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BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 401k Plan overview

Plan NameBLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE
Plan identification number 504

BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

BLUE CROSS AND BLUE SHIELD OF MISSISSIPPI, A MUTUAL INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:BLUE CROSS AND BLUE SHIELD OF MISSISSIPPI, A MUTUAL INSURANCE COMPANY
Employer identification number (EIN):640295748
NAIC Classification:524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042022-04-01
5042021-04-01
5042020-04-01
5042019-04-01
5042018-04-01
5042017-04-01CHERI GREEN CHERI GREEN2018-10-26
5042016-04-01CHERI GREEN CHERI GREEN2017-09-25
5042015-04-01CHERI GREEN CHERI GREEN2016-10-26
5042014-04-01CHERI GREEN CHERI GREEN2016-01-12
5042013-04-01ALISON TYLER ALISON TYLER2014-10-31
5042012-04-01JOHN PROCTOR JOHN PROCTOR2013-06-10
5042011-04-01AMY AYERS AMY AYERS2012-07-05
5042009-04-01AMY AYERS AMY AYERS2010-07-20

Plan Statistics for BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE

401k plan membership statisitcs for BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE

Measure Date Value
2022: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2022 401k membership
Total participants, beginning-of-year2022-04-01516
Total number of active participants reported on line 7a of the Form 55002022-04-01485
Number of retired or separated participants receiving benefits2022-04-0117
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01502
2021: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2021 401k membership
Total participants, beginning-of-year2021-04-01534
Total number of active participants reported on line 7a of the Form 55002021-04-01501
Number of retired or separated participants receiving benefits2021-04-010
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-01501
2020: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2020 401k membership
Total participants, beginning-of-year2020-04-01549
Total number of active participants reported on line 7a of the Form 55002020-04-01534
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-01534
2019: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2019 401k membership
Total participants, beginning-of-year2019-04-01574
Total number of active participants reported on line 7a of the Form 55002019-04-01549
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-01549
2018: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2018 401k membership
Total participants, beginning-of-year2018-04-01568
Total number of active participants reported on line 7a of the Form 55002018-04-01574
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-01574
2017: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-04-01543
Total number of active participants reported on line 7a of the Form 55002017-04-01568
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01568
2016: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-04-01551
Total number of active participants reported on line 7a of the Form 55002016-04-01543
Total of all active and inactive participants2016-04-01543
2015: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-04-01545
Total number of active participants reported on line 7a of the Form 55002015-04-01545
Total of all active and inactive participants2015-04-01545
2014: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-04-01567
Total number of active participants reported on line 7a of the Form 55002014-04-01550
Total of all active and inactive participants2014-04-01550
2013: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-04-01600
Total number of active participants reported on line 7a of the Form 55002013-04-01583
Total of all active and inactive participants2013-04-01583
2012: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-04-01623
Total number of active participants reported on line 7a of the Form 55002012-04-01604
Total of all active and inactive participants2012-04-01604
2011: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-04-01628
Total number of active participants reported on line 7a of the Form 55002011-04-01626
Total of all active and inactive participants2011-04-01626
2009: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-04-01770
Total number of active participants reported on line 7a of the Form 55002009-04-01690
Total of all active and inactive participants2009-04-01690
Total participants2009-04-010

Form 5500 Responses for BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE

2022: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – InsuranceYes
2021: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – InsuranceYes
2020: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – InsuranceYes
2019: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – InsuranceYes
2018: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – InsuranceYes
2017: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2014: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes
2009: BLUE CROSS & BLUE SHIELD OF MISS INC. AD&D CONTRACT WITH LIFE INSURANCE 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99075311
Policy instance 1
Insurance contract or identification number99075311
Number of Individuals Covered502
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
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
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99075311
Policy instance 1
Insurance contract or identification number99075311
Number of Individuals Covered501
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099075311
Policy instance 1
Insurance contract or identification number000099075311
Number of Individuals Covered534
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Total amount of commissions paid to insurance brokerUSD $633
Total amount of fees paid to insurance companyUSD $97
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $633
Amount paid for insurance broker fees97
Additional information about fees paid to insurance brokerCONTINGENT COMMISSION PAID
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099075311
Policy instance 1
Insurance contract or identification number000099075311
Number of Individuals Covered549
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $608
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $608
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099075311
Policy instance 1
Insurance contract or identification number000099075311
Number of Individuals Covered574
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099075311
Policy instance 1
Insurance contract or identification number000099075311
Number of Individuals Covered568
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $608
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $608
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameMATHISON INSURANCE PARTNERS, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099075311
Policy instance 1
Insurance contract or identification number000099075311
Number of Individuals Covered545
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameMATHISON INSURANCE PARTNERS, INC.
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number000099075311
Policy instance 1
Insurance contract or identification number000099075311
Number of Individuals Covered550
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $608
Total amount of fees paid to insurance companyUSD $284
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $608
Amount paid for insurance broker fees284
Additional information about fees paid to insurance brokerGUARANTEED SUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameMATHISON INSURANCE PARTNERS, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL659979
Policy instance 1
Insurance contract or identification numberABL659979
Number of Individuals Covered583
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
Insurance broker nameBANCORPSOUTH INSURANCE SE
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL659979
Policy instance 1
Insurance contract or identification numberABL659979
Number of Individuals Covered604
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameBANCORPSOUTH INSURANCE SE
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract numberABL659979
Policy instance 1
Insurance contract or identification numberABL659979
Number of Individuals Covered626
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )
Policy contract numberABL659979
Policy instance 1
Insurance contract or identification numberABL659979
Number of Individuals Covered622
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $143
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $143
Insurance broker organization code?3
Insurance broker nameBANCORPSOUTH INSURANCE SERVICE

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