BLUE CROSS AND BLUE SHIELD PLANS NATIONAL RETIREE HEALTH BENEFITS: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- BLUE CROSS AND BLUE SHIELD PLANS NATIONAL RETIREE HEALTH BENEFITS (EIN 36-7008317)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-10-07
- IRS object ID
- 202202809349300245
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-10-07T16:07:28-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 S RIVERSIDE PLAZA 9TH FLOOR | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 367008317 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE CROSS AND BLUE SHIELD PLANS | BusinessNameLine1Txt |
| Business Name Line2 | NATIONAL RETIREE HEALTH BENEFITS TRUST | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BLUE | BusinessNameControlTxt |
| Phone | 3124445670 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 NORTH MICHIGAN AVENUE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60601 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN BANTA | PersonNm |
| Person Title | ASST. SECRETARY OF COMMITTEE | PersonTitleTxt |
| Phone | 3124445670 | PhoneNum |
| Signature | 2022-09-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JOHN | PersonFirstNm |
| Person Last | BANTA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID LOWENTHAL | PreparerPersonNm |
| PTIN | P00378651 | PTIN |
| Phone | 3122071040 | PhoneNum |
| Preparation | 2022-09-29 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN BANTA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 NORTH MICHIGAN AVENUE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $46,087,176 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Trust | Yes (X) | TypeOfOrganizationTrustInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES OF THE BLUE CROSS & BLUE SHIELD COMPANIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 18 | TotalVolunteersCnt |
| Total Gross UBI | $5,847,193 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $5,158,502 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $325,000 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,340,846 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,535,133 | CYInvestmentIncomeAmt |
| PY Other Revenue | $801,253 | PYOtherRevenueAmt |
| CY Other Revenue | $9,717 | CYOtherRevenueAmt |
| PY Total Revenue | $6,467,099 | PYTotalRevenueAmt |
| CY Total Revenue | $8,544,850 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $8,088,456 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $10,424,100 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $481,064 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $664,482 | PYOtherExpensesAmt |
| CY Other Expenses | $1,853,481 | CYOtherExpensesAmt |
| PY Total Expenses | $9,234,002 | PYTotalExpensesAmt |
| CY Total Expenses | $12,277,581 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,766,903 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,732,731 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $215,885,033 | TotalAssetsBOYAmt |
| Total Assets EOY | $234,048,539 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,121,768 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,253,146 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $207,763,265 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $221,795,393 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE PRIMARY PURPOSE OF THE TRUST IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES OF THE BLUE CROSS & BLUE SHIELD COMPANIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Desc | PROVIDED HEALTH BENEFITS TO ELIGIBLE RETIREES OF BLUE CROSS & BLUE SHIELD. TOTAL HEALTH BENEFITS PAID DURING THE YEAR WAS $10,424,100. | Desc |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN BANTA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3122976000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 N MICHIGAN AVE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60601 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| ROBERT J KOLODGY | |||||||
| COMMITTEE MEMBER - THRU 9/21 | 0.10 | 40.00 | Yes (X) | $0 | $2,492,436 | $56,683 | |
| CHRISTOPHER BOOTH | |||||||
| COMMITTEE MEMBER - CHAIR - THRU 6/21 | 0.10 | 10.20 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DIANE GORE | |||||||
| COMMITTEE MEMBER - CHAIR - BEG 6/21 | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JOHN F GIBLIN | |||||||
| COMMITTEE MEMBER - VICE CHAIR | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| MATTHEW ALL | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| JENNIFER ALLEN | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| BRYAN CAMERLINCK | |||||||
| COMMITTEE MEMBER - THRU 3/21 | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| HENRY COURNAND | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| MARK EL-TAWIL | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| CHRISTINA FISHER | |||||||
| COMMITTEE MEMBER | 0.10 | 40.00 | Yes (X) | $0 | $170,550 | $4,253 | |
| LORI HAIR | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| CHRIS HAUSER | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| THURMAN JUSTICE | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| SUSAN LINDQUIST | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| GINA MARTING | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL MIZEUR | |||||||
| COMMITTEE MEMBER - THRU 10/21 | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| JAMES REED | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| DAWN SCHNEIDERMAN | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| ADAM SHORT | |||||||
| COMMITTEE MEMBER | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| MARK P STIMPSON | |||||||
| COMMITTEE MEMBER - THRU 10/21 | 0.10 | 0.20 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,662,986 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $60,936 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE NORTHERN TRUST COMPANY | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 803878 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60680 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | INVESTMENT MANAGEMENT | ServicesDesc |
| Compensation | $536,515 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,672,782 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $2,984,842 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,687,940 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $40,404,677 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $37,542,326 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,862,351 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,862,351 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $2,862,351 | UnrelatedBusinessRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INCOME TAX RECOVERY | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $9,717 | TotalRevenueColumnAmt |
| Exclusion | $9,717 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $9,717 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,544,850 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $5,847,193 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,697,657 | ExclusionAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,424,100 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,818 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $536,515 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,295 | TotalAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | TAXES INCURRED | Desc |
| Total | $1,265,853 | TotalAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,277,581 | TotalAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $213,817,735 | BOYAmt |
| EOY | $232,031,518 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,067,298 | BOYAmt |
| EOY | $2,017,021 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $215,885,033 | BOYAmt |
| EOY | $234,048,539 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,121,768 | BOYAmt |
| EOY | $12,253,146 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,121,768 | BOYAmt |
| EOY | $12,253,146 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,763,265 | BOYAmt |
| EOY | $221,795,393 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,763,265 | BOYAmt |
| EOY | $221,795,393 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $215,885,033 | BOYAmt |
| EOY | $234,048,539 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$3,732,731 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $17,764,859 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $26,309,709 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $17,764,859 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $17,764,859 | RevenueNotReportedAmt |
| Revenue Subtotal | $8,544,850 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $8,544,850 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,277,581 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,277,581 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,277,581 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | U.S. GAAP REQUIRES EVALUATION OF TAX POSITIONS TAKEN BY THE TRUST AND RECOGNITION OF A TAX LIABILITY OR ASSET IF THE TRUST HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE TRUST ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE TRUST AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A TAX LIABILITY OR ASSET OR FINANCIAL STATEMENT DISCLOSURE, OTHER THAN THOSE PREVIOUSLY DESCRIBED. THE TRUST IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS, HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS OTHER THAN THOSE PREVIOUSLY DESCRIBED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT J KOLODGY | ||||||||||||||
| COMMITTEE MEMBER - THRU 9/21 | $0 | $1,973,191 | $0 | $510,700 | $0 | $8,545 | $0 | $14,500 | $0 | $42,183 | $0 | $2,549,119 | $0 | $169,000 |
| CHRISTINA FISHER | ||||||||||||||
| COMMITTEE MEMBER | $0 | $170,111 | $0 | $0 | $0 | $439 | $0 | $4,253 | $0 | $0 | $0 | $174,803 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | CERTAIN MEMBERS OF THE NATIONAL EMPLOYEE BENEFITS COMMITTEE ("COMMITTEE") SERVE TOGETHER ON THE BOARD OF BLUE CROSS AND BLUE SHIELD ASSOCIATION. ALL MEMBERS OF THE COMMITTEE ARE EITHER EMPLOYEES OF THE BLUE CROSS AND BLUE SHIELD ASSOCIATION OR ONE OF THE MEMBER PLANS. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990'S CONTENT AND SOURCE OF INFORMATION ARE REVIEWED BY SUBJECT MATTER EXPERTS INCLUDING, BUT NOT LIMITED TO, INTERNAL AND EXTERNAL TAX AND ACCOUNTING PROFESSIONALS AND INTERNAL LEGAL PERSONNEL, AND THE AUDITED FINANCIAL STATEMENTS ARE PRESENTED TO THE COMMITTEE THAT SERVES AS THE GOVERNING BODY BY THE INDEPENDENT AUDITORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BLUE CROSS BLUE SHIELD ASSOCIATION (BCBSA) MAINTAINS A COMPREHENSIVE CODE OF CONDUCT AND COMPLIANCE PROGRAM APPLICABLE TO ALL EMPLOYEES AND OFFICERS, INCLUDING THOSE WHO EITHER SERVE ON THE COMMITTEE (THAT GOVERNS AND ACTS FOR THE ORGANIZATION) OR ACT ON BEHALF OF THAT COMMITTEE. IN ADDITION, ALL EMPLOYEES, OFFICERS, AND DIRECTORS (INCLUDING THOSE WHO SERVE ON THE COMMITTEE OR ACT ON ITS BEHALF) ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST FORM. THE BCBSA CHIEF AUDITOR AND COMPLIANCE OFFICER IS CHARGED WITH INVESTIGATING ANY ALLEGATIONS OF NON-COMPLIANCE WITH THE CODE OF CONDUCT, INCLUDING ANY COMPLAINTS REPORTED THROUGH THE ANONYMOUS HOTLINE MAINTAINED THROUGH AN INDEPENDENT ORGANIZATION. THE RESULTS OF THE COMPLIANCE PROGRAM'S EFFECTIVENESS ARE REPORTED TO THE AUDIT COMMITTEE OF THE BCBSA BOARD OF DIRECTORS ON AN ANNUAL BASIS. FAILURE TO ADHERE TO THE CODE OF CONDUCT MAY RESULT IN DISCIPLINARY ACTION, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. MOREOVER, COMMITTEE MEMBERS RECEIVE FIDUCIARY TRAINING FROM THE BCBSA CHIEF EMPLOYEE BENEFITS COUNSEL REGARDING THEIR FIDUCIARY DUTIES, INCLUDING THE ERISA FIDUCIARY CONFLICT OF INTEREST RULES. BCBSA'S CHIEF EMPLOYEE BENEFITS COUNSEL ALSO PROVIDES THE COMMITTEE WITH AN ANNUAL ASSESSMENT OF THE ORGANIZATION'S AND COMMITTEE'S LEGAL COMPLIANCE, INCLUDING COMPLIANCE WITH ERISA. AS EMPLOYEES OF VARIOUS BLUE PLANS, EACH COMMITTEE MEMBERS NOT EMPLOYED BY BCBSA IS SUBJECT TO ADDITIONAL CONFLICT OF INTEREST RESTRICTION UNDER POLICIES ADOPTED BY HIS OR HER EMPLOYER PLAN. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION DOES NOT REQUIRE COMPENSATION POLICIES AS IT DOES NOT COMPENSATE ANY OFFICERS, MANAGEMENT OFFICIALS, OR KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS AND FORM 990 ARE MADE AVAILABLE TO PARTICIPANTS IN THE EMPLOYEE BENEFIT PROGRAMS FUNDED THROUGH VEBA UPON REQUEST TO THE VICE PRESIDENT, NATIONAL EMPLOYEE BENEFITS ADMINISTRATION, BLUE CROSS AND BLUE SHIELD ASSOCIATION, 225 N. MICHIGAN AVENUE, CHICAGO, IL 60601. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE CROSS BLUE SHIELD ASSOCIATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 NORTH MICHIGAN AVE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 135656874 | EIN |
| Primary Activities | VEBA ADMINISTRATIVE SUPPORT | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(4) | ExemptCodeSectionTxt |
| Public Charity Status | N/A | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|
| BLUE CROSS & BLUE SHIELD OF WYOMING | |
| CONTRIBUTING EMPLOYER | 0 |
| ANTHEM INC & CONTROLLED AFFILIATES | |
| OTHER PARTICIPATING EMPLOYER | 0 |
| BLUE CROSS & BLUE SHIELD OF TENNESSEE & CONTROLLED AFFILIATES | |
| OTHER PARTICIPATING EMPLOYER | 0 |
| BLUE CROSS & BLUE SHIELD OF NORTH CAROLINA | |
| OTHER PARTICIPATING EMPLOYER | 0 |
| BLUE CROSS AND BLUE SHIELD OF ARIZONA & CONTROLLED AFFILIATES | |
| OTHER PARTICIPATING EMPLOYER | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE R, PART V, LINE 2: | FormAndLineReferenceDesc |
| Explanation | DESCRIPTION OF TRANSACTIONS REFERRED TO IN RESPONSE TO LINES 1P AND 1S LINE 1P: AS PERMITTED BY ERISA SECTIONS 408(B)(2) AND 408(C)(2), PROGRAM ASSETS ARE DISBURSED TO REIMBURSE PROGRAM BENEFIT PAYMENTS, PROGRAM PREMIUMS AND PROGRAM ADMINISTRATIVE EXPENSES. LINE 1S: IN 2021, NO EMPLOYERS MADE CONTRIBUTIONS TO FUND PROGRAM BENEFITS. IN PRIOR YEARS ALL THE PARTICIPATING EMPLOYERS HAD MADE CONTRIBUTIONS. | ExplanationTxt |