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BLUE CROSS AND BLUE SHIELD PLANS NATIONAL RETIREE HEALTH BENEFITS: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
BLUE CROSS AND BLUE SHIELD PLANS NATIONAL RETIREE HEALTH BENEFITS (EIN 36-7008317)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-03
IRS object ID
201123079349300722
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)
Timestamp2011-11-03T15:14:49-04:00Timestamp
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 SUITE 800AddressLine1
CityBETHESDACity
StateMDState
ZIP Code20814ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN367008317EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Blue Cross and Blue Shield Plans NationalBusinessNameLine1
Business Name Line2Retiree Health Benefits 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)
NameQuinlan TraceyName
Phone3016344900Phone
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 AVEAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts90445444GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1991YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTHE PRIMARY PURPOSE OF THE TRUST IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES OF BLUE CROSS & BLUE SHIELD companies.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI5751538TotalGrossUBI
Net Unrelated Business Txbl Income5325755NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2833690ProgramServiceRevenuePriorYear
Program Service Revenue CY2624290ProgramServiceRevenueCY
Investment Income Prior Year6473385InvestmentIncomePriorYear
Investment Income Current Year8935776InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year9307075TotalRevenuePriorYear
Total Revenue Current Year11560066TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year8472422BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY9068661BenefitsPaidToMembersCY
Salaries Etc Prior Year25741SalariesEtcPriorYear
Salaries Etc Current Year28495SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1137143OtherExpensePriorYear
Other Expenses Current Year1635491OtherExpensesCurrentYear
Total Expenses Prior Year9635306TotalExpensesPriorYear
Total Expenses Current Year10732647TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-328231RevenuesLessExpensesPriorYear
Revenues Less Expenses CY827419RevenuesLessExpensesCY
Total Assets BOY198751391TotalAssetsBOY
Total Assets EOY170289982TotalAssetsEOY
Total Liabilities BOY41454312TotalLiabilitiesBOY
Total Liabilities EOY9195065TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY157297079NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY161094917NetAssetsOrFundBalancesEOY
Mission DescriptionTHE PRIMARY PURPOSE OF THE TRUST IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES OF BLUE CROSS & BLUE SHIELD COMPANIES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
DescriptionPROVIDED HEALTH BENEFITS TO ELIGIBLE RETIREES OF BLUE CROSS SHIELD. TOTAL HEALTH BENEFITS PAID DURING THE YEAR WAS $9,068,661.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 StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
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
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
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
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
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 Line1255 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
Sherry Cladouhos
chairman0.1X000
Andrew C Corbin
Vice-Chairman0.1X000
Tim J Crilly
committee member0.1X000
R Chris Doerr
committee member0.1X000
John F Giblin
committee member0.1X000
Robert P Hiam
committee member0.1X000
Robert A Leichtle
committee member0.1X000
Michael Reitz
committee member0.1X000
Scott P Serota
committee member0.1X000
David Southwell
committee member0.1X000
Mark P Stimpson
committee member0.1X000
Paul von Ebers
committee member0.1X000
THE NORTHERN TRUST
TRUSTEE40.02849500X
FieldValueIRS element (for citing)
Total Reportable Comp From Org28495TotalReportableCompFromOrg
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 CONTRIBUTIONSDescription
Business Code900099BusinessCode
Total Revenue Column2624290TotalRevenueColumn
Related Or Exempt Function Income2624290RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue2624290TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5122980TotalRevenueColumn
Unrelated Business Revenue1938742UnrelatedBusinessRevenue
Exclusion$3,184,238ExclusionAmount

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)
Securities82698173Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities78885378Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities3812795Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column3812796TotalRevenueColumn
Unrelated Business Revenue3812796UnrelatedBusinessRevenue

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 Column11560066TotalRevenueColumn
Related Or Exempt Function Income2624290RelatedOrExemptFunctionIncome
Unrelated Business Revenue5751538UnrelatedBusinessRevenue
Exclusion$3,184,238ExclusionAmount

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)
Total9068661Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total28495Total

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)
Total29001Total

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)
Total410490Total

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

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionTAX EXPENSEDescription
Total1196000Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10732647Total

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY165789062BOY
EOY169260846EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY32962329BOY
EOY1029136EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY198751391BOY
EOY170289982EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY41454312BOY
EOY9195065EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY41454312BOY
EOY9195065EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY157297079BOY
EOY161094917EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY157297079BOY
EOY161094917EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY198751391BOY
EOY170289982EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses827419ReconcilationRevenueExpenses
Reconcilation Other Changes2970419ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
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 (2 entries)

DescriptionDescriptionAmountAmount
ACCRUED BENEFITS REIMBURSEMENT$9,048,478
ACCRUED PROFESSIONAL FEES$146,587
FieldValueIRS element (for citing)
Total Of Amounts9195065TotalOfAmounts
Total Revenue11560066TotalRevenue
Total Expenses10732647TotalExpenses
Excess Or Deficit For Year827419ExcessOrDeficitForYear
Net Unrealized GL On Investments2970419NetUnrealizedGLOnInvestments
Total Adjustments2970419TotalAdjustments
Excess Or Deficit Per FS3797838ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt14530485TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments2970419NetUnrealizedGainsInvestments
Revenue Not Rptd F9902970419RevenueNotRptdF990
Revenue Subtotal11560066RevenueSubtotal
Total Revenue Per Form99011560066TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt10732647TotExpensesEtcAuditedFinclStmt
Expenses Subtotal10732647ExpensesSubtotal
Total Expenses Per Form99010732647TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart X, ASC 740 FootnoteIdentifier
ExplanationThe Trust accounts for uncertainty in income taxes under ASC 740-10-25, "Accounting for Uncertainty in Income Taxes," which reduces the diversity in practice associated with certain aspects of the recognition and measurement related to accounting for income taxes and requires an organization to recognize the tax benefit associated with tax positions taken for tax return purposes when it is more-likely-than-not that the position will be sustained. The Trust does not believe there are any unrecognized tax benefits that should be recorded. There were no interest or penalties recorded or included in the statement of changes in net assets available for retiree health benefits for the years ended December 31, 2010 and 2009. The Trust's fiscal years 2007 to the present remain open to examination by taxing authorities under conventional statutes of limitations.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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 - $2,970,419Other 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

Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
WellPoint Inc
120 Monument CircleIndianapolisIN46204113713086Contrib.ERINnac corp000.00000
Blue Cross & Blue Shield of NC
5901 Chapel Hill RoadDurhamNC27707560894904Contrib.ERNCnac corp000.00000
The Regence Group
200 SW Market Street Suite 1500PortlandOR97201931179316Contrib.ERORnac corp000.00000
BlueCross BlueShield of Tennessee
1 Cameron Hill CircleChattanoogaTN37402621624483Contrib.ERTNnac corp000.00000
Blue Cross and Blue Shield of Wyoming
4000 House AvenueCheyenneWY82001830231011Contrib.ERWYnac corp000.00000