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HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 401k Plan overview

Plan NameHOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES
Plan identification number 503

HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

BLUE CROSS BLUE SHIELD OF NORTH DAKOTA has sponsored the creation of one or more 401k plans.

Company Name:BLUE CROSS BLUE SHIELD OF NORTH DAKOTA
Employer identification number (EIN):450173185
NAIC Classification:524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032020-01-01DAVE BREUER2021-07-27
5032019-01-01DAVE BREUER2020-07-22
5032018-01-01
5032017-01-01
5032016-01-01
5032015-01-01
5032014-01-01
5032013-01-01
5032012-01-01DAVE BREUER
5032011-01-01DAVE BREUER
5032009-01-01KRISTEN KUTZER

Plan Statistics for HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES

401k plan membership statisitcs for HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES

Measure Date Value
2020: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2020 401k membership
Total participants, beginning-of-year2020-01-012,590
Total number of active participants reported on line 7a of the Form 55002020-01-010
Total of all active and inactive participants2020-01-010
Total participants2020-01-010
2019: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2019 401k membership
Total participants, beginning-of-year2019-01-012,529
Total number of active participants reported on line 7a of the Form 55002019-01-012,590
Total of all active and inactive participants2019-01-012,590
Total participants2019-01-012,590
2018: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2018 401k membership
Total participants, beginning-of-year2018-01-012,464
Total number of active participants reported on line 7a of the Form 55002018-01-012,529
Total of all active and inactive participants2018-01-012,529
Total participants2018-01-012,529
2017: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2017 401k membership
Total participants, beginning-of-year2017-01-012,614
Total number of active participants reported on line 7a of the Form 55002017-01-012,464
Total of all active and inactive participants2017-01-012,464
Total participants2017-01-012,464
2016: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2016 401k membership
Total participants, beginning-of-year2016-01-012,675
Total number of active participants reported on line 7a of the Form 55002016-01-012,614
Total of all active and inactive participants2016-01-012,614
Total participants2016-01-012,614
2015: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2015 401k membership
Total participants, beginning-of-year2015-01-012,857
Total number of active participants reported on line 7a of the Form 55002015-01-012,675
Total of all active and inactive participants2015-01-012,675
Total participants2015-01-012,675
2014: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2014 401k membership
Total participants, beginning-of-year2014-01-012,266
Total number of active participants reported on line 7a of the Form 55002014-01-012,857
Total of all active and inactive participants2014-01-012,857
Total participants2014-01-012,857
2013: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2013 401k membership
Total participants, beginning-of-year2013-01-011,597
Total number of active participants reported on line 7a of the Form 55002013-01-012,266
Total of all active and inactive participants2013-01-012,266
Total participants2013-01-012,266
2012: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2012 401k membership
Total participants, beginning-of-year2012-01-011,516
Total number of active participants reported on line 7a of the Form 55002012-01-011,597
Total of all active and inactive participants2012-01-011,597
Total participants2012-01-011,597
2011: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2011 401k membership
Total participants, beginning-of-year2011-01-011,876
Total number of active participants reported on line 7a of the Form 55002011-01-011,516
Total of all active and inactive participants2011-01-011,516
Total participants2011-01-011,516
2009: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2009 401k membership
Total participants, beginning-of-year2009-01-012,105
Total number of active participants reported on line 7a of the Form 55002009-01-011,929
Total of all active and inactive participants2009-01-011,929
Total participants2009-01-011,929

Form 5500 Responses for HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES

2020: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01This submission is the final filingYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: HOSPITAL & MEDICAL COVERAGE FOR EMPLOYEES 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number0610
Policy instance 1
Insurance contract or identification number0610
Number of Individuals Covered2003
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $306,021
Welfare Benefit Premiums Paid to CarrierUSD $2,242,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees306021
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number0612
Policy instance 2
Insurance contract or identification number0612
Number of Individuals Covered3274
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of fees paid to insurance companyUSD $624,634
Welfare Benefit Premiums Paid to CarrierUSD $3,134,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees624634
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number0610
Policy instance 1
Insurance contract or identification number0610
Number of Individuals Covered2087
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $324,520
Welfare Benefit Premiums Paid to CarrierUSD $2,035,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees324520
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number0612
Policy instance 2
Insurance contract or identification number0612
Number of Individuals Covered3278
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of fees paid to insurance companyUSD $507,284
Welfare Benefit Premiums Paid to CarrierUSD $2,741,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees507284
Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number10200-01
Policy instance 1
Insurance contract or identification number10200-01
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19704
Policy instance 2
Insurance contract or identification number19704
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number10200-01
Policy instance 1
Insurance contract or identification number10200-01
Number of Individuals Covered2357
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Welfare Benefit Premiums Paid to CarrierUSD $1,710,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 55891 )
Policy contract number19704
Policy instance 2
Insurance contract or identification number19704
Number of Individuals Covered3104
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Welfare Benefit Premiums Paid to CarrierUSD $2,710,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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