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	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
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 OF NORTHEASTERN PENNSYLVANIA [EIN = 231743282]
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• BLUE CROSS BLUE SHIELD OF ALABAMA MEDICAL [EIN = 630843226]
• BLUE CROSS BLUE SHEILD OF ALABAMA [EIN = 273410813]
• 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]
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• BLUE CROSS BLUE SHIELD OF ALABAMA [EIN = 630843226]
• BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA [EIN = 223851031]
• BLUE CROSS BLUE SHIELD OF ND SEVERANCE PLAN [EIN = 262326076]
• 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]

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