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  5. Blue Cross & Blue Shield of Rhode Island

Blue Cross & Blue Shield of Rhode Island

Company Details

Name: Blue Cross & Blue Shield of Rhode Island
Jurisdiction: Rhode Island
Entity type: Domestic Non-Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 27 Feb 1939 (86 years ago)
Identification Number: 000031611
ZIP code: 02903
County: Providence County
Principal Address: 500 EXCHANGE STREET, PROVIDENCE, RI, 02903, USA
Purpose: TO OPERATE A NONPROFIT HOSPITAL SERVICE CORPORATION
NAICS: 524114 - Direct Health and Medical Insurance Carriers
Fictitious names: The Health & Wellness Institute (trading name, 2005-02-22 - 2006-12-08)
Historical names: Hospital Service Corporation of Rhode Island
BLUE CROSS OF RHODE ISLAND

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
254900ZW1PGH8B99UG03 000031611 US-RI GENERAL ACTIVE 1939-02-27

Addresses
Legal C/O MICHELE B. LEDERBERG, 500 EXCHANGE STREET, PROVIDENCE, US-RI, US, 02903
Headquarters 500 EXCHANGE STREET, PROVIDENCE, US-RI, US, 02903

Registration details
Registration Date 2023-12-04
Last Update 2023-12-04
Status ISSUED
Next Renewal 2024-12-04
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 000031611

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BCBSRI HEALTH AND DENTAL PLANS 2023 050158952 2024-07-11 BLUE CROSS & BLUE SHIELD OF RHODE ISLAND 921
File View Page
Three-digit plan number (PN) 506
Effective date of plan 1939-09-01
Business code 524140
Sponsor’s telephone number 4014591968
Plan sponsor’s mailing address 500 EXCHANGE ST, PROVIDENCE, RI, 029032630
Plan sponsor’s address 500 EXCHANGE ST, PROVIDENCE, RI, 029032630

Number of participants as of the end of the plan year
Active participants 798
Retired or separated participants receiving benefits 179

Signature of
Role Plan administrator
Date 2024-07-10
Name of individual signing KELSEY OWEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-10
Name of individual signing LAURA THOMAS
Valid signature Filed with authorized/valid electronic signature
BCBSRI FLEXIBLE SPENDING ACCOUNT 2023 050158952 2024-07-11 BLUE CROSS & BLUE SHIELD OF RHODE ISLAND 136
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2011-01-01
Business code 524140
Sponsor’s telephone number 4014591968
Plan sponsor’s mailing address 500 EXCHANGE ST, PROVIDENCE, RI, 029032630
Plan sponsor’s address 500 EXCHANGE ST, PROVIDENCE, RI, 029032630

Number of participants as of the end of the plan year
Active participants 144

Signature of
Role Plan administrator
Date 2024-07-09
Name of individual signing KELSEY OWEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-07-10
Name of individual signing LAURA THOMAS
Valid signature Filed with authorized/valid electronic signature
BCBSRI HEALTH AND DENTAL PLANS 2022 050158952 2023-07-26 BLUE CROSS & BLUE SHIELD OF RHODE ISLAND 948
File View Page
Three-digit plan number (PN) 506
Effective date of plan 1939-09-01
Business code 524140
Sponsor’s telephone number 4014591968
Plan sponsor’s mailing address 500 EXCHANGE ST, PROVIDENCE, RI, 029032630
Plan sponsor’s address 500 EXCHANGE ST, PROVIDENCE, RI, 029032630

Number of participants as of the end of the plan year
Active participants 725
Retired or separated participants receiving benefits 196

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing KELSEY OWEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-26
Name of individual signing LAURA THOMAS
Valid signature Filed with authorized/valid electronic signature
BCBSRI FLEXIBLE SPENDING ACCOUNT 2022 050158952 2023-07-26 BLUE CROSS & BLUE SHIELD OF RHODE ISLAND 120
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2011-01-01
Business code 524140
Sponsor’s telephone number 4014591968
Plan sponsor’s mailing address 500 EXCHANGE ST, PROVIDENCE, RI, 029032630
Plan sponsor’s address 500 EXCHANGE ST, PROVIDENCE, RI, 029032630

Number of participants as of the end of the plan year
Active participants 126

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing KELSEY OWEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-26
Name of individual signing LAURA THOMAS
Valid signature Filed with authorized/valid electronic signature
BLUE CROSS & BLUE SHIELD OF RI EMPLOYER SPONSORED FRINGE BENEFIT PLAN - FLEXIBLE SPENDING ACCOUNT 2010 050158952 2011-09-22 BLUE CROSS & BLUE SHIELD OF RHODE ISLAND 359
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2003-01-01
Business code 524140
Sponsor’s telephone number 4014591008
Plan sponsor’s mailing address 500 EXCHANGE STREET, PROVIDENCE, RI, 02903
Plan sponsor’s address 500 EXCHANGE STREET, PROVIDENCE, RI, 02903

Plan administrator’s name and address
Administrator’s EIN 050158952
Plan administrator’s name BLUE CROSS & BLUE SHIELD OF RHODE ISLAND
Plan administrator’s address 500 EXCHANGE STREET, PROVIDENCE, RI, 02903
Administrator’s telephone number 4014591008

Number of participants as of the end of the plan year
Active participants 444
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2011-09-22
Name of individual signing SHANNON BROADBENT
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-22
Name of individual signing ERIC GASBARRO
Valid signature Filed with authorized/valid electronic signature
BLUE CROSS & BLUE SHIELD OF RI EMPLOYER SPONSORED FRINGE BENEFIT PLAN - FLEXIBLE SPENDING ACCOUNT 2009 050158952 2010-10-07 BLUE CROSS & BLUE SHIELD OF RHODE ISLAND 713
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2003-01-01
Business code 524140
Sponsor’s telephone number 4014591008
Plan sponsor’s mailing address 500 EXCHANGE STREET, PROVIDENCE, RI, 02903
Plan sponsor’s address 500 EXCHANGE STREET, PROVIDENCE, RI, 02903

Plan administrator’s name and address
Administrator’s EIN 050158952
Plan administrator’s name BLUE CROSS & BLUE SHIELD OF RHODE ISLAND
Plan administrator’s address 500 EXCHANGE STREET, PROVIDENCE, RI, 02903
Administrator’s telephone number 4014591008

Number of participants as of the end of the plan year
Active participants 359
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-10-06
Name of individual signing ERIC GASBARRO
Valid signature Filed with authorized/valid electronic signature
BLUE CROSS & BLUE SHIELD OF RI EMPLOYER SPONSORED FRINGE BENEFIT PLAN - FLEXIBLE SPENDING ACCOUNT 2009 050158952 2010-10-04 BLUE CROSS & BLUE SHIELD OF RHODE ISLAND 713
Three-digit plan number (PN) 510
Effective date of plan 2003-01-01
Business code 524140
Sponsor’s telephone number 4014591008
Plan sponsor’s mailing address 500 EXCHANGE STREET, PROVIDENCE, RI, 02903
Plan sponsor’s address 500 EXCHANGE STREET, PROVIDENCE, RI, 02903

Plan administrator’s name and address
Administrator’s EIN 050158952
Plan administrator’s name BLUE CROSS & BLUE SHIELD OF RHODE ISLAND
Plan administrator’s address 500 EXCHANGE STREET, PROVIDENCE, RI, 02903
Administrator’s telephone number 4014591008

Number of participants as of the end of the plan year
Active participants 359
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2010-10-04
Name of individual signing ERIC GASBARRO
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Address
MICHELE B. LEDERBERG Agent 500 EXCHANGE STREET, PROVIDENCE, RI, 02903, USA

TREASURER

Name Role Address
MICHAEL MARRONE TREASURER 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA

SECRETARY

Name Role Address
MICHELE B. LEDERBERG SECRETARY 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA

CEO

Name Role Address
MARTHA WOFFORD CEO 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA

VICE PRESIDENT

Name Role Address
LINDA WINFREY VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
TARA DEMOURA VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
CHRISTOPHER BUSH VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
CHRISTINA PITNEY VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
DAVID COMELLA VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
CHRIS MUSIAL VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
JEREMY DUNCAN VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
MELISSA CUMMINGS VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
KRISTEN MCLEAN VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
MICHAEL MENARD VICE PRESIDENT 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA

DIRECTOR

Name Role Address
VICKI VIRGILIO DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
JOSEPH DIAZ M.D. DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
SHARON MORRIS DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
STEPHEN COHAN DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
ADENRELE ABIADE DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
KEVIN MURPHY DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
CHRISTOPHER BUFFERY DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
ERNIE ALMONTE DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
MARGARET HOLLAND MCDUFF DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA
LOU GIANCOLA DIRECTOR 500 EXCHANGE STREET PROVIDENCE, RI 02903 USA

Events

Type Date Old Value New Value
Name Change 1982-10-01 BLUE CROSS OF RHODE ISLAND Blue Cross & Blue Shield of Rhode Island
Merged 1982-10-01 BLUE SHIELD OF RHODE ISLAND on Blue Cross & Blue Shield of Rhode Island
Name Change 1973-11-20 Hospital Service Corporation of Rhode Island BLUE CROSS OF RHODE ISLAND

Filings

Number Name File Date
202449999820 Annual Report 2024-04-02
202333097210 Annual Report 2023-04-17
202215745620 Annual Report 2022-04-26
202195985320 Annual Report 2021-04-27
202039115380 Annual Report 2020-05-01
201990066650 Annual Report 2019-04-08
201870858900 Annual Report 2018-06-28
201745902680 Annual Report 2017-06-21
201600881550 Annual Report 2016-06-21
201562906650 Annual Report 2015-06-09

Related by officers

MICHELE B. LEDERBERG

Blue Cross & Blue Shield of Rhode Island Employees Scholarship Foundation The Health & Wellness Institute, LLC

MARTHA WOFFORD

The Greater Providence Chamber of Commerce Partnership for Rhode Island

LINDA WINFREY

STAND UP FOR ANIMALS

CHRISTINA PITNEY

Meals on Wheels of RI, Inc.

JEREMY DUNCAN

Blue Cross & Blue Shield of Rhode Island Employees Scholarship Foundation

MELISSA CUMMINGS

Rhode Island PBS Foundation and The Public's Radio

MICHAEL MENARD

JOMEG CONSTRUCTION COMPANY, INC.

SHARON MORRIS

CENTRAL HIGH SCHOOL ALUMNI ASSOCIATION PROVIDENCE

KEVIN MURPHY

Blount Fine Foods Corp. WESTERLY TRACK & ATHLETIC CLUB, INC. Steelcase Architectural Walls Inc. Oodlin Sherberton LLC 2 Vets Towing, LLC HOSPITALITY STAFFING SOLUTIONS, LLC Northern Light Cremation Services, llc

CHRISTOPHER BUFFERY

R. I. INSTITUTE FOR LABOR STUDIES AND RESEARCH

ERNIE ALMONTE

LEADERSHIP RHODE ISLAND EDUCATIONAL FOUNDATION

MARGARET HOLLAND MCDUFF

QUALITY CARE COMPANY, L.L.C. Partnership for Families, Inc. Ocean State Network for Children and Families, inc.

LOU GIANCOLA

THE JONNYCAKE CENTER, INC. Trinity Repertory Company

ROBERT SANDERS

Hip Hop Kolours, Inc.

CHRISTOPHER CROSBY

FRENCH & BEAN COMPANY Associated Lease Corp. Associated Grocers of New England, Inc. Short Game LLC

KAREN HAMMOND

Rhode Island School of Design THE TYLER DOCK ASSOCIATION RISD Holdings, Inc. Community Lending Corporation

WILLIAM MURRAY

Rock Ministries Mikri, LLC WPM LLC TRANSFORM ASSOCIATES, INC. Waterman Homestead Condominium Association Freedom In Christ Church

CATHERINE CROMWELL

Rhode Islanders for Good Government

Related by address

500 EXCHANGE STREET, PROVIDENCE, RI, 02903, USA

NORTEK, INC. Blue Cross & Blue Shield of Rhode Island Employees Scholarship Foundation The Health & Wellness Institute, LLC Top Shelf LLC

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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