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BLUE CROSS & BLUE SHIELD OF MS INC. GROUP LIFE INS BLUEBONNET LIFE 401k Plan overview

Plan NameBLUE CROSS & BLUE SHIELD OF MS INC. GROUP LIFE INS BLUEBONNET LIFE
Plan identification number 505

BLUE CROSS & BLUE SHIELD OF MS INC. GROUP LIFE INS BLUEBONNET LIFE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

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

Company Name:BLUE CROSS & BLUE SHIELD OF MISSISSIPPI A MUTUAL INSURANCE CO.
Employer identification number (EIN):640295748
NAIC Classification:524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE CROSS & BLUE SHIELD OF MS INC. GROUP LIFE INS BLUEBONNET LIFE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052024-04-01HAROLD R. ROGERS
5052023-04-01
5052023-04-01HAROLD R. ROGERS
5052022-04-01
5052022-04-01HAROLD R. ROGERS
5052021-04-01
5052021-04-01HAROLD ROGERS
5052020-04-01
5052019-04-01
5052018-04-01
5052017-04-01CHERI GREEN CHERI GREEN2018-10-26
5052016-04-01CHERI GREEN CHERI GREEN2017-09-25
5052015-04-01CHERI GREEN CHERI GREEN2016-10-26
5052014-04-01CHERI GREEN CHERI GREEN2016-01-12
5052013-04-01JOHN H. PROCTOR III JOHN H. PROCTOR III2014-10-31
5052012-04-01JOHN PROCTOR JOHN PROCTOR2013-06-10
5052011-04-01AMY AYERS AMY AYERS2012-07-05
5052009-04-01AMY AYERS AMY AYERS2010-07-20

Form 5500 Responses for BLUE CROSS & BLUE SHIELD OF MS INC. GROUP LIFE INS BLUEBONNET LIFE

2023: BLUE CROSS & BLUE SHIELD OF MS INC. GROUP LIFE INS BLUEBONNET LIFE 2023 form 5500 responses
2023-04-01Type of plan entitySingle employer plan
2023-04-01Submission has been amendedNo
2023-04-01This submission is the final filingNo
2023-04-01This return/report is a short plan year return/report (less than 12 months)No
2023-04-01Plan is a collectively bargained planNo
2023-04-01Plan funding arrangement – InsuranceYes
2023-04-01Plan benefit arrangement – InsuranceYes
2022: BLUE CROSS & BLUE SHIELD OF MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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 MS INC. GROUP LIFE INS BLUEBONNET LIFE 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

BLUEBONNET LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 68535 )
Policy contract numberBG80079
Policy instance 1
Insurance contract or identification numberBG80079
Number of Individuals Covered844
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
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 BenefitYes
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 $785,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUEBONNET LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 68535 )
Policy contract numberBG80079
Policy instance 1
Insurance contract or identification numberBG80079
Number of Individuals Covered826
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 BenefitYes
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 $762,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUEBONNET LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 68535 )
Policy contract numberBG80079
Policy instance 1
BLUEBONNET LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 68535 )
Policy contract numberBG80079
Policy instance 1
BLUEBONNET LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 68535 )
Policy contract numberBG80079
Policy instance 1
BLUEBONNET LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 68535 )
Policy contract numberBG80079
Policy instance 1
BLUEBONNET LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 68535 )
Policy contract numberBG80079
Policy instance 1

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