Capital Blue Cross Retiree Medical Plan — Form 5500 plan (Capital Blue Cross)
Plain-English plan summary
According to public Form 5500 filings published through the U.S. Department of Labor (DOL) Employee Benefits Security Administration (EBSA) via the EFAST2 system, Capital Blue Cross Retiree Medical Plan is a benefit plan reported by Capital Blue Cross under EIN 23-0455154 and plan number 512. The latest loaded filing year is 2023. The filing reports 1,124 participants and not reported in the loaded dataset in end-of-year plan assets, where available in the loaded dataset.
Key reported metrics
- Plan sponsor
- Capital Blue Cross
- EIN
- 23-0455154
- Plan number
- 512
- Plan type
- 2
- Location
- Harrisburg, PA
- Latest filing year
- 2023
- Participants
- 1,124
- End-of-year plan assets
- not reported in the loaded dataset
Form 5500 filing history
| Filing year | Participants | Schedules | Filing |
|---|---|---|---|
| 2023 | 1,124 | C | 20241008083632NAL0028170736001 |
Reported financial statement
This plan is loaded, but Schedule H / I financial-statement detail is not present for it in the current loaded dataset.
Service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. | Year |
|---|---|---|---|---|
| Capital Advantage Insurance Company | CONTRACT ADMINISTRATOR | $33,743 | not reported in the loaded dataset | 2023 |
| Capital Advantage Assurance Company | CONTRACT ADMINISTRATOR | $21,618 | not reported in the loaded dataset | 2023 |