401k Plan data: CAPITAL BLUE CROSS SEVERANCE PAY PLAN plan

CAPITAL BLUE CROSS SEVERANCE PAY PLAN 401k Plan overview

Plan Name	CAPITAL BLUE CROSS SEVERANCE PAY PLAN
Plan identification number	507

CAPITAL BLUE CROSS SEVERANCE PAY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Severance pay Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CAPITAL BLUE CROSS has sponsored the creation of one or more 401k plans.

Company Name: CAPITAL BLUE CROSS

Employer identification number (EIN): 230455154

NAIC Classification: 524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPITAL BLUE CROSS SEVERANCE PAY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2022-01-01
507 2021-01-01
507 2020-01-01
507 2019-01-01
507 2018-01-01
507 2017-01-01 KIERAN HULL
507 2016-01-01 KIERAN HULL
507 2015-01-01 KIERAN HULL KIERAN HULL 2016-09-07
507 2014-01-01 KIERAN HULL KIERAN HULL 2015-09-10
507 2013-01-01 KIERAN HULL KIERAN HULL 2014-09-12
507 2012-01-01 KIERAN HULL
507 2011-01-01 KIERAN HULL
507 2009-01-01 KIERAN HULL

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
507	2022-01-01
507	2021-01-01
507	2020-01-01
507	2019-01-01
507	2018-01-01
507	2017-01-01	KIERAN HULL
507	2016-01-01	KIERAN HULL
507	2015-01-01	KIERAN HULL	KIERAN HULL	2016-09-07
507	2014-01-01	KIERAN HULL	KIERAN HULL	2015-09-10
507	2013-01-01	KIERAN HULL	KIERAN HULL	2014-09-12
507	2012-01-01	KIERAN HULL
507	2011-01-01	KIERAN HULL
507	2009-01-01	KIERAN HULL

Plan Statistics for CAPITAL BLUE CROSS SEVERANCE PAY PLAN

401k plan membership statisitcs for CAPITAL BLUE CROSS SEVERANCE PAY PLAN

Measure Date Value
2022: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 2,240
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 2,277
Number of retired or separated participants receiving benefits 2022-01-01 9
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 2,286
2021: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 2,219
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 2,170
Number of retired or separated participants receiving benefits 2021-01-01 70
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 2,240
2020: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,981
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 2,218
Number of retired or separated participants receiving benefits 2020-01-01 21
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 2,239
2019: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,931
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,959
Number of retired or separated participants receiving benefits 2019-01-01 22
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 1,981
2018: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,958
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,878
Number of retired or separated participants receiving benefits 2018-01-01 53
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 1,931
2017: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,930
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,852
Number of retired or separated participants receiving benefits 2017-01-01 106
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 1,958
2016: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,953
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,905
Number of retired or separated participants receiving benefits 2016-01-01 25
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 1,930
2015: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2,033
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,942
Number of retired or separated participants receiving benefits 2015-01-01 11
Total of all active and inactive participants 2015-01-01 1,953
Total participants 2015-01-01 1,953
2014: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,011
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,992
Number of retired or separated participants receiving benefits 2014-01-01 41
Total of all active and inactive participants 2014-01-01 2,033
Total participants 2014-01-01 2,033
2013: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,887
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,992
Number of retired or separated participants receiving benefits 2013-01-01 19
Total of all active and inactive participants 2013-01-01 2,011
Total participants 2013-01-01 2,011
2012: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 54
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,872
Number of retired or separated participants receiving benefits 2012-01-01 15
Total of all active and inactive participants 2012-01-01 1,887
Total participants 2012-01-01 1,887
2011: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 66
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 54
Total of all active and inactive participants 2011-01-01 54
Total participants 2011-01-01 54
2009: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 178
Total of all active and inactive participants 2009-01-01 178
Total participants 2009-01-01 178

Measure	Date	Value
2022: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	2,240
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	2,277
Number of retired or separated participants receiving benefits	2022-01-01	9
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	2,286
2021: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,219
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	2,170
Number of retired or separated participants receiving benefits	2021-01-01	70
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	2,240
2020: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,981
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	2,218
Number of retired or separated participants receiving benefits	2020-01-01	21
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	2,239
2019: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,931
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,959
Number of retired or separated participants receiving benefits	2019-01-01	22
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	1,981
2018: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,958
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,878
Number of retired or separated participants receiving benefits	2018-01-01	53
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	1,931
2017: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,930
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,852
Number of retired or separated participants receiving benefits	2017-01-01	106
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	1,958
2016: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,953
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,905
Number of retired or separated participants receiving benefits	2016-01-01	25
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	1,930
2015: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2,033
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,942
Number of retired or separated participants receiving benefits	2015-01-01	11
Total of all active and inactive participants	2015-01-01	1,953
Total participants	2015-01-01	1,953
2014: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,011
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,992
Number of retired or separated participants receiving benefits	2014-01-01	41
Total of all active and inactive participants	2014-01-01	2,033
Total participants	2014-01-01	2,033
2013: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,887
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,992
Number of retired or separated participants receiving benefits	2013-01-01	19
Total of all active and inactive participants	2013-01-01	2,011
Total participants	2013-01-01	2,011
2012: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	54
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,872
Number of retired or separated participants receiving benefits	2012-01-01	15
Total of all active and inactive participants	2012-01-01	1,887
Total participants	2012-01-01	1,887
2011: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	66
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	54
Total of all active and inactive participants	2011-01-01	54
Total participants	2011-01-01	54
2009: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	178
Total of all active and inactive participants	2009-01-01	178
Total participants	2009-01-01	178

Form 5500 Responses for CAPITAL BLUE CROSS SEVERANCE PAY PLAN

2022: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: CAPITAL BLUE CROSS SEVERANCE PAY PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: CAPITAL BLUE CROSS SEVERANCE PAY 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	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: CAPITAL BLUE CROSS SEVERANCE PAY 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 – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: CAPITAL BLUE CROSS SEVERANCE PAY 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 – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: CAPITAL BLUE CROSS SEVERANCE PAY 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 – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: CAPITAL BLUE CROSS SEVERANCE PAY 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 – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: CAPITAL BLUE CROSS SEVERANCE PAY 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 – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: CAPITAL BLUE CROSS SEVERANCE PAY 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 – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	CAPITAL BLUE CROSS
Employer identification number (EIN):	230455154
NAIC Classification:	524140