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BLUE CROSS BLUE SHIELD ASSOC RETIRE BENEFIT TRUST: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
BLUE CROSS BLUE SHIELD ASSOC RETIRE BENEFIT TRUST (EIN 36-4018700)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-03
IRS object ID
201113079349301371
Schema version
2010v3.4
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)
Timestamp2011-11-03T15:15:44-04:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BDO USA LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line17101 WISCONSIN AVE STE 800AddressLine1
CityBETHESDACity
StateMDState
ZIP Code20814ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN364018700EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Blue Cross Blue Shield Assoc RetireBusinessNameLine1
Business Name Line2Benefits TrustBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlBLUENameControl
Phone3124445670Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1225 North Michigan AvenueAddressLine1
CityChicagoCity
StateILState
ZIP Code60601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
Namedavid manuszakName
Titleexecutive directorTitle
Phone3122976375Phone
Date Signed2011-11-02DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone3016544900Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDavid ManuszakNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1225 North Michigan AvenueAddressLine1
CityChicagoCity
StateILState
ZIP Code60601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4913024GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1994YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTHE TRUST WAS CREATED FOR THE EXCLUSIVE PURPOSE OF PROVIDING POST- RETIREMENT HEALTH CARE & LIFE INSURANCE BENEFITS TO ELIGIBLE retirees RETIREES & THEIR DEPENDENTS UNDER BCBSA benefit programs.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2940491ProgramServiceRevenuePriorYear
Program Service Revenue CY2911415ProgramServiceRevenueCY
Investment Income Prior Year437432InvestmentIncomePriorYear
Investment Income Current Year1414161InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year3377923TotalRevenuePriorYear
Total Revenue Current Year4325576TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year1062383BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY814918BenefitsPaidToMembersCY
Salaries Etc Prior Year26831SalariesEtcPriorYear
Salaries Etc Current Year31121SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year7803OtherExpensePriorYear
Other Expenses Current Year10338OtherExpensesCurrentYear
Total Expenses Prior Year1097018TotalExpensesPriorYear
Total Expenses Current Year856377TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2280905RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3469199RevenuesLessExpensesCY
Total Assets BOY32062577TotalAssetsBOY
Total Assets EOY37182603TotalAssetsEOY
Total Liabilities BOY1145918TotalLiabilitiesBOY
Total Liabilities EOY896710TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY30916659NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY36285893NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE TRUST WAS CREATED FOR THE EXCLUSIVE PURPOSE OF PROVIDING POST-RETIREMENT HEALTH CARE AND LIFE INSURANCE BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS UNDER BLUE CROSS & BLUE SHIELD ASSOCIATION'S BENEFIT PROGRAMS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
DescriptionPROVIDED POST-RETIREMENT HEALTH CARE AND LIFE INSURANCE BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS UNDER BLUE CROSS & BLUE SHIELD ASSOCIATION'S BENEFIT PROGRAMS. TOTAL BENEFITS PAID TO (OR FOR THE BENEFIT OF) PARTICIPANTS AND THEIR DEPENDENTS DURING YEAR WERE $814,918.Description
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonEXECUTIVE DIRECTORNamePerson
Telephone Number3122976000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1225 NORTH MICHIGAN AVEAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60601ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationInstitutional TrusteeInstitutionalTrustee
Tim J Crilly
committee member0.1X000
Robert A Leichtle
committee member0.1X000
Robert P Hiam
committee member0.1X000
Andrew C Corbin
Vice-Chairman0.1X000
Sherry Cladouhos
Chairman0.1X000
Michael Reitz
committee member0.1X000
Scott P Serota
committee member0.1X000
R Chris Doerr
committee member0.1X000
David Southwell
committee member0.1X000
John F Giblin
committee member0.1X000
Mark P Stimpson
committee member0.1X000
Paul von Ebers
committee member0.1X000
THE NORTHERN TRUST
TRUSTEE40.03112100X
FieldValueIRS element (for citing)
Total Reportable Comp From Org31121TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionEMPLOYER CONTRIB.Description
Total Revenue Column2911415TotalRevenueColumn
Related Or Exempt Function Income2911415RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue2911415TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column900896TotalRevenueColumn
Exclusion$900,896ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1100713Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities587448Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities513265Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column513265TotalRevenueColumn
Exclusion$513,265ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column4325576TotalRevenueColumn
Related Or Exempt Function Income2911415RelatedOrExemptFunctionIncome
Exclusion$1,414,161ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total814918Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total31121Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total10338Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total856377Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY282435BOY
EOY1192151EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY31630534BOY
EOY35914158EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY149608BOY
EOY76294EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY32062577BOY
EOY37182603EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY84241BOY
EOY81792EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1061677BOY
EOY814918EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1145918BOY
EOY896710EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY30916659BOY
EOY36285893EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY30916659BOY
EOY36285893EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY32062577BOY
EOY37182603EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3469199ReconcilationRevenueExpenses
Reconcilation Other Changes1900035ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements
EquipmentEquipment
Other Land BuildingsOtherLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO SPONSOR PREMIUM REIMBURSMENTDescription
Amount$814,918Amount
FieldValueIRS element (for citing)
Total Of Amounts814918TotalOfAmounts

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
part v, line 3athe organization does not have any unrelated business income.
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 11BForm 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 consolidated audited financial statements of the blue cross and blue shield health and life program 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.
Part XI, Line 5U/R Gain - $1,965,077 Prior Period Adj to beginning net assets - ($65,042)Other Changes in Net Assets or Fund Balances

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Blue Cross Blue Shield AssociationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1225 North Michigan AveAddressLine1
CityChicagoCity
StateILState
ZIP Code60601ZIPCode
FieldValueIRS element (for citing)
EIN135656874EIN
Primary ActivitiesContrib.ERPrimaryActivities
Legal Domicile StateILLegalDomicileState
Exempt Code Section501(c)(4)ExemptCodeSection
Public Charity StatusN/APublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Sharing Of Paid EmployeestrueSharingOfPaidEmployees