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BLUE CROSS AND BLUE SHIELD PLANS NATIONAL RETIREE HEALTH BENEFITS: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
BLUE CROSS AND BLUE SHIELD PLANS NATIONAL RETIREE HEALTH BENEFITS (EIN 36-7008317)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-11-16
IRS object ID
201543209349306154
Schema version
2014v5.0
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

FieldValueIRS element (for citing)
Return2015-11-16T11:41:07-06:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BDO USA LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1330 N Wabash Suite 3200AddressLine1Txt
CityCHICAGOCityNm
State AbbreviationILStateAbbreviationCd
ZIP60611ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN367008317EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Blue Cross and Blue Shield Plans NationalBusinessNameLine1Txt
Business Name Line2Retiree Health Benefits TrustBusinessNameLine2Txt
FieldValueIRS element (for citing)
In Care Of% NEBA EXECUTIVE DIRECTORInCareOfNm
Business Name ControlBLUEBusinessNameControlTxt
Phone3124445670PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1225 North Michigan AvenueAddressLine1Txt
CityChicagoCityNm
State AbbreviationILStateAbbreviationCd
ZIP60601ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTERRENCE J COONEYPersonNm
Person TitleOFFICERPersonTitleTxt
Phone3124445670PhoneNum
Signature2015-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRebekuh EleyPreparerPersonNm
PTINP01247672PTIN
Phone3128569100PhoneNum
Preparation2015-11-15PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-04-25 22:37:26ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTerrence J CooneyPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1225 NORTH MICHIGAN AVEAddressLine1Txt
CityCHICAGOCityNm
State AbbreviationILStateAbbreviationCd
ZIP60601ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$77,827,265GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressN/AWebsiteAddressTxt
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Formation1991FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionTHE PRIMARY PURPOSE OF THE TRUST IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES OF THE BLUE CROSS & BLUE SHIELD COMPANIES.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$6,818,162TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$6,190,024NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$16,847,806PYProgramServiceRevenueAmt
CY Program Service Revenue$839,099CYProgramServiceRevenueAmt
PY Investment Income$11,017,800PYInvestmentIncomeAmt
CY Investment Income$11,077,046CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$27,865,606PYTotalRevenueAmt
CY Total Revenue$11,916,145CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$10,686,041PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$12,681,130CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,522,567PYOtherExpensesAmt
CY Other Expenses$2,453,830CYOtherExpensesAmt
PY Total Expenses$13,208,608PYTotalExpensesAmt
CY Total Expenses$15,134,960CYTotalExpensesAmt
PY Revenues Less Expenses$14,656,998PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$3,218,815CYRevenuesLessExpensesAmt
Total Assets BOY$213,711,157TotalAssetsBOYAmt
Total Assets EOY$217,692,831TotalAssetsEOYAmt
Total Liabilities BOY$10,840,553TotalLiabilitiesBOYAmt
Total Liabilities EOY$14,219,375TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$202,870,604NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$203,473,456NetAssetsOrFundBalancesEOYAmt
MissionTHE PRIMARY PURPOSE OF THE TRUST IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES OF THE BLUE CROSS & BLUE SHIELD COMPANIES.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
DescPROVIDED HEALTH BENEFITS TO ELIGIBLE RETIREES OF BLUE CROSS & BLUE SHIELD. TOTAL HEALTH BENEFITS PAID DURING THE YEAR WAS $12,681,130.Desc
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
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Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
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Professional FundraisingfalseProfessionalFundraisingInd
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Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
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Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
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Independent Voting Member10IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
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Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
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Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
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Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
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Local ChaptersfalseLocalChaptersInd
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Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonNEBA EXECUTIVE DIRECTORPersonNm
Phone3122976000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1225 NORTH MICHIGAN AVEAddressLine1Txt
CityCHICAGOCityNm
State AbbreviationILStateAbbreviationCd
ZIP60601ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtInstitutional TrusteeInstitutionalTrusteeInd
Andrew C Corbin
Committee Member0.10.0Yes (X)$0$0$0
R Chris Doerr
committee member0.10.0Yes (X)$0$0$0
John F Giblin
Vice Chairman0.10.0Yes (X)$0$0$0
Michael Gold
committee member0.10.0Yes (X)$0$0$0
Mark P Stimpson
committee member0.10.0Yes (X)$0$0$0
Karen M Abraham
COMMITTEE MEMBER0.10.0Yes (X)$0$0$0
MICHAEL MIZEUR
COMMITTEE MEMBER0.10.0Yes (X)$0$0$0
PETER ANDRUSZKIEWICZ
COMMITTEE MEMBER0.10.0Yes (X)$0$0$0
RICK SCHUM
CHAIRMAN0.10.0Yes (X)$0$0$0
Chuck DiVita
Committee Member0.10.0Yes (X)$0$0$0
Don George
Committee Member0.10.0Yes (X)$0$0$0
Tim Huckle
Committee Member0.10.0Yes (X)$0$0$0
Robert J Kolodgy
Committee Member0.10.0Yes (X)$0$762,323$0
Mary O'Hara
Committee Member0.10.0Yes (X)$0$0$0
THE NORTHERN TRUST
TRUSTEE40.00.0$51,225$0$0Yes (X)
FieldValueIRS element (for citing)
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Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

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PersonThe Northern TrustPersonNm

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CityCHICAGOCityNm
State AbbreviationILStateAbbreviationCd
ZIP60603ZIPCd
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ServicesInvestment MgmtServicesDesc
Compensation$512,605CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

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DescEMPLOYER CONTRIBUTIONSDesc
Business900099BusinessCd
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Related Or Exempt Func Income$839,099RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
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Investment Income InvestmentIncomeGrp

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Unrelated Business Revenue$3,637,606UnrelatedBusinessRevenueAmt
Exclusion$4,258,884ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

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Royalties Revenue RoyaltiesRevenueGrp

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Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

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Gross Amount Sales Assets GrossAmountSalesAssetsGrp

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Net Income Or Loss NetIncomeOrLossGrp

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FieldValueIRS element (for citing)
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Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
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Exclusion$4,258,884ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

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Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

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Foreign Grants ForeignGrantsGrp

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Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
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Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

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Comp Disqual Persons CompDisqualPersonsGrp

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Pension Plan Contributions PensionPlanContributionsGrp

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Payroll Taxes PayrollTaxesGrp

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Fees For Services Legal FeesForServicesLegalGrp

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Fees For Services Accounting FeesForServicesAccountingGrp

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Fees For Services Lobbying FeesForServicesLobbyingGrp

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Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

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Fees For Services Other FeesForServicesOtherGrp

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Office Expenses OfficeExpensesGrp

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Information Technology InformationTechnologyGrp

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Royalties RoyaltiesGrp

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Occupancy OccupancyGrp

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Travel TravelGrp

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Interest InterestGrp

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Insurance InsuranceGrp

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DescTAX EXPENSEDesc
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Total Functional Expenses TotalFunctionalExpensesGrp

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Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

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Intangible Assets IntangibleAssetsGrp

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Total Assets TotalAssetsGrp

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Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$10,840,553BOYAmt
EOY$14,219,375EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$202,870,604BOYAmt
EOY$203,473,456EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

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BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
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Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$202,870,604BOYAmt
EOY$203,473,456EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$213,711,157BOYAmt
EOY$217,692,831EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$3,218,815ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$3,821,667NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp
BuildingsBuildingsGrp
Leasehold ImprovementsLeaseholdImprovementsGrp
EquipmentEquipmentGrp
Other Land BuildingsOtherLandBuildingsGrp
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
ACCRUED BENEFITS REIMBURSEMENT$12,681,130
ACCRUED PROFESSIONAL FEES$292,485
DUE TO BROKERS$1,245,760
FieldValueIRS element (for citing)
Total Liability$14,219,375TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$15,737,812TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$3,821,667NetUnrealizedGainsInvstAmt
Revenue Not Reported$3,821,667RevenueNotReportedAmt
Revenue Subtotal$11,916,145RevenueSubtotalAmt
Total Revenue Per Form990$11,916,145TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$15,134,960TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$15,134,960ExpensesSubtotalAmt
Total Expenses Per Form990$15,134,960TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart X, ASC 740 FootnoteFormAndLineReferenceDesc
ExplanationACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE TRUST MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE TRUST AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE TRUST ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE TRUST, AND HAS CONCLUDED THAT AS OF DECEMEBER 31, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF THE LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE TRUST IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.ExplanationTxt

Schedule J IRS990ScheduleJ

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonRobert J KolodgyPersonNm
TitleCommittee MemberTitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$467,771CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$222,000BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$26,445OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$17,500DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$28,607NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$762,323TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART VI, LINE 2CERTAIN MEMBERS OF THE NATIONAL EMPLOYEE BENEFITS COMMITTEE ("COMMITTEE") SERVE TOGETHER ON THE BOARD OF THE 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.
PART VI, LINE 11Form 990's content and sources 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 were presented to the Committee that serves as the governing body by the independent auditors.
PART VI, SECTION B, 12CBCBSA 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 hot-line 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 the Committee's legal compliance, including compliance with ERISA. As employees of various Blue Plans, each Committee member not employed by BCBSA is subject to additional conflict of interest restriction under policies adopted by his or her Employer Plan.
PART VI, LINE 15 A AND Bthe organization does not require compensation policies as it does not compensate any officers, management officials or key employees.
PART VI, LINE 19The governing documents and Form 990 are made available upon request to the Executive Director, National Employee Benefits Administration, Blue Cross and Blue Shield Association, 225 N. Michigan Avenue, Chicago, IL 60601.
PART VII, SECTION Awith the exception of the institutional trustee, all listed are members of an independent committee that supervises the trust.
990 XI, LINE 5Unrealized Gain of $3,821,667.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Blue Cross Blue Shield AssociationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1225 North Michigan AveAddressLine1Txt
CityChicagoCityNm
State AbbreviationILStateAbbreviationCd
ZIP60601ZIPCd
FieldValueIRS element (for citing)
EIN135656874EIN
Primary ActivitiesContrib.ERPrimaryActivitiesTxt
Legal Domicile StateILLegalDomicileStateCd
Exempt Code Section501(C)(4)ExemptCodeSectionTxt
Public Charity Statusn/aPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1naBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (20 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
Anthem Inc
120 Monument CircleIndianapolisIN46204352147515Contrib.ERINnac corpfalse
Blue Cross & Blue Shield of NC
5901 Chapel Hill RoadDurhamNC27707560894904Contrib.ERNCnac corpfalse
BlueCross BlueShield of Tennessee
1 Cameron Hill CircleChattanoogaTN37402621624483Contrib.ERTNnac corpfalse
Blue Cross and Blue Shield of Wyoming
4000 House AvenueCheyenneWY82001830231011Contrib.ERWYnac corpfalse
Community Insurance Company
4361 Irwin Simpson RoadMasonOH45040311440175CONTRIB.EROHAnthem IncC Corpfalse
Anthem Holding Corp
120 Monument CircleIndianapolisIN46204611459939CONTRIB.ERINAnthem IncC Corpfalse
National Government Services Inc
8115 Knue RoadIndianapolisIN46250351840597CONTRIB.ERINAnthem IncC Corpfalse
ATH Holding Company LLC
120 Monument CircleIndianapolisIN46204113713086CONTRIB.ERINAnthem IncC Corpfalse
Anthem Insurance Companies Inc
120 Monument CircleIndianapolisIN46204350781558Contrib.ERINAnthem IncC Corpfalse
Volunteer State Health Plan Inc
1 Cameron Hill CircleChattanoogaTN37402621656610CONTRIB.ERTNBCBS of TennessC Corpfalse
Shared Health
401 M L King BlvdChattanoogaTN37402203484545CONTRIB.ERTNBCBS of TennessC Corpfalse
RiverBend Government Benefits Admisistra
1 Cameron Hill CircleChattanoogaTN37402202469347CONTRIB.ERTNBCBS of TennessC Corpfalse
RiverTrust Solutions Inc
1 Cameron Hill CircleChattanoogaTN37402200528228CONTRIB.ERTNBCBS of TennessC Corpfalse
Cambia Health SolutionsInc
200 SW Market Street Suite 1500PortlandOR97201931179316Contrib.ERORnaC Corpfalse
Regence Blueshield of Idaho
1602 21st AvenueLewistonID83501820206874Contrib.ERIDCambia HealthC Corpfalse
Regence Bluecross Blueshield Utah
2890 East Cottonwood ParkwaySalt Lake CityUT84121870200138Contrib.ERUTCambia HealthC Corpfalse
Regence Blueshield
1800 Ninth AvenueSeattleWA98101910282080Contrib.ERWACambia HealthC Corpfalse
Regence Blue Cross and Blue Shield of Or
200 SW Market Street Suite 1500PortlandOR97201930238155Contrib.ERORCambia HealthC Corpfalse
Blue Cross and Blue Shield of Arizona
2444 West Las Palmaritas DrPhoenixAZ85021860004538Contrib. ERAZnac corpfalse
CSA General Insurance Agency Inc
2480 West Las Palmaritas DrPhoenixAZ85021860489277Contrib.ERAZBCBS Arizonac corpfalse
FieldValueIRS element (for citing)
Paid Employees SharingYes (true)PaidEmployeesSharingInd