-31	$20,212,769
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$19,779,210
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$0
Value of total assets at end of year	2013-12-31	$259,399,850
Value of total assets at beginning of year	2013-12-31	$238,679,782
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$433,559
Total interest from all sources	2013-12-31	$112,849
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$456,412
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$456,412
Administrative expenses professional fees incurred	2013-12-31	$151,431
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$10,000,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$35,531,146
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$31,043,534
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$440,014
Other income not declared elsewhere	2013-12-31	$829,842
Administrative expenses (other) incurred	2013-12-31	$85,219
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$20,720,068
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$259,399,850
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$238,679,782
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Assets. partnership/joint venture interests at end of year	2013-12-31	$15,148,240
Assets. partnership/joint venture interests at beginning of year	2013-12-31	$14,121,093
Investment advisory and management fees	2013-12-31	$195,559
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$112,422,859
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$64,077,043
Value of interest in pooled separate accounts at end of year	2013-12-31	$95,552,722
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$128,342,671
Interest earned on other investments	2013-12-31	$112,849
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$744,883
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$655,427
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$10,069,541
Net investment gain/loss from pooled separate accounts	2013-12-31	$31,285,485
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$0
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$19,779,210
Contract administrator fees	2013-12-31	$1,350
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Aggregate proceeds on sale of assets	2013-12-31	$30,953,200
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$33,135,620
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	PRICEWATERHOUSECOOPERS LLP
Accountancy firm EIN	2013-12-31	133178044
2012 : BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$5,159,542
Total unrealized appreciation/depreciation of assets	2012-12-31	$5,159,542
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$45,878,254
Total loss/gain on sale of assets	2012-12-31	$12,475
Total of all expenses incurred	2012-12-31	$40,062,828
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$39,701,662
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$10,937,444
Value of total assets at end of year	2012-12-31	$238,679,782
Value of total assets at beginning of year	2012-12-31	$232,864,356
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$361,166
Total interest from all sources	2012-12-31	$134,669
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$680,377
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$680,377
Administrative expenses professional fees incurred	2012-12-31	$96,677
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$10,000,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$31,043,534
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$27,448,588
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$440,014
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$106,365
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$5,815,426
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$238,679,782
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$232,864,356
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Assets. partnership/joint venture interests at end of year	2012-12-31	$14,121,093
Assets. partnership/joint venture interests at beginning of year	2012-12-31	$12,777,513
Investment advisory and management fees	2012-12-31	$158,124
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$64,077,043
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$59,058,162
Value of interest in pooled separate accounts at end of year	2012-12-31	$128,342,671
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$130,464,325
Interest earned on other investments	2012-12-31	$134,669
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$655,427
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$3,115,768
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$9,741,074
Net investment gain/loss from pooled separate accounts	2012-12-31	$19,212,673
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$10,937,444
Employer contributions (assets) at end of year	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$39,701,662
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Aggregate proceeds on sale of assets	2012-12-31	$158,124
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$145,649
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	PRICEWATERHOUSECOOPERS LLP
Accountancy firm EIN	2012-12-31	134008324
2011 : BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$-1,697,080
Total unrealized appreciation/depreciation of assets	2011-12-31	$-1,697,080
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$12,337,549
Total loss/gain on sale of assets	2011-12-31	$-7,702
Total of all expenses incurred	2011-12-31	$41,226,252
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$40,868,439
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$11,459,450
Value of total assets at end of year	2011-12-31	$232,864,356
Value of total assets at beginning of year	2011-12-31	$261,753,059
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$357,813
Total interest from all sources	2011-12-31	$1,248,667
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$2,263,834
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$2,263,834
Administrative expenses professional fees incurred	2011-12-31	$76,987
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$10,000,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$27,448,588
Administrative expenses (other) incurred	2011-12-31	$106,365
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-28,888,703
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$232,864,356
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$261,753,059
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Assets. partnership/joint venture interests at end of year	2011-12-31	$12,777,513
Assets. partnership/joint venture interests at beginning of year	2011-12-31	$14,656,757
Investment advisory and management fees	2011-12-31	$174,461
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$59,058,162
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$52,006,216
Value of interest in pooled separate accounts at end of year	2011-12-31	$130,464,325
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$158,458,944
Interest earned on other investments	2011-12-31	$1,248,667
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$3,115,768
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$36,631,142
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-3,301,888
Net investment gain/loss from pooled separate accounts	2011-12-31	$2,372,268
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$11,459,450
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$40,868,439
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Aggregate proceeds on sale of assets	2011-12-31	$174,461
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$182,163
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	LEFKOWITZ,GARFINKEL,CHAMPI,DERIENZO
Accountancy firm EIN	2011-12-31	050456296
2010 : BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$3,014,249
Total unrealized appreciation/depreciation of assets	2010-12-31	$3,014,249
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$51,607,235
Total loss/gain on sale of assets	2010-12-31	$10,884
Total of all expenses incurred	2010-12-31	$8,545,026
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$8,247,688
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$11,300,000
Value of total assets at end of year	2010-12-31	$261,753,059
Value of total assets at beginning of year	2010-12-31	$218,690,850
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$297,338
Total interest from all sources	2010-12-31	$1,656,976
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$688,688
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$688,688
Administrative expenses professional fees incurred	2010-12-31	$136,014
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$10,000,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Administrative expenses (other) incurred	2010-12-31	$3,918
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$43,062,209
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$261,753,059
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$218,690,850
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Assets. partnership/joint venture interests at end of year	2010-12-31	$14,656,757
Assets. partnership/joint venture interests at beginning of year	2010-12-31	$11,789,030
Investment advisory and management fees	2010-12-31	$157,406
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$52,006,216
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$32,597,699
Value of interest in pooled separate accounts at end of year	2010-12-31	$158,458,944
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$134,602,200
Interest earned on other investments	2010-12-31	$1,656,976
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$36,631,142
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$38,201,921
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$7,944,829
Net investment gain/loss from pooled separate accounts	2010-12-31	$26,991,609
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$11,300,000
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$1,500,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$8,247,688
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Aggregate proceeds on sale of assets	2010-12-31	$157,406
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$146,522
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	LEFKOWITZ,GARFINKEL,CHAMPI,DERIENZO
Accountancy firm EIN	2010-12-31	050456296
2009 : BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN

2016: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
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 funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

PF 593

Policy instance

Insurance contract or identification number	PF 593
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

PF 593

Policy instance

Insurance contract or identification number	PF 593
Number of Individuals Covered	1980
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

SA 12723

Policy instance

Insurance contract or identification number	SA 12723
Number of Individuals Covered	2027
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	GROUP ANNUITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

PF 593

Policy instance

Insurance contract or identification number	PF 593
Number of Individuals Covered	2027
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	GROUP ANNUITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

SA 12723

Policy instance

Insurance contract or identification number	SA 12723
Number of Individuals Covered	2090
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	GROUP ANNUITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Insurance broker name

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

PF 593

Policy instance

Insurance contract or identification number	PF 593
Number of Individuals Covered	2090
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	GROUP ANNUITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Insurance broker name

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

PF 593

Policy instance

Insurance contract or identification number	PF 593
Number of Individuals Covered	2814
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	GROUP ANNUITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

SA 12723

Policy instance

Insurance contract or identification number	SA 12723
Number of Individuals Covered	2814
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	GROUP ANNUITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

PF 593

Policy instance

Insurance contract or identification number	PF 593
Number of Individuals Covered	3039
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	GROUP ANNUITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

SA 12723

Policy instance

Insurance contract or identification number	SA 12723
Number of Individuals Covered	3039
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	GROUP ANNUITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND
Employer identification number (EIN):	050158952
NAIC Classification:	524140