401k Plan data: INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO plan

INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO 401k Plan overview

Plan Name	INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO
Plan identification number	502

INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

INDEPENDENCE BLUE CROSS has sponsored the creation of one or more 401k plans.

Company Name: INDEPENDENCE BLUE CROSS

Employer identification number (EIN): 232184623

NAIC Classification: 621340
NAIC Description: Offices of Physical, Occupational and Speech Therapists, and Audiologists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-01-01

Plan Statistics for INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO

401k plan membership statisitcs for INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO

Measure Date Value
2023: INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO 2023 401k membership
Total participants, beginning-of-year 2023-01-01 104
Number of retired or separated participants receiving benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 0
Total participants 2023-01-01 0

Measure	Date	Value
2023: INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO 2023 401k membership
Total participants, beginning-of-year	2023-01-01	104
Number of retired or separated participants receiving benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	0
Total participants	2023-01-01	0

Form 5500 Responses for INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO

2023: INDEPENDENCE BLUE CROSS PERSONAL CHOICE HDHP PLUS 8C PPO 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

0002219408

Policy instance

Insurance contract or identification number	0002219408
Number of Individuals Covered	185
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Total amount of commissions paid to insurance broker	USD $58,285
Total amount of fees paid to insurance company	USD $0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

Potentially related plans

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Company Name:	INDEPENDENCE BLUE CROSS
Employer identification number (EIN):	232184623
NAIC Classification:	621340
NAIC Description:	Offices of Physical, Occupational and Speech Therapists, and Audiologists