BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. OMNIBUS WELFARE PLAN

[ EIN: 04-1045815 | Plan No. 512 ]

Form 5500 filing classifies BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. OMNIBUS WELFARE PLAN as a Health & Welfare plan, sponsored by BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC.. The plan is a Large Plan with 0 participants and total assets of $0 reported for the 2023 plan year.

Health & Welfare plans are subject to ERISA disclosure requirements and annual reporting obligations.

---

Plan Sponsor: BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC.

Location: 101 HUNTINGTON AVENUE, SUITE 1300, BOSTON, MA 02199

EIN: 041045815

Plan Number: 512

Plan Year: 2023

Plan Size: Large Plan

Plan Entity Type: Health & Welfare

Plan Type: Health & Welfare

Participants: 0

Total Assets: $0

---