2021-11-05T08:18:45-05:00 2020-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2020-01-01 367008317 BLUE CROSS AND BLUE SHIELD PLANS NATIONAL RETIREE HEALTH BENEFITS TRUST BLUE 3124445670 225 NORTH MICHIGAN AVENUE CHICAGO IL 60601 TERRENCE J COONEY ASST. SECRETARY OF COMMITTEE 3124445670 2021-10-26 1 TERRENCE COONEY 999009999 DAVID LOWENTHAL P00378651 3122071040 2021-10-23 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z TERRENCE J COONEY 225 NORTH MICHIGAN AVENUE CHICAGO IL 60601 46008303 0 X N/A X 1991 IL TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES OF THE BLUE CROSS & BLUE SHIELD COMPANIES. 13 11 0 11 2388146 1805288 0 0 0 325000 14141346 5340846 0 801253 14141346 6467099 0 0 9704792 8088456 424171 481064 0 0 0 821197 664482 10950160 9234002 3191186 -2766903 211021064 215885033 10603750 8121768 200417314 207763265 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 $8,088,456. 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 13 11 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X TERRENCE J COONEY 3122976000 225 N MICHIGAN AVE CHICAGO IL 60601 ROBERT J KOLODGY COMMITTEE MEMBER 0.10 40.00 X 0 1088737 60273 CHRISTOPHER BOOTH COMMITTEE MEMBER - CHAIR 0.10 10.20 X X 0 0 0 JOHN F GIBLIN COMMITTEE MEMBER - VICE CHAIR 0.10 0.20 X X 0 0 0 MATT ALL COMMITTEE MEMBER 0.10 0.20 X 0 0 0 BRYAN CAMERLINCK COMMITTEE MEMBER 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 DIANE GORE COMMITTEE MEMBER 0.10 0.20 X 0 0 0 THURMAN JUSTICE 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 0.10 0.20 X 0 0 0 MARK P STIMPSON COMMITTEE MEMBER 0.10 0.20 X 0 0 0 THE NORTHERN TRUST TRUSTEE 40.00 0.00 X 481064 0 0 481064 1088737 60273 0 0 1 0 0 EMPLOYER CONTRIBUTION 900099 325000 325000 325000 5545612 2592912 2952700 39336438 39541204 -204766 -204766 -204766 INCOME TAX RECOVERY 900099 801253 801253 801253 6467099 325000 2388146 3753953 8088456 481064 37441 16667 TAXES INCURRED 610374 9234002 206896198 213817735 4124866 2067298 211021064 215885033 9990880 8121768 612870 0 10603750 8121768 X 200417314 207763265 0 0 0 0 200417314 207763265 211021064 215885033 -2766903 10112854 0 X 0 1 X 1 0 0 X 16579953 10112854 10112854 6467099 0 6467099 9234002 0 9234002 0 9234002 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, 2020 AND 2019, 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 1 0 ROBERT J KOLODGY COMMITTEE MEMBER 0 643867 0 435800 0 9070 0 14250 0 46023 0 1149010 0 0 PART I, LINE 4B ROBERT KOLODGY PARTICIPATED IN A LONG-TERM INCENTIVE PLAN BUT DID NOT RECEIVE ANY DISTRIBUTIONS FROM THE PLAN IN 2020. 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 1 BLUE CROSS & BLUE SHIELD OF WYOMING S 325000 COST 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 2020, BLUE CROSS BLUE SHIELD OF WYOMING MADE CONTRIBUTIONS TO FUND PROGRAM BENEFITS. IN PRIOR YEARS ALL THE PARTICIPATING EMPLOYERS DID LIKEWISE.