2022-10-07T16:07:28-05:00 2021-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2021-01-01 367008317 BLUE CROSS AND BLUE SHIELD PLANS NATIONAL RETIREE HEALTH BENEFITS TRUST BLUE 3124445670 225 NORTH MICHIGAN AVENUE CHICAGO IL 60601 JOHN BANTA ASST. SECRETARY OF COMMITTEE 3124445670 2022-09-29 1 JOHN BANTA 999009999 DAVID LOWENTHAL P00378651 3122071040 2022-09-29 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JOHN BANTA 225 NORTH MICHIGAN AVENUE CHICAGO IL 60601 46087176 0 X N/A X 1991 IL TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES OF THE BLUE CROSS & BLUE SHIELD COMPANIES. 15 14 0 18 5847193 5158502 0 0 325000 0 5340846 8535133 801253 9717 6467099 8544850 0 0 8088456 10424100 481064 0 0 0 0 664482 1853481 9234002 12277581 -2766903 -3732731 215885033 234048539 8121768 12253146 207763265 221795393 THE PRIMARY PURPOSE OF THE TRUST IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES OF THE BLUE CROSS & BLUE SHIELD COMPANIES. 0 0 PROVIDED HEALTH BENEFITS TO ELIGIBLE RETIREES OF BLUE CROSS & BLUE SHIELD. TOTAL HEALTH BENEFITS PAID DURING THE YEAR WAS $10,424,100. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 X 15 14 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X JOHN BANTA 3122976000 225 N MICHIGAN AVE CHICAGO IL 60601 ROBERT J KOLODGY COMMITTEE MEMBER - THRU 9/21 0.10 40.00 X 0 2492436 56683 CHRISTOPHER BOOTH COMMITTEE MEMBER - CHAIR - THRU 6/21 0.10 10.20 X X 0 0 0 DIANE GORE COMMITTEE MEMBER - CHAIR - BEG 6/21 0.10 0.20 X X 0 0 0 JOHN F GIBLIN COMMITTEE MEMBER - VICE CHAIR 0.10 0.20 X X 0 0 0 MATTHEW ALL COMMITTEE MEMBER 0.10 0.20 X 0 0 0 JENNIFER ALLEN COMMITTEE MEMBER 0.10 0.20 X 0 0 0 BRYAN CAMERLINCK COMMITTEE MEMBER - THRU 3/21 0.10 0.20 X 0 0 0 HENRY COURNAND COMMITTEE MEMBER 0.10 0.20 X 0 0 0 MARK EL-TAWIL COMMITTEE MEMBER 0.10 0.20 X 0 0 0 CHRISTINA FISHER COMMITTEE MEMBER 0.10 40.00 X 0 170550 4253 LORI HAIR COMMITTEE MEMBER 0.10 0.20 X 0 0 0 CHRIS HAUSER COMMITTEE MEMBER 0.10 0.20 X 0 0 0 THURMAN JUSTICE COMMITTEE MEMBER 0.10 0.20 X 0 0 0 SUSAN LINDQUIST COMMITTEE MEMBER 0.10 0.20 X 0 0 0 GINA MARTING COMMITTEE MEMBER 0.10 0.20 X 0 0 0 MICHAEL MIZEUR COMMITTEE MEMBER - THRU 10/21 0.10 0.20 X 0 0 0 JAMES REED COMMITTEE MEMBER 0.10 0.20 X 0 0 0 DAWN SCHNEIDERMAN COMMITTEE MEMBER 0.10 0.20 X 0 0 0 ADAM SHORT COMMITTEE MEMBER 0.10 0.20 X 0 0 0 MARK P STIMPSON COMMITTEE MEMBER - THRU 10/21 0.10 0.20 X 0 0 0 0 2662986 60936 0 0 1 0 THE NORTHERN TRUST COMPANY PO BOX 803878 CHICAGO IL 60680 INVESTMENT MANAGEMENT 536515 1 5672782 2984842 2687940 40404677 37542326 2862351 2862351 2862351 INCOME TAX RECOVERY 900099 9717 9717 9717 8544850 0 5847193 2697657 10424100 38818 536515 12295 TAXES INCURRED 1265853 12277581 213817735 232031518 2067298 2017021 215885033 234048539 8121768 12253146 8121768 12253146 X 207763265 221795393 0 0 0 0 207763265 221795393 215885033 234048539 -3732731 17764859 0 X 0 1 X 1 0 0 X 26309709 17764859 17764859 8544850 0 8544850 12277581 0 12277581 0 12277581 PART X, LINE 2: 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. 0 0 0 ROBERT J KOLODGY COMMITTEE MEMBER - THRU 9/21 0 1973191 0 510700 0 8545 0 14500 0 42183 0 2549119 0 169000 CHRISTINA FISHER COMMITTEE MEMBER 0 170111 0 0 0 439 0 4253 0 0 0 174803 0 0 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. BLUE CROSS BLUE SHIELD ASSOCIATION 225 NORTH MICHIGAN AVE CHICAGO IL 60601 135656874 VEBA ADMINISTRATIVE SUPPORT IL 501(C)(4) N/A N/A 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 FORM 990, SCHEDULE R, PART V, LINE 2: 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.