BLUE CROSS BLUE SHIELD OF MASS FD INC FOR EXPANDING HEALTHCARE ACCES: Form 990PF, tax year 2020
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- Organization
- BLUE CROSS BLUE SHIELD OF MASS FD INC FOR EXPANDING HEALTHCARE ACCES (EIN 04-3148824)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-06
- IRS object ID
- 202113119349100201
- Schema version
- 2020v4.1
- 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
- Form 990-PF
- Schedule B
- All Oth Prog Rltd Investments Sch
- Compensation Explanation
- Contractor Compensation Expln
- Depreciation Schedule
- Investments Other Schedule2
- Other Expenses Schedule
- Other Income Schedule2
- Other Increases Schedule
- Other Liabilities Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-06T20:07:58-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 043148824 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Blue Cross and Blue Shield of Massachusetts | BusinessNameLine1Txt |
| Business Name Line2 | Foundation for Expanding Healthcare Access | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % MICHAEL CARDER | InCareOfNm |
| Business Name Control | BLUE | BusinessNameControlTxt |
| Phone | 6172465000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 Huntington Avenue Suite 1300 | AddressLine1Txt |
| City | Boston | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 021997611 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Audrey Shelto | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 6172465313 | PhoneNum |
| Signature | 2021-11-14 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Audrey | PersonFirstNm |
| Person Last | Shelto | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $108,059,342 | FMVAssetsEOYAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $1,296,302 | ContriRcvdRevAndExpnssAmt |
| Dividends Rev And Expnss | $762,765 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $762,765 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $5,367,431 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $19,986,425 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $5,367,431 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $7,426,498 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $6,130,196 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Taxes Rev And Expnss | $153,870 | TaxesRevAndExpnssAmt |
| Occupancy Rev And Expnss | $108,677 | OccupancyRevAndExpnssAmt |
| Occupancy Dsbrs Chrtbl | $108,677 | OccupancyDsbrsChrtblAmt |
| Trav Conf Meeting Rev And Expnss | $33,753 | TravConfMeetingRevAndExpnssAmt |
| Trav Conf Meeting Dsbrs Chrtbl | $33,753 | TravConfMeetingDsbrsChrtblAmt |
| Printing And Pub Rev And Expnss | $5,386 | PrintingAndPubRevAndExpnssAmt |
| Printing And Pub Dsbrs Chrtbl | $5,386 | PrintingAndPubDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $3,559,544 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Dsbrs Chrtbl | $3,559,544 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $3,861,230 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $0 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $3,707,360 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $3,877,104 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $3,877,104 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $7,738,334 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $0 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $7,584,464 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$311,836 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $6,130,196 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $850,094 | CashBOYAmt |
| Cash EOY | $2,522,021 | CashEOYAmt |
| Acct Rcvbl | $28,057 | AcctRcvblAmt |
| Acct Rcvbl BOY | $38,553 | AcctRcvblBOYAmt |
| Acct Rcvbl EOY | $28,057 | AcctRcvblEOYAmt |
| Grants Receivable BOY | $87,173 | GrantsReceivableBOYAmt |
| Grants Receivable EOY | $232,888 | GrantsReceivableEOYAmt |
| Other Investments BOY | $78,379,429 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $76,341,445 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $108,059,342 | OtherInvestmentsEOYFMVAmt |
| Total Assets BOY | $79,355,249 | TotalAssetsBOYAmt |
| Total Assets EOY | $79,124,411 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $108,059,342 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $86,958 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $17,450 | AccountsPayableEOYAmt |
| Other Liabilities BOY | $929,769 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $1,080,278 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $1,016,727 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,097,728 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | $105,116,868 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | $109,744,581 | NoDonorRstrNetAssestsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $105,116,868 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $109,744,581 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $106,133,595 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $110,842,309 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $105,116,868 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$311,836 | ExcessRevenueOverExpensesAmt |
| Other Increases | $4,939,549 | OtherIncreasesAmt |
| Subtotal | $109,744,581 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $109,744,581 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Property | REALIZED GAIN OR LOSS | PropertyDesc |
| Gross Sales Price | $19,986,425 | GrossSalesPriceAmt |
| Cost Or Other Basis | $14,618,994 | CostOrOtherBasisAmt |
| Gain Or Loss | $5,367,431 | GainOrLossAmt |
| Gains Minus Excess Or Losses | $5,367,431 | GainsMinusExcessOrLossesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $5,367,431 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $85,210 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $85,210 | SubtotalAmt |
| Tax Based On Investment Income | $85,210 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $108,382 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Total Payments And Credits | $108,382 | TotalPaymentsAndCreditsAmt |
| Overpayment | $23,172 | OverpaymentAmt |
| Applied To ES Tax | $23,172 | AppliedToESTaxAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (true) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | false | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
| Website Address | bcbsmafoundation.org | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MICHAEL CARDER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6172465000 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 HUNTINGTON AVENUE SUITE 1300 | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 021997611 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | Yes (true) | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | false | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Undistr Incm Sect4942a2 Not App | false | UndistrIncmSect4942a2NotAppInd |
| Business Holdings | false | BusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | See Attachment | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 Huntington Avenue Suite 1300 | AddressLine1Txt |
| City | Boston | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 021997611 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Title | 0 | TitleTxt |
| Average Hrs Per Wk Devoted To Pos | 0 | AverageHrsPerWkDevotedToPosRt |
| Compensation | $0 | CompensationAmt |
| Employee Benefit Program | $0 | EmployeeBenefitProgramAmt |
| Expense Account Other Allwnc | $0 | ExpenseAccountOtherAllwncAmt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Service TypeServiceTypeTxt | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MANATT PHELPS & PHILLIPS LLP | |||||
| 7 Times Square | NEW YORK | NY | 10036 | CONSULTING | $609,397 |
| TYE LAWRENCE S | |||||
| 139A Fayerwaeather Street | CAMBRIDGE | MA | 02138 | CONSULTING | $140,890 |
| UNIVERSITY OF MASSACHUSETTS MEDICAL SCHO | |||||
| 55 Lake Ave North Worcester MA 0165 | NORTH WORCESTER | MA | 01655 | CONSULTING | $105,280 |
| NEPC LLC | |||||
| 255 State Street | BOSTON | MA | 02109 | 0 | $127,709 |
| CENTER FOR HEALTH CARE STRATEGIES INC | |||||
| 200 American Metro Blvd 119 | TRENTON | NJ | 08619 | CONSULTING | $195,996 |
Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | THE MISSION (PURPOSE) OF THE BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS FOUNDATION INC. IS TO EXPAND ACCESS TO HEALTH CARE THROUGH GRANTS & POLICY INITIATIVES, THE FOUNDATION | Description1Txt |
| Description2 | WORKS WITH PUBLIC AND PRIVATE ORGANIZATIONS TO BROADEN HEALTHCARE THROUGH GRANTS AND POLICY INITIATIVES. THE FOUNDATION WILL FOCUS ON DEVELOPING SOLUTIONS THAT BENEFIT | Description2Txt |
| Description3 | UNINSURED, VULNERABLE AND LOW INCOME INDIVIDUALS AND FAMILIES IN THE COMMONWEALTH. THROUGH CATALYST GRANTS, THE FOUNDATION IS A RESOURCE FOR | Description3Txt |
| Description4 | MINI GRANTS OF UP TO $5,000 TO ORGANIZATIONS SERVING THE HEALTH NEEDS OF LOW INCOME AND UNINSURED RESIDENTS OF MA. | Description4Txt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | NONE | Description1Txt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $100,651,327 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $0 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $100,651,327 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $100,651,327 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $1,509,770 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $99,141,557 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $4,957,078 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $4,957,078 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $85,210 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $85,210 | TotalTaxAmt |
| Distributable Before Adj | $4,871,868 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $4,871,868 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $4,871,868 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $7,584,464 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Charitable Assets Acquis Paid | $0 | CharitableAssetsAcquisPaidAmt |
| Set Aside Suitability Test | $0 | SetAsideSuitabilityTestAmt |
| Set Aside Cash Distri Test | $0 | SetAsideCashDistriTestAmt |
| Qualifying Distributions | $7,584,464 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $0 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $7,584,464 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $4,871,868 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Prior Year1 | 2018 | PriorYear1Yr |
| Prior Year2 | 2017 | PriorYear2Yr |
| Prior Year3 | 2016 | PriorYear3Yr |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $4,572,468 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $4,298,743 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $3,732,685 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $2,441,391 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $2,695,308 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $17,740,595 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $7,584,464 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Current Year | $4,871,868 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $2,712,596 | RemainingDistriFromCorpusAmt |
| Total Corpus | $20,453,191 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov From Yr5 | $4,572,468 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $15,880,723 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $4,298,743 | ExcessFromYear4Amt |
| Excess From Year3 | $3,732,685 | ExcessFromYear3Amt |
| Excess From Year2 | $2,441,391 | ExcessFromYear2Amt |
| Excess From Year1 | $2,695,308 | ExcessFromYear1Amt |
| Excess From Current Year | $2,712,596 | ExcessFromCurrentYearAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Private Operating Foundations | PrivateOperatingFoundationsGrp |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | NOT APPLICABLE | ContributingManagerNm |
| Shareholder Manager | NOT APPLICABLE | ShareholderManagerNm |
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | AUDREY SHELTO | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 HUNTINGTON AVENUE SUITE 1300 | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 021997611 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 6172465000 | RecipientPhoneNum |
| Form And Info And Materials | A TWO PAGE LETTER OF INQUIRY CAN BE SUBMITTED TO AUDREY SHELTO | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | N/A | SubmissionDeadlinesTxt |
| Restrictions On Awards | N/A | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE ATTACHMENT | BusinessNameLine1Txt |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 Huntington Avenue Suite 1300 | AddressLine1Txt |
| City | Boston | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02199 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Relationship | FILER ADDRESS | RecipientRelationshipTxt |
| Recipient Foundation Status | I | RecipientFoundationStatusTxt |
| Grant Or Contribution Purpose | TOTAL GRANTS PAID | GrantOrContributionPurposeTxt |
| Amt | $3,877,104 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $3,877,104 | TotalGrantOrContriPdDurYrAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Program Service Rev Part VII ProgramServiceRevPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CONTRIBUTIONS, GIFTS, AND GRANTS | Desc |
| Related Or Exempt Function Incm | $1,296,302 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees Contracts From Govt Ag | FeesContractsFromGovtAgGrp | |
| Membership Dues And Assmnt | MembershipDuesAndAssmntGrp | |
| Int On Sav And Temp Cash Invst | IntOnSavAndTempCashInvstGrp |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $762,765 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Rntl Incm Re Debt Fincd Prop | NetRntlIncmReDebtFincdPropGrp | |
| Net Rntl Incm Re Not Debt Fincd Prop | NetRntlIncmReNotDebtFincdProp | |
| Net Rental Income Personal Prop | NetRentalIncomePersonalPropGrp | |
| Other Investment Incm Part VII | OtherInvestmentIncmPartVIIGrp |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $5,367,431 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Income Loss From Special Evt | NetIncomeLossFromSpecialEvtGrp | |
| Gross Profit Loss Sls Of Invntry | GrossProfitLossSlsOfInvntryGrp |
Other Revenue Described OtherRevenueDescribedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | UNREALIZED GAIN OR LOSS ON INVESTMENTS | Desc |
| Exclusion | 14 | ExclusionCd |
| Related Or Exempt Function Incm | $4,939,549 | RelatedOrExemptFunctionIncmAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $6,130,196 | ExclusionAmt |
| Related Or Exempt Function Incm | $6,235,851 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $12,366,047 | TotalIncomeProducingActyAmt |
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp (2 entries)
| Line NumberLineNumberTxt | Relationship StatementRelationshipStatementTxt |
|---|---|
| 14 | Dividends provide income for future grant making and mission activities |
| 18 | The gain or loss from sale of assets are utilized to provide for future grant making and mission activities |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | Yes (true) | RelationshipsNonchrtblEOInd |
Relationship Schedule Detail RelationshipScheduleDetail (2 entries)
| Organization TypeOrganizationTypeDesc | Relationship DescriptionRelationshipDescriptionTxt |
|---|---|
| BLUE CROSS AND BLUE | |
| CORPORATION | AFFILIATE |
| HEALTHCARE | |
| CORPORATION | INACTIVE AFFILIATE |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| General Rule | Yes (X) | GeneralRuleInd |
Contributor Information ContributorInformationGrp (16 entries)
| ContributorContributorNum | Address Line1ContributorUSAddress/AddressLine1Txt | CityContributorUSAddress/CityNm | State AbbreviationContributorUSAddress/StateAbbreviationCd | ZIPContributorUSAddress/ZIPCd | Total ContributionsTotalContributionsAmt | Person ContributionPersonContributionInd | Payroll ContributionPayrollContributionInd |
|---|---|---|---|---|---|---|---|
| Robert Wood Johnson Foundation | |||||||
| 1 | 50 College Road East | Princeton | NJ | 085432316 | $21,250 | Yes (X) | |
| Employees of Blue Cross Blue Shield | |||||||
| 2 | 101 Huntington Avenue Suite 1300 | Boston | MA | 021997611 | $123,468 | Yes (X) | |
| National Institute for Healthcare M | |||||||
| 3 | 1225 19th Street NW Ste 710 | Washington | DC | 20036 | $19,000 | Yes (X) | |
| Blue Cross Blue Shield of Masachuse | |||||||
| 4 | 101 Huntington Avenue Suite 1300 | Boston | MA | 021997611 | $964,734 | Yes (X) | |
| CT Health Foundation | |||||||
| 5 | 100 Pearl Street | Hartford | CT | 06103 | $20,000 | Yes (X) | |
| Bower Foundation Grant - HC Fellows | |||||||
| 6 | 578 Highland Colony Parkway Suite 1 | Ridgeland | MS | 39157 | $19,000 | Yes (X) | |
| St David's Foundation | |||||||
| 7 | 1303 San Antonio Street Suite 500 | San Antonio | TX | 78701 | $5,000 | Yes (X) | |
| Episcopal Health Foundation | |||||||
| 8 | 500 Fannin St Suite 300 | Houston | TX | 77002 | $5,000 | Yes (X) | |
| Meadows Mental Health Policy - 2019 | |||||||
| 9 | 1303 San Antonio Street Suite 810 | San Antonio | TX | 78701 | $5,000 | Yes (X) | |
| Methodist Healthcare Minsitries of | |||||||
| 10 | 4507 Medical Drive San Antonio | San Antonio | TX | 78229 | $5,000 | Yes (X) | |
| Robert Wood Johnson Foundation gra | |||||||
| 11 | 50 College Road East Princeton | Princeton | NJ | 085432316 | $18,850 | Yes (X) | |
| Henry J Kaiser Foundation | |||||||
| 12 | 185 Berry Street - Suite 2000 | San Francisco | CA | 94107 | $20,000 | Yes (X) | |
| Main Health Access Foundation | |||||||
| 13 | 150 Capitol Street Suite 4 | Augusta | ME | 04330 | $19,000 | Yes (X) | |
| Blue Shield of CA Foundation | |||||||
| 14 | 315 Montgomery Street Suite 1200 | San Francisco | CA | 94104 | $40,000 | Yes (X) | |
| Episcopal Health Foundation | |||||||
| 15 | 500 Fannin St Suite 300 | Houston | TX | 77002 | $5,000 | Yes (X) | |
| Meadows Mental Health Policy Instit | |||||||
| 16 | 1303 San Antonio Street Suite 810 | San Antonio | TX | 78701 | $5,000 | Yes (X) | |
All Oth Prog Rltd Investments Sch AllOthProgRltdInvestmentsSch
All Other Program Related Invst AllOtherProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NONE | Desc |
Compensation Explanation CompensationExplanation
Compensation Explanation CompensationExplanationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | See Attachment | PersonNm |
| Short Explanation | SEE ATTACHMENT | ShortExplanationTxt |
Contractor Compensation Expln ContractorCompensationExpln
Contractor Comp Expln ContractorCompExplnGrp (5 entries)
| ExplanationExplanationTxt |
|---|
| MANATT PHELPS PHILLIPS LLP |
| PROFESSIONAL LEGAL AND CONSULTING SERVICES |
| TYE LAWRENCE S |
| PROFESSIONAL CONSULTING SERVICES |
| UNIVERSITY OF MASSACHUSETTS MEDICAL |
| PROFESSIONAL CONSULTING SERVICES |
| NEPC LLC |
| CONSULTING |
| CENTER FOR HEALTH CARE STRATEGIES I |
| CONSULTING |
Depreciation Schedule DepreciationSchedule
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (13 entries)
| Category Or ItemCategoryOrItemTxt | Listed At Cost Or FMVListedAtCostOrFMVCd | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| ACCESS CAPITAL COMM INV FUND | FMV | $4,176,424 | $4,024,252 |
| PUTNAM TOTAL RETURN FUND | FMV | $13,962,343 | $13,851,512 |
| PIMCO ALL ASSET FUND | FMV | $3,162,924 | $3,377,090 |
| SSGA S&P 500 TOBACCO FREE FUND | FMV | $15,560,026 | $37,485,652 |
| SANDERSON TOBACCO FREE IN FUND | FMV | $8,195,112 | $16,329,128 |
| PIMCO TOTAL RETURN FUND | FMV | ||
| IRONBRIDGE SM CAP LIFE CY FUND | FMV | $6,880,821 | $6,831,128 |
| CF DV DYNAMIC GROWTH FUND | FMV | $2,481,544 | $3,251,233 |
| SCHRODER EM MKT M/S BND-R6 | FMV | $4,542,668 | $4,426,133 |
| SEGALL BRYANT & HAMILL INTL SM | FMV | $5,268,781 | $4,353,658 |
| SSGA US TIPS INDEX STRATEGY | FMV | $3,598,843 | $4,386,950 |
| SCHRODER EMERG MKT EQ FD-SDR | FMV | $4,011,959 | $5,071,532 |
| WILLIAM BLAIR EMERGING MARKET | FMV | $4,500,000 | $4,671,074 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (4 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|
| POSTAGE AND TELEPHONE | $17,376 | $17,376 |
| EXTERNAL PROFESSIONAL SERVICES | $1,677,495 | $1,677,495 |
| PURCHASED SERVICES FROM BCBS | $1,860,843 | $1,860,843 |
| MISCELLANEOUS EXPENSES | $3,830 | $3,830 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Unrealized Gain Or Loss on Investments | Desc |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | UNREALIZED GAIN OR LOSS ON INVESTMENTS | Desc |
| Amt | $4,939,549 | Amt |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail (3 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt |
|---|---|---|
| DUE TO AFFILIATE BLUE CROSS AN | $339,034 | $585,673 |
| FEDERAL INCOME TAXES ON INVEST | $372,220 | $440,880 |
| FEDERAL INCOME TAX LIABILITY | $218,515 | $53,725 |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | TAX ON INVESTMENT INCOME | CategoryTxt |
| Amt | $153,870 | Amt |