2013-11-13T12:48:35-06:00 2012-12-31 621199757 LATTIMORE BLACK MORGAN & CAIN PC 605 CHESTNUT STREET SUITE 1100 CHATTANOOGA TN 37450 990 2012-01-01 581406632 SOUTHERN HEALTH PLAN INC SOUT 4235357163 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 T RALPH WOODARD JR 4235357163 2013-11-12 0 PATRICIA K COSGROVE P00025712 4237566585 2012 2016-02-25 16:41:14Z BLUECROSS BLUESHIELD TN COM TR CALVIN ANDERSON 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 1215429 0 X SEE SCHEDULE O X 1980 TN SEE SCH O FORM 990, PART III, LINE 4A FOR DESCRIPTION. 3 0 0 0 19607 0 0 0 0 0 316689 430440 0 0 316689 430440 524416 542718 0 0 0 0 0 0 0 133815 178951 658231 721669 -341542 -291229 11831726 12259308 16579 12412 11815147 12246896 X TO SUPPORT PROGRAMS THAT IMPROVE THE QUALITY OF LIFE IN TENNESSEE AND TO PROMOTE GOOD HEALTH; IMPROVE THE AVAILABILITY, ACCESSIBILITY AND QUALITY OF HEALTH CARE FOR THE PEOPLE OF TENNESSEE. 0 0 542718 542718 SEE SCH O FORM 990, PART III, LINE 4A FOR DESCRIPTION. THE COMPANY SUPPORTED PROGRAMS THAT PROMOTE ACCESS TO HEALTH CARE SERVICES AND HEALTH EDUCATION.THE COMPANY SUPPORTED PROGRAMS THAT PROMOTE WELLNESS AND ILLNESS PREVENTION, AS WELL AS EFFECTIVE, EFFICIENT DISEASE MANAGEMENT.THE COMPANY SUPPORTED PROGRAMS FOR ALL LEVELS OF EDUCATION THUS BUILDING A COMPETENT WORKFORCE AND PROSPEROUS ECONOMY.THE COMPANY SUPPORTED EVENTS AND PROGRAMS THAT EMPHASIZE ECONOMIC AND COMMUNITY DEVELOPMENT.THE COMPANY DEMONSTRATED EXCELLENT CORPORATE CITIZENSHIP AND COMMITMENT TO TENNESSEANS, WITH THE PRIORITY TO SUPPORT THE COMMUNITIES IT SERVED, EMPHASIZING HEALTHY LIVING, HEALTH CARE ACCESS AND QUALITY OF LIFE. 542718 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 147 0 1 0 1 1 1 CA 0 0 0 0 X 3 0 1 1 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X T RALPH WOODARD JR 4235355192 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 X CALVIN ANDERSON 2.00 X X 0 601226 104348 INGA HIMELRIGHT 1.00 X 0 521246 77856 MARK HOOTON 1.00 X 0 239102 45400 T RALPH WOODARD JR 0.50 X 0 399937 67324 BRIAN STANA 1.50 X 0 246048 40579 ALAINE ZACHARY 0.50 X 0 302109 55901 SHELIA CLEMONS 0.50 X 0 139869 71912 KATHARINE LAURANCE 0.50 X 0 77201 20966 VICKY GREGG 0.00 X 0 12715289 885289 RON HARR 0.00 X 0 584786 0 WILLIAM YOUNG 0.00 X 0 577419 0 DANNY TIMBLIN 0.00 X 0 384680 65457 CHRIS HUNTER 0.00 X 0 855299 95677 JOHN GIBLIN 0.00 X 0 2579284 514133 0 20223495 2044842 0 1 1 0 0 230813 19607 211206 984616 784989 199627 199627 199627 430440 0 19607 410833 542718 542718 5500 5500 20535 20535 15748 15748 ADMIN EXP, TAXES & LICE 136668 136668 NATIONAL ASSOCIATION DU 500 500 721669 542718 178951 0 104231 63906 483781 474973 10038685 7467309 4253094 1205029 26 11831726 12259308 5250 414 11329 11998 16579 12412 X 11815147 12246896 11815147 12246896 11831726 12259308 X -291229 742585 -19607 X X 0 1 X 1 0 0 2843019 F 1410075 F 4253094 DUE TO AFFILIATE 11998 11998 1132883 742585 -20535 722050 410833 19607 19607 430440 701134 0 701134 20535 20535 721669 PART XI, LINE 2D - OTHER ADJUSTMENTS: EXTERNAL INVESTMENT EXPENSE -20,535. PART XI, LINE 4B - OTHER ADJUSTMENTS: UBTI FLOW THRU FROM AURORA SPA PARTNERS 19,607. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXTERNAL INVESTMENT EXPENSE 20,535. 1 COLAB 55 E MAIN STREET CHATTANOOGA TN 37408 263934828 501(C)(3) 20000 0 GENERAL SUPPORT AMERICAN LUNG ASSOCIATION OF TN 1466 RIVERSIDE DR STE D CHATTANOOGA TN 37406 314379531 501(C)(3) 20000 0 GENERAL SUPPORT ARTHRITIS FOUNDATION SE REGION INC PO BOX 7669 ATLANTA GA 30357 581341679 501(C)(3) 8000 0 GENERAL SUPPORT CLEVELAND BRADLEY CHAMBER FOUNDATION 225 KEITH STREET SW CLEVELAND TN 37320 620162970 501(C)(3) 6250 0 GENERAL SUPPORT CHATTANOOGA WOMEN'S LEADERSHIP INSTITUTE PO BOX 4363 CHATTANOOGA TN 37405 621827475 501(C)(3) 15000 0 GENERAL SUPPORT HEALTHY MEMPHIS COMMON TABLE 3203 N AVENEL COVE MEMPHIS TN 38125 621820264 501(C)(3) 10000 0 GENERAL SUPPORT JUNIOR ACHIEVEMENT INC 307 MADISON AVENUE MEMPHIS TN 38103 620549549 501(C)(3) 7500 0 GENERAL SUPPORT MARCH OF DIMES 651 EAST 4TH ST STE 150 CHATTANOOGA TN 37402 131846366 501(C)(3) 7500 0 GENERAL SUPPORT NATIONAL CIVIL RIGHTS MUSEUM 450 MULBERRY STREET MEMPHIS TN 38103 581484027 501(C)(3) 6500 0 GENERAL SUPPORT FIRST BAPTIST CHURCH OF CHATTANOOGA 401 GATEWAY AVENUE CHATTANOOGA TN 37402 620485727 501(C)(3) 10000 0 HOMELESS HOUSING PLACEMENT PROJECT MUSCULAR DYSTROPHY ASSOCIATION INC 2115 CHAPMAN ROAD SUITE 163 CHATTANOOGA TN 37421 131665552 501(C)(3) 10000 0 GENERAL SUPPORT MEMORIAL HEALTH CARE SYSTEM FOUNDATION I 2525 DESALES AVENUE CHATTANOOGA TN 37404 621839548 501(C)(3) 10000 0 GENERAL SUPPORT ST JUDE CHILDREN'S RESEARCH HOSPITAL 3225 CLUB A SOUTH WIND NASHVILLE TN 37243 620646012 501(C)(3) 15000 0 GENERAL SUPPORT RIVER ROCKS INC 720 CHERRY STREET CHATTANOOGA TN 37402 274615735 501(C)(3) 8334 0 GENERAL SUPPORT UTC MATHEMATICS DEPARTMENT 615 MCCALLIE AVENUE CHATTANOOGA TN 37403 626001636 501(C)(3) 8000 0 GENERAL SUPPORT UTC ATHLETICS 301 ANDY HOLT TOWER KNOXVILLE TN 37996 626001636 501(C)(3) 25000 0 GENERAL SUPPORT MEMPHIS IN MAY INTERNATIONAL FESTIVAL 88 UNION AVE MEMPHIS TN 38103 237308001 501(C)(3) 6000 0 GENERAL SUPPORT SHELBY FARMS PARK CONSERVANCY 500 NORTH PINE LAKE DR MEMPHIS TN 38134 260350397 501(C)(3) 8000 0 GENERAL SUPPORT TENNESSEE RESIDENCE FOUNDATION 2908 POSTON AVE NASHVILLE TN 37203 621840646 501(C)(3) 25000 0 GENERAL SUPPORT 19 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES: CONFIRMATION OF SUPPORT WILL BE MADE BY FOLLOW-UP WITH ORGANIZATIONS AND EVALUATION FORM COMPLETED FOR PROGRAM BENEFITS SUCH AS TABLE ATTENDEES, LOGO NEED, PROGRAM AD NEED, BOOTH SET-UP, AND GOODIE-BAG ITEMS. 0 1 0 0 0 0 0 0 0 CALVIN ANDERSON 0 311140 0 237442 0 52644 0 78445 0 25903 0 705574 0 0 INGA HIMELRIGHT 0 343246 0 171940 0 6060 0 62738 0 15118 0 599102 0 0 MARK HOOTON 0 184423 0 51532 0 3147 0 31935 0 13465 0 284502 0 0 T RALPH WOODARD JR 0 216552 0 179246 0 4139 0 48641 0 18683 0 467261 0 0 BRIAN STANA 0 201928 0 0 0 44120 0 27220 0 13359 0 286627 0 0 ALAINE ZACHARY 0 165644 0 133878 0 2587 0 34149 0 21752 0 358010 0 0 SHELIA CLEMONS 0 111151 0 26653 0 2065 0 59382 0 12530 0 211781 0 0 VICKY GREGG 0 1283723 0 2929265 0 8502301 0 867990 0 17299 0 13600578 0 7849958 RON HARR 0 0 0 335608 0 249178 0 0 0 0 0 584786 0 232684 WILLIAM YOUNG 0 0 0 475345 0 102074 0 0 0 0 0 577419 0 47360 DANNY TIMBLIN 0 205299 0 177177 0 2204 0 43953 0 21504 0 450137 0 0 CHRIS HUNTER 0 272501 0 503926 0 78872 0 84773 0 10904 0 950976 0 0 JOHN GIBLIN 0 496202 0 871966 0 1211116 0 493113 0 21020 0 3093417 0 800000 PART I, LINE 4B LISTED BELOW ARE THE COMPENSATED OFFICERS, AND KEY EMPLOYEES OF THE RELATED ORGANIZATION WHO ARE INCLUDED IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OF THE RELATED ORGANIZATION BCBST: CALVIN ANDERSON (SERP) 17,025 CHRIS HUNTER (SERP) 43,206 DANNY TIMBLIN (SERP) 4,145 JOHN GIBLIN (SERP) 51,863 VICKY GREGG (SERP) 193,248 INGA HIMELRIGHT (SERP) 18,578 T RALPH WOODARD JR (SERP) 4,677 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS SERVE AS TRUSTEE, DIRECTOR, OR OFFICER FOR BOTH SHP AND BCBST, AND THEREFORE, HAVE A BUSINESS RELATIONSHIP: CALVIN ANDERSON, CHAIRPERSON AND PRESIDENT INGA HIMELRIGHT, BOARD MEMBER T RALPH WOODARD JR, CFO BRIAN STANA, TREASURER ALAINE ZACHERY, ASSISTANT TREASURER SHELIA CLEMONS, SECRETARY FORM 990, PART VI, SECTION A, LINE 3 DELEGATION OF MANAGEMENT DUTIES: PURSUANT TO ARTICLE 1, SECTION 2 OF THE ADMINISTRATIVE SERVICES AGREEMENT (ASA), SHP GRANTS AND DELEGATES THE EXCLUSIVE DISCRETIONARY AUTHORITY TO SUPERVISE AND MANAGE THE DAY-TO-DAY DUTIES OF SHP TO BCBST. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF ONE OR MORE MEMBERS OF GOVERNING BODY: PURSUANT TO ARTICLE VI, SECTION 2 OF THE SHP BYLAWS, DIRECTORS SHALL BE APPOINTED BY THE BCBST BOARD. FORM 990, PART VI, SECTION A, LINE 7B BY-LAWS STIPULATE THAT "THE BOARD SHALL NOT HAVE THE POWER OR AUTHORITY TO: A) ELECT, APPOINT OR REMOVE DIRECTORS, OR SET THE COMPENSATION OF DIRECTORS; OR B) APPROVE A PLAN OF MERGER, CONSOLIDATION, CONVERSION OR DISSOLUTION; OR C) APPROVE A SALE, PLEDGE, OR ASSIGNMENT OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; OR D) TAKE ACTIONS WHICH WOULD NOT BE PERMITTED BY APPLICABLE LAWS. SUCH POWERS ARE RESERVED FOR ACTION BY THE BCBST BOARD." FORM 990, PART VI, SECTION B, LINE 11 PROCESS USED TO REVIEW FORM 990: INTERNAL CONTROLS ARE IN PLACE TO INSURE AN ACCURATE RECORDING OF TRANSACTIONS AND AN ACCURATE REPORTING OF THE RESULTS. THE PROCESS TO REVIEW FORM 990 STARTS WITH THE PREPARATION OF THE WORK PAPERS; REVIEWED BY MANAGEMENT; AND THEN A FINAL REVIEW OF FORM 990 IS MADE BY OFFICERS RESPONSIBLE FOR FILING OF THE RETURN. A COPY OF THE FORM 990 WAS PROVIDED TO THE SOUTHERN HEALTH PLAN BOARD OF DIRECTORS BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMPANY MAINTAINS AN ONGOING PROCESS FOR THE COLLECTION, EVALUATION, AND MONITORING OF BOTH INDIVIDUAL AND ORGANIZATIONAL BUSINESS ACTIVITIES TO FACILITATE REPORTING OBLIGATIONS AND RISK MITIGATION EFFORTS ASSOCIATED WITH ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. THE COMPANY COMMUNICATES TO ALL EMPLOYEES, CONTRACTORS, OFFICERS, DIRECTORS, AFFILIATES, AND BUSINESS ASSOCIATES THE CLEAR EXPECTATION THAT THEY SUPPORT OUR EFFORTS IN THE AVOIDANCE OF CONFLICTS OF INTEREST AND PROMOTE A COMMITMENT TO INTEGRITY, SOUND BUSINESS PRACTICES, AND GOOD CORPORATE GOVERNANCE. AN EXAMPLE OF WAYS IN WHICH WE MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY INCLUDE BUT ARE NOT LIMITED TO: - UPON HIRE OR APPOINTMENT, AND AT LEAST ANNUALLY THEREAFTER, A CONFLICT OF INTEREST QUESTIONNAIRE MUST BE COMPLETED BY ALL EMPLOYEES, CONTRACTORS, OFFICERS, AND MEMBERS OF THE BOARD OF DIRECTORS. - SEMI-ANNUALLY AN ORGANIZATIONAL CONFLICT OF INTEREST REMINDER NOTIFICATION IS DISTRIBUTED TO AN IDENTIFIED GROUP OF KEY PERSONNEL REPRESENTING VITAL AREAS OF THE COMPANY SOLICTING ANY CONCERNS. - UPON ESTABLISHING THE INITIAL BUSINESS RELATIONSHIP, AND AT LEAST ANNUALLY THEREAFTER, THE CODE OF CONDUCT, WHICH INCLUDES A CONFLICT OF INTEREST STANDARD, IS PROVIDED TO ALL EMPLOYEES, CONTRACTORS, OFFICERS, DIRECTORS, VENDORS, AGENTS & BROKERS, AND CONTRACTED PROVIDERS. - VARIOUS OTHER METHODS OF NOTIFICATION, COLLECTION AND MONITORING TECHNIQUES ARE UTILIZED BY SPECIFIC BUSINESS UNITS TO PROMOTE AN ENVIRONMENT OF ETHICAL BUSINESS CONDUCT FREE OF CONFLICTS OF INTEREST WITH OUR AFFILIATES AND BUSINESS ASSOCIATES. - COMMUNICATION IS PROVIDED TO ALL BUSINESS ASSOCIATES THAT QUESTIONS REGARDING ANY COMPLIANCE CONCERNS, INCLUDING CONFLICTS OF INTEREST, ARE TO BE DIRECTED TO THE CHIEF COMPLIANCE OFFICER, PRODUCT LINE COMPLIANCE OFFICERS OR THE CORPORATE COMPLIANCE DEPARTMENT. ADDITIONAL INFORMATION CAN BE PROVIDED UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. HOURS WORKED FOR RELATED ORGANIZATION FORM 990, PART VII, SECTION A, COLUMN B CURRENT OFFICERS AND DIRECTORS LISTED ARE FULL-TIME EMPLOYEES OF A RELATED ORGANIZATION AND WORK A TOTAL OF 40-50 HOURS PER WEEK ON AVERAGE COMBINED. THEIR TIME IS DEVOTED TO SYSTEM WIDE ACTIVITIES WHICH COULD INCLUDE TIME SPENT ON ANY OF THE RELATED ORGANIZATIONS LISTED IN SCHEDULE R. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FLOW THROUGH FROM PARTNERSHIP UNRELATED BUSINESS TAXABLE INCOME -19,607. OVERSIGHT OF AUDIT PROCESS BY INDEPENDENT ACCOUNTANT. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. WEBSITE ADDRESS FORM 990, PAGE 1, LINE J HTTP://WWW.BCBST.COM/WHY-BCBST/ABOUT-US/CORPORATE-RESPONSIBILITY/ COMMUNITY-TRUST.PAGE TENNESSEE HEALTH FOUNDATION INC 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 200298456 PRIVATE FDN TN 501(C)(3) PRIVATE FOUNDATION 0 BLUECROSS BLUESHIELD OF TENNESSEE (BCBST) 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 620427913 HEALTH INSURANCE TN N/A C 0 GOLDEN SECURITY INSURANCE COMPANY 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 621156312 STOP-LOSS INSURANCE TN N/A C 0 VOLUNTEER STATE HEALTH PLAN 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 621656610 HEALTH MAINTENANCE TN N/A C 0 GROUP INSURANCE SERVICES 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 620721232 INSURANCE BROKER TN N/A C 0 SOUTHERN DIVERSIFIED BUSINESS 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 621156889 HOLDING COMPANY TN N/A C 0 RIVERBEND GOVERNMENT BENEFIT 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 202469347 3RD PARTY ADMIN TN N/A C 0 RIVERTRUST SOLUTIONS INC 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 200528228 MEDICARE APPEALS TN N/A C 0 SECURITYCARE OF TENNESSEE INC 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 461548495 HMO TN N/A C 0 SHARED HEALTH INC 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 203484545 HLTH INFO TECH TN N/A C 0 ONLIFE HEALTH INC 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 621631426 WELLNESS SERVICES TN N/A C 0 BENEVIVE INC 1 CAMERON HILL CIRCLE CHATTANOOGA TN 37402 208042682 HOLDING COMPANY TN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0