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BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 401k Plan overview

Plan NameBLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA
Plan identification number 507

BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA Benefits

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

401k Sponsoring company profile

COASTAL COMMUNITY ACTION, INC. has sponsored the creation of one or more 401k plans.

Company Name:COASTAL COMMUNITY ACTION, INC.
Employer identification number (EIN):566075606
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072016-01-01PAULS DICKSON
5072015-01-01KENNETH HUNT
5072014-01-01KENNETH HUNT
5072013-01-01KENNETH HUNT
5072012-01-01KENNETH HUNT
5072011-01-01DAWN KOFFARNUS
5072009-01-01ANGELA MILLER

Plan Statistics for BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA

401k plan membership statisitcs for BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA

Measure Date Value
2016: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2016 401k membership
Total participants, beginning-of-year2016-01-01166
Total number of active participants reported on line 7a of the Form 55002016-01-01161
Total of all active and inactive participants2016-01-01161
Total participants2016-01-01161
2015: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2015 401k membership
Total participants, beginning-of-year2015-01-01166
Total number of active participants reported on line 7a of the Form 55002015-01-01178
Total of all active and inactive participants2015-01-01178
Total participants2015-01-01178
2014: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2014 401k membership
Total participants, beginning-of-year2014-01-01162
Total number of active participants reported on line 7a of the Form 55002014-01-01166
Total of all active and inactive participants2014-01-01166
Total participants2014-01-01166
2013: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2013 401k membership
Total participants, beginning-of-year2013-01-01166
Total number of active participants reported on line 7a of the Form 55002013-01-01162
Total of all active and inactive participants2013-01-01162
Total participants2013-01-01162
2012: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2012 401k membership
Total participants, beginning-of-year2012-01-01161
Total number of active participants reported on line 7a of the Form 55002012-01-01165
Number of retired or separated participants receiving benefits2012-01-011
Total of all active and inactive participants2012-01-01166
Total participants2012-01-01166
2011: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2011 401k membership
Total participants, beginning-of-year2011-01-01163
Total number of active participants reported on line 7a of the Form 55002011-01-01160
Number of retired or separated participants receiving benefits2011-01-011
Total of all active and inactive participants2011-01-01161
Total participants2011-01-01161
2009: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2009 401k membership
Total participants, beginning-of-year2009-01-01134
Total number of active participants reported on line 7a of the Form 55002009-01-01162
Number of retired or separated participants receiving benefits2009-01-011
Total of all active and inactive participants2009-01-01163
Total participants2009-01-01163

Form 5500 Responses for BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA

2016: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01First time form 5500 has been submittedYes
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01First time form 5500 has been submittedYes
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01First time form 5500 has been submittedYes
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01First time form 5500 has been submittedYes
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number060650
Policy instance 1
Insurance contract or identification number060650
Number of Individuals Covered178
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $29,722
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,722
Insurance broker nameHOLLI STALLING QUINN
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number060650
Policy instance 1
Insurance contract or identification number060650
Number of Individuals Covered166
Insurance policy start date2014-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $27,311
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,311
Insurance broker nameQUINN, HOLLI S.
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number060650
Policy instance 1
Insurance contract or identification number060650
Number of Individuals Covered162
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $29,520
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,012,306
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,520
Insurance broker nameQUINN, HOLLI S
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number060650
Policy instance 1
Insurance contract or identification number060650
Number of Individuals Covered166
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $31,050
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $31,050
Insurance broker nameQUINN, HOLLI S
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number060650
Policy instance 1
Insurance contract or identification number060650
Number of Individuals Covered161
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $30,190
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number
Policy instance 1
Number of Individuals Covered161
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $30,904
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,905
Insurance broker nameJOHN MELLING

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