BLUE CROSS & BLUE SHIELD OF RHODE ISLAND GROUP BUSINESS TRAVEL ACCIDENT PLAN 401k Plan overview

BLUE CROSS & BLUE SHIELD OF RHODE ISLAND GROUP BUSINESS TRAVEL ACCIDENT PLAN Benefits

401k Sponsoring company profile

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

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
509	2022-09-23	LAURA THOMAS	2024-04-25
509	2021-09-23	KELSEY OWEN	2023-04-26
509	2020-09-23	LAURA THOMAS	2022-03-22

Plan Statistics for BLUE CROSS & BLUE SHIELD OF RHODE ISLAND GROUP BUSINESS TRAVEL ACCIDENT PLAN

Measure	Date	Value
2022: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND GROUP BUSINESS TRAVEL ACCIDENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-09-23	775
Total number of active participants reported on line 7a of the Form 5500	2022-09-23	899
Number of retired or separated participants receiving benefits	2022-09-23	0
Number of other retired or separated participants entitled to future benefits	2022-09-23	0
Total of all active and inactive participants	2022-09-23	899
2021: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND GROUP BUSINESS TRAVEL ACCIDENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-09-23	796
Total number of active participants reported on line 7a of the Form 5500	2021-09-23	775
Number of retired or separated participants receiving benefits	2021-09-23	0
Number of other retired or separated participants entitled to future benefits	2021-09-23	0
Total of all active and inactive participants	2021-09-23	775
2020: BLUE CROSS & BLUE SHIELD OF RHODE ISLAND GROUP BUSINESS TRAVEL ACCIDENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-09-23	769
Total number of active participants reported on line 7a of the Form 5500	2020-09-23	796
Number of retired or separated participants receiving benefits	2020-09-23	0
Number of other retired or separated participants entitled to future benefits	2020-09-23	0
Total of all active and inactive participants	2020-09-23	796

Form 5500 Responses for BLUE CROSS & BLUE SHIELD OF RHODE ISLAND GROUP BUSINESS TRAVEL ACCIDENT PLAN

Insurance Providers Used on plan

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• BLUE CROSS BLUE SHIELD OF WYOMING TAX-FAVORED SAVINGS PROGRAM [EIN = 830231011]
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• BLUE CROSS BLUE SHIELD EMPLOYEE MEDICAL PLAN [EIN = 630453343]
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• BLUE CROSS AND BLUE SHIELD OF ALABAMA GROUP HEALTH AND DENTAL CARE [EIN = 630103830]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 201182509]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA GROUP TRAVEL ACCIDENT INSURANCE [EIN = 630103830]
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• BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA [EIN = 270229866]
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• BLUE CROSS BLUE SHIELD DENTAL [EIN = 570678887]
• BLUE CROSS BLUE SHIELD OF ILLINOIS HMOS [EIN = 383984647]
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• BLUE CROSS AND BLUE SHIELD HOSPITAL AND MEDICAL INSURANCE PLAN [EIN = 380533740]
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• BLUE CROSS BLUE SHIELD HEALTH INS [EIN = 510333030]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 201137248]
• BLUE CROSS BLUE SHIELD OF NORTH CAROLINA [EIN = 561236854]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 201137248]
• BLUE CROSS BLUE SHIELD OF ILLINOIS GROUP HEALTH INSURANCE PLAN [EIN = 362754650]
• BLUE CROSS BLUE SHIELD NC [EIN = 141919474]
• BLUE CROSS BLUE SHIELD OF GREATER NY MEDICAL PLAN [EIN = 133957095]
• BLUE CROSS BLUE SHIELD OF MICHIGAN [EIN = 381362823]
• BLUE CROSS & BLUE SHIELD OF MICHIGAN GROUP INSURANCE PLAN [EIN = 381956049]
• BLUE CROSS OF NORTHWEST OHIO EMPLOYEES' RETIREMENT TRUST [EIN = 340648820]
• BLUE CROSS BLUE SHIELD DENTAL [EIN = 042103638]
• BLUE CROSS BLUE SHIELD GP HOSP AND MED SURG PL MAJOR MEDICAL COVERAGE [EIN = 610458355]
• BLUE CROSS BLUE SHIELD OF ILLINIOS HMOS [EIN = 363984647]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 561975885]
• BLUE CROSS & BLUE SHIELD OF ALABAMA ELECTIVE LIFE INSURANCE PLAN [EIN = 630103830]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 561625075]
• BLUE CROSS BLUE SHIELD OF RI [EIN = 160812661]
• BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA EMPLOYEE SAVINGS AND SALARY REDUCTION PLAN [EIN = 942872506]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 581622664]
• BLUE CROSS BLUE SHIELD OF MA GROUP HLTH INS EMPLS UNION BUTTERFIELD [EIN = 561628422]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 562161782]
• BLUE CROSS AND BLUE SHIELD PPO [EIN = 205832739]
• BLUE CROSS BLUE SHIELD COMPCARE [EIN = 391500683]
• BLUE CROSS BLUE SHIELD [EIN = 751299243]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 133082788]
• BLUE CROSS BLUE SHIELD OF MISSISSIPPI [EIN = 620510412]
• BLUE CROSS/BLUE SHIELD OF MICHIGAN GAYLORD DIVISION PLAN [EIN = 340549970]
• BLUE CROSS BLUE SHIELD GROUP INSURANCE [EIN = 160743037]
• BLUE CROSS OF NORTHEASTERN PENNSYLVANIA [EIN = 231743282]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 561038919]
• BLUE CROSS BLUE SHIELD ALABAMA [EIN = 630355713]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA [EIN = 630103830]
• BLUE CROSS BLUE SHIELD OF ALABAMA MEDICAL [EIN = 630843226]
• BLUE CROSS BLUE SHEILD OF NORTH CAROLINA [EIN = 562384240]
• BLUE CROSS BLUE SHIELD ALABAMA DENTAL [EIN = 630355713]
• BLUE CROSS BLUE SHIELD PLAN [EIN = 451580204]
• BLUE CROSS BLUE SHIELD OF MICHIGAN EMPLOYEES' MASTER RETIREMENT TRUST [EIN = 301140600]
• BLUE CROSS BLUE SHIELD OF MINNESOTA [EIN = 416050237]
• BLUE CROSS ANIMAL HOSPITAL GROUP 401(K) PLAN [EIN = 870903171]
• BLUE CROSS BLUE SHIELD OF ALABAMA MEDICAL [EIN = 630843226]
• BLUE CROSS BLUE SHIELD OF ARIZONA, INC. EXECUTIVE SEVERANCE PLAN [EIN = 860004538]
• BLUE CROSS BLUE SHIELD OF TEXAS MEDICAL INSURANCE PLAN [EIN = 842662763]
• BLUE CROSS BLUE SHIELD OF ALABAMA [EIN = 630843226]
• BLUE CROSS BLUE SHIELD OF NORTH DAKOTA HEALTHCARE REIMBURSEMENT PLAN [EIN = 262326076]
• BLUE CROSS BLUE SHIELD OF AZ [EIN = 882806512]
• BLUE CROSS PET CARE, INC 401K PLAN [EIN = 873520766]
• BLUE CROSS OF IDAHO RETIREE HEALTH REIMBURSEMENT ARRANGEMENT [EIN = 820344294]
• BLUE CROSS BLUE SHIELD OF ALABAMA [EIN = 831077369]
• BLUE CROSS BLUE SHIELD OF ALABAMA [EIN = 630843226]
• BLUE CROSS MEDICAL [EIN = 844205975]
• BLUE CROSS AND BLUE SHIELD OF MINNESOTA [EIN = 411500646]
• BLUE CROSS BLUE SHIELD OF TEXAS [EIN = 812845733]
• BLUE CROSS AND BLUE SHIELD OF MINNESOTA PENSION PLAN [EIN = 831330245]

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