2024-11-15T00:14:03-06:00 2023-12-31 382029668 GJC CPA'S & ADVISORS 1001 WOODWARD AVENUE SUITE 850 DETROIT MI 482261904 990 2023-01-01 816482696 BLUE CROSS BLUE SHIELD OF MICHIGAN LONG TERM DISABILITY TRUST (VEBA) BLUE 3139831633 600 LAFAYETTE EAST MAIL CODE 1801 DETROIT MI 482262998 PATRICIA SNYDER ADMINISTRATIVE COMMITTEE MEMBER 3139831633 2024-11-15 1 1 MICHAEL R NICHOLAS P00966144 3139652655 2023 2024-10-15 13:58:12Z PATRICIA SNYDER 600 LAFAYETTE EAST MAIL CODE 1801 DETROIT MI 482262998 3404214 0 X N/A X 2016 MI THE TRUST WAS CREATED FOR THE EXCLUSIVE PURPOSE OF PROVIDING LONG-TERM DISABILITY BENEFITS TO ELIGIBLE EMPLOYEES OF BLUE CROSS BLUE SHIELD OF MICHIGAN. 4 4 0 0 0 0 0 0 0 0 -48990 52787 0 0 -48990 52787 0 0 2899211 3163363 124 7921 0 0 0 254519 234030 3153854 3405314 -3202844 -3352527 10381636 7923738 0 0 10381636 7923738 THE TRUST WAS CREATED FOR THE EXCLUSIVE PURPOSE OF PROVIDING LONG-TERM DISABILITY BENEFITS TO ELIGIBLE EMPLOYEES OF BLUE CROSS BLUE SHIELD OF MICHIGAN. 0 0 PROVIDED LONG-TERM DISABILITY BENEFITS TO ELIGIBLE EMPLOYEES OF BLUE CROSS BLUE SHIELD OF MICHIGAN. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 0 0 0 X THE NORTHERN TRUST COMPANY 3125571442 333 SOUTH WABASH AVENUE WB 42 CHICAGO IL 606044107 LYNDSAY JONES ADMINISTRATIVE COMMITTEE MEMBER 0.30 X 0 0 0 BOBBY KING ADMINISTRATIVE COMMITTEE MEMBER 0.30 X 0 0 0 BENITA LIGGANS ADMINISTRATIVE COMMITTEE MEMBER 0.50 X 0 0 0 PATRICIA SNYDER ADMINISTRATIVE COMMITTEE MEMBER 0.30 X 0 0 0 THE NORTHERN TRUST COMPANY TRUSTEE 1.00 X 7921 0 0 7921 0 0 0 0 0 0 BROADSPIRE SERVICES INC 1391 NW 136TH AVENUE SUNRISE FL 333232800 ADMINISTRATIVE AND RECORDKEEPING 194463 1 257930 257930 3146284 3351427 -205143 -205143 -205143 52787 0 0 52787 3163363 7921 234030 3405314 72630 81291 10309006 7842447 10381636 7923738 0 0 X 10381636 7923738 0 0 0 0 10381636 7923738 10381636 7923738 -3352527 894629 0 X 0 1 X 1 0 0 X 947416 894629 894629 52787 0 52787 3405314 0 3405314 0 3405314 PART X, LINE 2: THE PROGRAM ADMINISTRATOR IS NOT AWARE OF ANY UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF DECEMBER 31, 2023 OR 2022. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE PROGRAM'S FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED AND APPROVED BY A REPRESENTATIVE OF THE INVESTMENT COMMITTEE AND THE ADMINISTRATIVE COMMITTEE BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE ADMINISTRATIVE COMMITTEE AND THE INVESTMENT COMMITTEE ARE EMPLOYEES OF BLUE CROSS BLUE SHIELD OF MICHIGAN AND ARE REQUIRED TO CERTIFY THEIR REVIEW OF CONFLICT OF INTEREST POLICIES ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE VEBA'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY, AS WELL AS THE FINANCIAL STATEMENTS OF THE RELATED PLAN, ARE AVAILABLE UPON REQUEST. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC THE NORTHERN TRUST COMPANY - 333 SOUTH WABASH AVENUE, WB 42, CHICAGO, IL 60604-4107. BLUE CARE NETWORK OF MICHIGAN 20500 CIVIC CENTER DRIVE SOUTHFIELD MI 480764115 382359234 CONTRIBUTING EMPLOYER MI 501(C)(4) N/A BLUE CROSS BLUE SHIELD OF MICHIGAN 0 BLUE CROSS BLUE SHIELD OF MICHIGAN FOUNDATION 600 LAFAYETTE EAST DETROIT MI 482262998 382338506 CONTRIBUTING EMPLOYER MI 501(C)(3) LINE 12A, I BLUE CROSS BLUE SHIELD OF MICHIGAN 0 BCBSM BARGAINING UNIT INTERNAL HEALTH BENEFIT TRUST 600 LAFAYETTE EAST DETROIT MI 482262998 846869872 FUND HEALTH BENEFITS MI 501(C)(9) N/A N/A 0 BCBSM NON-BARGAINING UNIT INTERNAL HEALTH BENEFIT TRUST 600 LAFAYETTE EAST DETROIT MI 482262998 846871980 FUND HEALTH BENEFITS MI 501(C)(9) N/A N/A 0 BLUE CROSS BLUE SHIELD OF MICHIGAN MUTUAL INSURANCE COMPANY 600 LAFAYETTE EAST DETROIT MI 482262998 382069753 HEALTH CARE INSURANCE MI N/A C 0 LIFESECURE HOLDINGS CORPORATION 10559 CITATION DRIVE BRIGHTON MI 481168381 201420821 CONTRIBUTING EMPLOYER AZ N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0