2025-11-14T14:11:06-06:00 2024-12-31 991856619 GRANT THORNTON ADVISORS LLC 53 STATE STREET SUITE 1600 BOSTON MA 02109 990 2024-01-01 846871980 BCBSM NON-BARGAINING UNIT INTERNAL HEALTH BENEFIT TRUST BCBS 3139831633 600 LAFAYETTE EAST MAIL CODE 1801 DETRIOT MI 482262998 PATRICIA SNYDER ADMINISTRATIVE COMMITTEE MEMBER 3139831633 2025-11-14 1 1 ERIN COUTURE P01390592 6177237900 2024 2025-03-06 01:10:19Z WAYMOND HARRIS 25970829 0 X N/A X 2019 MI SEE SCHEDULE OTHE TRUST WAS CREATED FOR THE EXCLUSIVE PURPOSE OF PROVIDING HEALTH BENEFITS TO ELIGIBLE EMPLOYEES OF BLUE CROSS BLUE SHIELD OF MICHIGAN. 1 0 0 0 1800152 1799152 0 0 0 0 829636 3105939 0 0 829636 3105939 0 0 17322368 27603248 29487 24826 0 0 0 193787 232283 17545642 27860357 -16716006 -24754418 53944248 30158950 24046 12579 53920202 30146371 THE TRUST WAS CREATED FOR THE EXCLUSIVE PURPOSE OF PROVIDING HEALTH BENEFITS TO ELIGIBLE EMPLOYEES OF BLUE CROSS BLUE SHIELD OF MICHIGAN. 0 0 PROVIDED HEALTH BENEFITS TO ELIGIBLE EMPLOYEES OF BLUE CROSS BLUE SHIELD OF MICHIGAN. 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 1 0 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 X THE NORTHERN TRUST COMPANY TRUSTEE 1.00 0.00 X 24826 0 0 24826 0 0 0 0 0 0 0 1644592 338805 1305787 24326237 22864890 1461347 1461347 1461347 3105939 0 1800152 1305787 27603248 24826 190966 UNR. BUS. INCOME TAX 41317 27860357 2314387 22287362 9955457 31227703 17889106 429183 53944248 30158950 24046 12579 24046 12579 X 53920202 30146371 0 0 0 0 53920202 30146371 53944248 30158950 -24754418 980587 0 X 0 0 0 0 MUNICIPAL BONDS 17889106 F 17889106 PAYABLE TO BROKER FOR SECURITIES PURCHASED 12579 12579 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED AND APPROVED BY A MEMBER OF THE SENIOR MANAGEMENT OF BLUE CROSS BLUE SHIELD OF MICHIGAN, THE PRIMARY CONTRIBUTING EMPLOYER, BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE TRUST'S ADMINISTRATIVE 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 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 FORM 990, PAGE 1, ITEM C - LEGAL NAME OF ORGANIZATION: THE LEGAL NAME OF THE ORGANIZATION IS THE "BLUE CROSS BLUE SHIELD OF MICHIGAN NON-BARGAINING UNIT INTERNAL HEALTH BENEFIT TRUST". 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 BLUE CROSS BLUE SHIELD OF MICHIGAN LONG TERM DISABILITY TRUST 600 LAFAYETTE EAST DETROIT MI 482262998 816482696 FUND LONG-TERM DISABILITY BENEFITS MI 501(C)(9) N/A N/A 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 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 ~ONTRIBUTING 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