BLUE CROSS BLUE SHIELD OF MINNESOTA 401k Plan overview

BLUE CROSS BLUE SHIELD OF MINNESOTA Benefits

401k Sponsoring company profile

Company Name:	TRI-COUNTY COMMUNITY ACTION PROGRAM , INC
Employer identification number (EIN):	416050237
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-01-01	TERESA CARTER	2022-07-24

Plan Statistics for BLUE CROSS BLUE SHIELD OF MINNESOTA

Measure	Date	Value
2021: BLUE CROSS BLUE SHIELD OF MINNESOTA 2021 401k membership
Total participants, beginning-of-year	2021-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	84
Number of retired or separated participants receiving benefits	2021-01-01	0
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	84
Number of employers contributing to the scheme	2021-01-01	0

Form 5500 Responses for BLUE CROSS BLUE SHIELD OF MINNESOTA

Insurance Providers Used on plan

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• BLUE CROSS BLUE SHIELD HEALTH PLAN [EIN = 041106240]
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• BLUE CROSS OF IDAHO GROUP O. 10031115 [EIN = 820471954]
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• BLUE CROSS & BLUE SHIELD OF MS, INC. VOL GRP AD&D COMMERCIAL LIFE INS [EIN = 640295748]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA SHORT TERM DISABILITY PLAN [EIN = 630103830]
• BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. RETIREE WELFARE BENEFIT PLAN [EIN = 041045815]
• BLUE CROSS BLUE SHIELD OF FLORIDA [EIN = 201480564]
• BLUE CROSS BLUE SHIELD OF MI DENTAL INSURANCE [EIN = 382069753]
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• BLUE CROSS AND BLUE SHIELD OF LOUISIANA [EIN = 650394050]
• BLUE CROSS OF NORTHEASTERN PA [EIN = 593472656]
• BLUE CROSS HEALTH INSURANCE FOR EMPLOYEES OF GUTHRIE TOWANDA MEMORIAL HOSPITAL [EIN = 240786657]
• BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS, INC. EMPLOYEE SAVINGS PLAN [EIN = 041045815]
• BLUE CROSS-BLUE SHIELD PLAN FOR HOURLY EMPLOYEES OF OCCIDENTAL CHEMICAL CORPORATION AT NIAGARA FALLS [EIN = 160484732]
• BLUE CROSS BLUE SHIELD OF WYOMING TAX-FAVORED SAVINGS PROGRAM [EIN = 830231011]
• BLUE CROSS AND BLUE SHIELD ASSOCIATION LONG TERM DISABILITY PROGRAM [EIN = 135656874]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 561987279]
• BLUE CROSS BLUE SHIELD EMPLOYEE MEDICAL PLAN [EIN = 630453343]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA WELFARE BENEFIT PLAN [EIN = 560894904]
• BLUE CROSS BLUE SHIELD OF MICHIGAN HEALTH CARE [EIN = 382069753]
• BLUE CROSS BLUE SHIELD OF TENNESSEE [EIN = 621840271]
• BLUE CROSS BLUE SHIELD HEALTH AND DENTAL [EIN = 411795536]
• BLUE CROSS AND BLUE SHIELD ASSOCIATION TAX-FAVORED SAVINGS PROGRAM [EIN = 135656874]
• BLUE CROSS BLUE SHIELD OF MI EMPLOYEES' RETIREMENT ACCOUNT PLAN [EIN = 382069753]
• BLUE CROSS & BLUE SHIELD OF MS INC GROUP LIFE INS BLUEBONNET LIFE PENSION [EIN = 640295748]
• BLUE CROSS & BLUE SHIELD OF MISS, INC. GROUP DENTAL PLAN [EIN = 640295748]
• 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 & BLUE SHIELD OF RHODE ISLAND RETIREMENT PLAN [EIN = 050158952]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA GROUP TRAVEL ACCIDENT INSURANCE [EIN = 630103830]
• BLUE CROSS BLUE SHIELD OF NORTH CAROLINA [EIN = 560340590]
• BLUE CROSS BLUE SHIELD OF FLORIDA BO [EIN = 592015694]
• BLUE CROSS GROUP PLAN [EIN = 111541330]
• BLUE CROSS BLUE SHIELD OF ARIZONA, INC. EMPLOYEE ASSISTANCE PROGRAM [EIN = 860004538]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA SEVERANCE PAY PLAN MANAGEMENT [EIN = 630103830]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA SEVERANCE PAY PLAN NON-EXEMPT [EIN = 630103830]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA RETIREMENT PLAN [EIN = 560894904]
• BLUE CROSS BLUE SHIELD OF OKLAHOMA [EIN = 274368749]
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• BLUE CROSS BLUE SHIELD OF ARIZONA, INC. VOLUNTARY LEGAL BENEFIT PLAN [EIN = 860004538]
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• BLUE CROSS & BLUE SHIELD OF MS INC COMPENSATION PLUS CAFETERIA PLAN [EIN = 640295748]
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• BLUE CROSS AND BLUE SHIELD OF KANSAS CITY 401(K) PLAN [EIN = 431257251]
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• BLUE CROSS BLUE SHIELD OF MICHIGAN GROUP TERM LIFE [EIN = 382069753]
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• BLUE CROSS AND BLUE SHIELD OF ALABAMA GROUP SEVERANCE PAY PLAN [EIN = 630103830]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA LONG TERM CARE PLAN [EIN = 630103830]
• BLUE CROSS BLUE SHIELD OF MICHIGAN HEALTH CARE REIMBURSEMENT ACCOUNT [EIN = 382069753]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA RETIREMENT PLAN [EIN = 630103830]
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• BLUE CROSS & BLUE SHIELD OF MS, INC. EMPLOYEE GROUP HEALTH PLAN [EIN = 640295748]
• BLUE CROSS BLUE SHIELD HEALTH PLAN ROGER WILLIAMS UNIVERSITY [EIN = 050277222]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 562120767]
• BLUE CROSS BLUE SHIELD OF WESTERN PA PORT ALLEGANY HOURLY [EIN = 250729265]
• BLUE CROSS AND BLUE SHIELD PLANS' NATIONAL RETIREE HEALTH BENEFITS TRUST [EIN = 367008317]
• BLUE CROSS BLUE SHIELD OF SC EMPLOYEE SAVINGS AND SALARY REDUCTION PLAN [EIN = 570287419]
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• BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. OMNIBUS WELFARE PLAN [EIN = 041045815]
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• BLUE CROSS AND BLUE SHIELD OF ALABAMA VOLUNTARY ACCIDENT INSURANCE PLAN [EIN = 630103830]
• BLUE CROSS BLUE SHIELD OF MICHIGAN EMPLOYEES' SAVINGS PLAN [EIN = 382069753]
• BLUE CROSS BLUE SHIELD AMERITAS [EIN = 470531394]
• BLUE CROSS AND BLUE SHIELD OF KANSAS CITY PENSION PLAN [EIN = 431257251]
• BLUE CROSS BLUE SHIELD OF FLORIDA [EIN = 621861889]
• BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN [EIN = 410984460]
• BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. RETIREE GROUP BENEFIT PLAN [EIN = 592015694]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA LONG TERM DISABILITY PLAN [EIN = 630103830]
• BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL [EIN = 166018833]
• BLUE CROSS BLUE SHIELD OF AL [EIN = 630455815]
• BLUE CROSS AND BLUE SHIELD FCU 401(K) PLAN AND TRUST [EIN = 930565976]
• BLUE CROSS LABORATORIES, INC. PROFIT SHARING PLAN [EIN = 952209117]
• BLUE CROSS PET HOSPITAL PENSION PLAN [EIN = 943383512]
• BLUE CROSS ANIMAL HOSPITAL, LTD. PROFIT SHARING PLAN [EIN = 411364646]
• BLUE CROSS BLUE SHIELD OF MAINE EMPLOYEES FEDERAL CREDIT UNION RETIREMENT SAVINGS PLAN & TRUST [EIN = 010263767]
• BLUE CROSS PET HOSPITAL 401K PROFIT SHARING PLAN [EIN = 800773675]
• BLUE CROSS PET HOSPITAL 401K PROFIT SHARING PLAN [EIN = 680250895]
• BLUE CROSS OF WESTERN PA MEDICARE SUPPLEMENT OVER 65 SPECIAL SEDALIA HOURLY [EIN = 250729265]
• BLUE CROSS BLUE SHIELD OF MICHIGAN [EIN = 381788719]
• BLUE CROSS BLUE SHIELD OF MICHIGAN REPRESENTED EMPLOYEES' RETIREMENT INCOME PLAN [EIN = 382069753]
• BLUE CROSS BLUE SHIELD OF MICHIGAN HEALTH CARE [EIN = 382069753]
• BLUE CROSS OF NORTH EASTERN PENNSYLVANIA [EIN = 202572391]
• BLUE CROSS BLUE SHIELD OF WYOMING FLEXIBLE BENEFIT PLAN [EIN = 830231011]
• BLUE CROSS BLUE SHIELD OF MICHIGAN FOR ALMA COLLEGE [EIN = 381359083]
• BLUE CROSS BLUE SHIELD [EIN = 751299243]
• BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA [EIN = 570621127]
• BLUE CROSS & BLUE SHIELD OF MS INC. GROUP LIFE INS BLUEBONNET LIFE [EIN = 640295748]
• BLUE CROSS BLUE SHIELD [EIN = 620427913]
• BLUE CROSS BLUE SHIELD OF RI PROVIDENCE METALLIZING CO., INC. [EIN = 050268053]
• BLUE CROSS BLUE SHIELD OF MASSACHUSETTS [EIN = 042111203]
• BLUE CROSS BLUE SHIELD OF DELAWARE RETIREMENT PLAN [EIN = 510020405]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 561954133]
• BLUE CROSS BLUE SHIELD OF ILLINOIS MEDICAL PLAN [EIN = 364276352]
• BLUE CROSS BLUE SHIELD OF RI [EIN = 050258809]
• BLUE CROSS BLUE SHIELD OF GEORGIA HEALTH PPO 1047626000 [EIN = 582067428]
• BLUE CROSS/BLUE SHIELD [EIN = 580707657]
• BLUE CROSS VISION PROGRAM [EIN = 251494402]
• BLUE CROSS BLUE SHIELD OF DELAWARE RETIREE MEDICAL PLAN [EIN = 510020405]
• BLUE CROSS OF NORTHEASTERN PENNSYLVANIA [EIN = 161486032]
• BLUE CROSS & BLUE SHIELD PLAN [EIN = 541874309]
• BLUE CROSS AND BLUE SHIELD OF MINNESOTA EMPLOYEES' SAVINGS PLAN [EIN = 410984460]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA RETIREMENT SAVINGS PLAN [EIN = 560894904]
• BLUE CROSS OF NORTHEASTERN PENNSYLVANIA [EIN = 161486032]
• BLUE CROSS BLUE SHIELD OF DELAWARE FLEXIBLE BENEFITS PLAN [EIN = 510020405]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 560890670]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 561607563]
• BLUE CROSS BLUE SHIELD ASSOCIATION LONG TERM DISABILITY PROGRAM [EIN = 135656874]
• BLUE CROSS BLUE SHIELD OF ILLINOIS [EIN = 362549132]
• BLUE CROSS OF IDAHO HEALTH SERVICE, INC. 401(K) PLAN [EIN = 820344294]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA RETIREE MEDICAL PLAN [EIN = 630103830]
• BLUE CROSS BLUE SHIELD OF MICHIGAN GROUP TRAVEL ACCIDENT INSURANCE [EIN = 382069753]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA 401(K) SALARY DEFERRAL PLAN & TRUST [EIN = 630103830]
• BLUE CROSS BLUE SHIELD OF MICHIGAN REPRESENTED EMPLOYEES SAVINGS PLAN [EIN = 382069753]
• BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. 401(K) RETIREMENT SAVINGS PLAN [EIN = 592015694]
• BLUE CROSS BLUE SHIELD MICHIGAN LONG TERM DISABILITY PLAN [EIN = 382069753]
• BLUE CROSS AND BLUE SHIELD OF KANSAS, INC. VISION [EIN = 480952857]
• BLUE CROSS BLUE SHIELD OF ALABAMA [EIN = 630932057]
• BLUE CROSS BLUE SHEILD [EIN = 464218169]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA DENTAL PLAN [EIN = 561868823]
• BLUE CROSS BLUE SHEILD OF ALABAMA [EIN = 273410813]
• BLUE CROSS AND BLUE SHIELD OF NEBRASKA WRAP PLAN [EIN = 470095156]
• BLUE CROSS AND BLUE SHIELD OF ALABAMA VISION PLAN [EIN = 630103830]
• BLUE CROSS BLUE SHIELD OF ALABAMA [EIN = 200232609]
• BLUE CROSS BLUE SHIELD OF TEXAS [EIN = 752469062]
• BLUE CROSS/BLUE SHIELD SEDALIA PLANT HOURLY AND RETIRED HOURLY [EIN = 250729265]
• BLUE CROSS BLUE SHIELD [EIN = 030369958]
• BLUE CROSS BLUE SHIELD [EIN = 273144760]
• BLUE CROSS & BLUE SHIELD OF MONTANA TAX-FAVORED SAVINGS PROGRAM [EIN = 810216685]
• BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA [EIN = 270229866]
• BLUE CROSS BLUE SHIELD OF ILLINOIS MEDICAL PLAN [EIN = 300752433]
• BLUE CROSS BLUE SHIELD OF NORTH CAROLINA [EIN = 562151684]
• BLUE CROSS OF WESTERN PENNSYLVANIA MEDICARE SUPPLEMENT OVER 65 SPECIAL PORT ALLEGANY [EIN = 250729265]
• BLUE CROSS BLUE SHIELD DENTAL [EIN = 570678887]
• BLUE CROSS BLUE SHIELD OF ILLINOIS HMOS [EIN = 383984647]
• BLUE CROSS AND BLUE SHIELD OF NC [EIN = 560611127]
• BLUE CROSS VISION [EIN = 231365953]
• BLUE CROSS BLUE SHIELD MAJOR MEDICAL HEALTH [EIN = 050269232]
• BLUE CROSS AND BLUE SHIELD HOSPITAL AND MEDICAL INSURANCE PLAN [EIN = 380533740]
• BLUE CROSS BLUE SHIELD OF DELAWARE RETIREE LIFE INSURANCE PLAN [EIN = 510020405]
• BLUE CROSS BLUE SHIELD OF DELAWARE SEVERANCE PLAN [EIN = 510020405]
• BLUE CROSS BLUE SHIELD OF NORTH DAKOTA [EIN = 911853068]
• BLUE CROSS BLUE SHIELD OF NORTH CAROLINA [EIN = 561902865]
• BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC [EIN = 043000119]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 561950817]
• 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 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 ANIMAL HOSPITAL GROUP 401(K) PLAN [EIN = 870903171]
• BLUE CROSS & BLUE SHIELD OF RHODE ISLAND GROUP BUSINESS TRAVEL ACCIDENT PLAN [EIN = 050158952]
• 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 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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