BLUE CROSS BLUE SHIELD OF TEXAS MEDICAL INSURANCE PLAN 401k Plan overview

BLUE CROSS BLUE SHIELD OF TEXAS MEDICAL INSURANCE PLAN Benefits

401k Sponsoring company profile

Company Name:	STONEBRIAR AUTO SERVICES DBA JIFFY LUBE
Employer identification number (EIN):	842662763
NAIC Classification:	441300
NAIC Description:	Automotive Parts, Accessories, and Tire Stores

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-04-01	ALAN BARRINGTON	2023-09-15
501	2021-04-01	ALAN BARRINGTON	2022-11-14

Plan Statistics for BLUE CROSS BLUE SHIELD OF TEXAS MEDICAL INSURANCE PLAN

Measure	Date	Value
2022: BLUE CROSS BLUE SHIELD OF TEXAS MEDICAL INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-04-01	139
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	160
Number of retired or separated participants receiving benefits	2022-04-01	0
Number of other retired or separated participants entitled to future benefits	2022-04-01	0
Total of all active and inactive participants	2022-04-01	160
2021: BLUE CROSS BLUE SHIELD OF TEXAS MEDICAL INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-04-01	139
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	139
Number of retired or separated participants receiving benefits	2021-04-01	0
Number of other retired or separated participants entitled to future benefits	2021-04-01	0
Total of all active and inactive participants	2021-04-01	139

Form 5500 Responses for BLUE CROSS BLUE SHIELD OF TEXAS MEDICAL INSURANCE PLAN

Insurance Providers Used on plan

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• BLUE CROSS BLUE SHIELD OF NORTH CAROLINA [EIN = 561236854]
• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 201137248]
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• BLUE CROSS BLUE SHIELD OF MICHIGAN [EIN = 381362823]
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• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 561975885]
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• BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA [EIN = 561625075]
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• 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]
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• 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 BLUE SHIELD OF MINNESOTA [EIN = 416050237]
• 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 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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