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BLUE CROSS AND BLUE SHIELD OF MINNESOTA 401k Plan overview

Plan NameBLUE CROSS AND BLUE SHIELD OF MINNESOTA
Plan identification number 507

BLUE CROSS AND BLUE SHIELD OF MINNESOTA Benefits

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

401k Sponsoring company profile

KOWALSKI COMPANIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:KOWALSKI COMPANIES, INC.
Employer identification number (EIN):411500646
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072023-01-01JAKE HEURUNG2024-07-23

Plan Statistics for BLUE CROSS AND BLUE SHIELD OF MINNESOTA

401k plan membership statisitcs for BLUE CROSS AND BLUE SHIELD OF MINNESOTA

Measure Date Value
2023: BLUE CROSS AND BLUE SHIELD OF MINNESOTA 2023 401k membership
Total participants, beginning-of-year2023-01-01108
Total number of active participants reported on line 7a of the Form 55002023-01-010
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-010
Number of employers contributing to the scheme2023-01-010

Form 5500 Responses for BLUE CROSS AND BLUE SHIELD OF MINNESOTA

2023: BLUE CROSS AND BLUE SHIELD OF MINNESOTA 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01First time form 5500 has been submittedYes
2023-01-01This submission is the final filingYes
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract number178146
Policy instance 1
Insurance contract or identification number178146
Number of Individuals Covered225
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $43,533
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $967,410
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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