TENNESSEE HEALTH FOUNDATION INC: Form 990PF, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
TENNESSEE HEALTH FOUNDATION INC (EIN 20-0298456)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-09-19
IRS object ID
201312629349100401
Schema version
2012v2.1
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)
Timestamp2013-09-19T12:50:56-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN621199757EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LATTIMORE BLACK MORGAN & CAIN PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1605 CHESTNUT STREET SUITE 1100AddressLine1
CityCHATTANOOGACity
StateTNState
ZIP Code37450ZIPCode
FieldValueIRS element (for citing)
Return Type990PFReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN200298456EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1TENNESSEE HEALTH FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlTENNNameControl
Phone4235357350Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11 CAMERON HILL CIRCLEAddressLine1
CityCHATTANOOGACity
StateTNState
ZIP Code37402ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameT RALPH WOODARD JRName
TitleCAO & CONTROLLERTitle
Phone4235357350Phone
Date Signed2013-09-19DateSigned
Authorize Third Party0AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NamePATRICIA K COSGROVEName
PTINP00025712PTIN
Phone4237566585Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Exempt PFXExemptPF
FMV Assets EOY164070865FMVAssetsEOY
Method Of Accounting AccrualXMethodOfAccountingAccrual

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Received Rev And Expnss28000000ContriReceivedRevAndExpnss
Interest On Savings Rev And Expnss4457InterestOnSavingsRevAndExpnss
Interest On Savings Net Invst Incm265521InterestOnSavingsNetInvstIncm
Dividends Rev And Expnss2110553DividendsRevAndExpnss
Dividends Net Invst Incm2913659DividendsNetInvstIncm
Net Gain Sale Assets Rev And Expnss1259520NetGainSaleAssetsRevAndExpnss
Capital Gain Net Incm Net Invst Incm15854161CapitalGainNetIncmNetInvstIncm
Other Income Net Invst Incm28328OtherIncomeNetInvstIncm
Total Revenue And Expenses31374530TotalRevenueAndExpenses
Total Net Investment Income19061669TotalNetInvestmentIncome
Comp Ofcr Dir Trst Rev And Expnss0CompOfcrDirTrstRevAndExpnss
Comp Ofcr Dir Trst Net Invst Incm0CompOfcrDirTrstNetInvstIncm
Comp Ofcr Dir Trst Dsbrs Chrtbl Prps0CompOfcrDirTrstDsbrsChrtblPrps
Accounting Fees Rev And Expnss8750AccountingFeesRevAndExpnss
Accounting Fees Net Invst Incm1313AccountingFeesNetInvstIncm
Accounting Fees Dsbrs Chrtbl Prps7438AccountingFeesDsbrsChrtblPrps
Other Prof Fees Rev And Expnss221720OtherProfFeesRevAndExpnss
Other Prof Fees Net Invst Incm221720OtherProfFeesNetInvstIncm
Other Prof Fees Dsbrs Chrtbl Prps0OtherProfFeesDsbrsChrtblPrps
Taxes Rev And Expnss195711TaxesRevAndExpnss
Taxes Net Invst Incm66879TaxesNetInvstIncm
Taxes Dsbrs Chrtbl Prps0TaxesDsbrsChrtblPrps
Other Expenses Rev And Expnss570194OtherExpensesRevAndExpnss
Other Expenses Net Invst Incm46847OtherExpensesNetInvstIncm
Other Expenses Dsbrs Chrtbl Prps569584OtherExpensesDsbrsChrtblPrps
Tot Opr Expenses Rev And Expnss996375TotOprExpensesRevAndExpnss
Tot Opr Expenses Net Invst Incm336759TotOprExpensesNetInvstIncm
Tot Opr Expenses Dsbrs Chrtbl Prps577022TotOprExpensesDsbrsChrtblPrps
Contri Gifts Paid Rev And Expnss5717471ContriGiftsPaidRevAndExpnss
Contri Gifts Paid Dsbrs Chrtbl Prps5717471ContriGiftsPaidDsbrsChrtblPrps
Total Expenses Rev And Expnss6713846TotalExpensesRevAndExpnss
Total Expenses Net Invst Incm336759TotalExpensesNetInvstIncm
Total Expenses Dsbrs Chrtbl Prps6294493TotalExpensesDsbrsChrtblPrps
Excess Of Revenue Over Expenses24660684ExcessOfRevenueOverExpenses
Net Investment Income18724910NetInvestmentIncome

Balance Sheets BalanceSheets

FieldValueIRS element (for citing)
Savings And Temp Cash Invst BOY15663368SavingsAndTempCashInvstBOY
Savings And Temp Cash Invst EOY10340087SavingsAndTempCashInvstEOY
Savings And Temp Cash Invst EOYFMV10340087SavingsAndTempCashInvstEOYFMV
Investments Corp Stock BOY104183198InvestmentsCorpStockBOY
Investments Corp Stock EOY153725995InvestmentsCorpStockEOY
Investments Corp Stock EOYFMV153725995InvestmentsCorpStockEOYFMV
Other Assets BOY9101284OtherAssetsBOY
Other Assets EOY4783OtherAssetsEOY
Other Assets EOYFMV4783OtherAssetsEOYFMV
Total Assets BOY128947850TotalAssetsBOY
Total Assets EOY164070865TotalAssetsEOY
Total Assets EOYFMV164070865TotalAssetsEOYFMV
Accounts Payable BOY2165AccountsPayableBOY
Accounts Payable EOY4236AccountsPayableEOY
Other Liabilities BOY44342OtherLiabilitiesBOY
Other Liabilities EOY-267OtherLiabilitiesEOY
Total Liabilities BOY46507TotalLiabilitiesBOY
Total Liabilities EOY3969TotalLiabilitiesEOY
Org That Follow SFAS117XOrgThatFollowSFAS117
Unrestricted BOY128901343UnrestrictedBOY
Unrestricted EOY164066896UnrestrictedEOY
Total Net Assets BOY128901343TotalNetAssetsBOY
Total Net Assets EOY164066896TotalNetAssetsEOY
Total Liabilities Net Assets BOY128947850TotalLiabilitiesNetAssetsBOY
Total Liabilities Net Assets EOY164070865TotalLiabilitiesNetAssetsEOY

Changes In Net Assets Fund Balances ChangesInNetAssetsFundBalances

FieldValueIRS element (for citing)
Total Net Assets Fund Balances BOY128901343TotalNetAssetsFundBalancesBOY
Excess Of Revenue Over Expenses24660684ExcessOfRevenueOverExpenses
Other Increases10504869OtherIncreases
Subtotal164066896Subtotal
Other Decreases0OtherDecreases
Total Net Assets Fund Balances EOY164066896TotalNetAssetsFundBalancesEOY

Capital Gains And Losses CapitalGainsAndLosses

Capital Gains And Losses Info CapitalGainsAndLossesInfo (4 entries)

Description Of AssetDescriptionOfAssetHow AcquiredHowAcquiredGain Or LossGainOrLossGains Minus Excess Or LossesGainsMinusExcessOrLosses
CAPITAL GAIN ON CONTRIBUTED STOCKSD1372165113721651
SILCHESTER K-1 CAP GAINSP42354235
SILCHESTER K-1 CAP GAINSP868755868755
MARKETABLE SECURITIESP12595201259520
FieldValueIRS element (for citing)
Capital Gain Net Income15854161CapitalGainNetIncome

Qlfy Und Sect4940e For Reduced Tax QlfyUndSect4940eForReducedTax

FieldValueIRS element (for citing)
Liable For4942 Tax0LiableFor4942Tax
Qualifying Distributions Year15278257QualifyingDistributionsYear1
Noncharitable Assets Year1115203888NoncharitableAssetsYear1
Distribution Ratio Year10.045817DistributionRatioYear1
Qualifying Distributions Year24246999QualifyingDistributionsYear2
Noncharitable Assets Year2103465432NoncharitableAssetsYear2
Distribution Ratio Year20.041048DistributionRatioYear2
Qualifying Distributions Year34194354QualifyingDistributionsYear3
Noncharitable Assets Year387277228NoncharitableAssetsYear3
Distribution Ratio Year30.048058DistributionRatioYear3
Qualifying Distributions Year43302145QualifyingDistributionsYear4
Noncharitable Assets Year488399801NoncharitableAssetsYear4
Distribution Ratio Year40.037355DistributionRatioYear4
Qualifying Distributions Year52427801QualifyingDistributionsYear5
Noncharitable Assets Year579614291NoncharitableAssetsYear5
Distribution Ratio Year50.030495DistributionRatioYear5
Total Distribution Ratio0.202773TotalDistributionRatio
Average Distribution Ratio0.040555AverageDistributionRatio
Net Noncharitable Assets132433040NetNoncharitableAssets
Adjusted Noncharitable Assets5370822AdjustedNoncharitableAssets
One Percent Net Investment Income187249OnePercentNetInvestmentIncome
Adj Nonchrtbl Assets And One5558071AdjNonchrtblAssetsAndOnePct
Qualifying Distributions6294493QualifyingDistributions

Excise Tax Based On Investment Incm ExciseTaxBasedOnInvestmentIncm

FieldValueIRS element (for citing)
Domestic Org Meeting Sect4940eXDomesticOrgMeetingSect4940e
Investment Income Excise Tax187249InvestmentIncomeExciseTax
Tax Under Section5110TaxUnderSection511
Subtotal187249Subtotal
Subtitle A Tax0SubtitleATax
Tax Based On Investment Income187249TaxBasedOnInvestmentIncome
Est Tax Payments And Overpayment170022EstTaxPaymentsAndOverpayment
Tax Paid With Extension20000TaxPaidWithExtension
Total Credits And Payments190022TotalCreditsAndPayments
Form2220 AttachedXForm2220Attached
Overpayment2773Overpayment
Amount Credited To Next Year2773AmountCreditedToNextYear
Amount To Be Refunded0AmountToBeRefunded

Statements Regarding Activities StatementsRegardingActivities

FieldValueIRS element (for citing)
Legislative Political Activities0LegislativePoliticalActivities
More Than100 Spent0MoreThan100Spent
Form1120 POL Filed0Form1120POLFiled
Sect4955 Tax On Organization0Sect4955TaxOnOrganization
Sect4955 Tax On Managers0Sect4955TaxOnManagers
Reimbursement Of Tax0ReimbursementOfTax
Activities Not Prev Reported0ActivitiesNotPrevReported
Changes To Articles Or Bylaws0ChangesToArticlesOrBylaws
Unrelated Bus Income Over10000UnrelatedBusIncomeOver1000
Termination Etc0TerminationEtc
Requirements Of Sect508e1RequirementsOfSect508e
At Least5000 In Assets1AtLeast5000InAssets
States Filed WithTNStatesFiledWith
Form990 PF Filed With AG1Form990PFFiledWithAG
Private Operating Foundation0PrivateOperatingFoundation
New Substantial Contributors0NewSubstantialContributors
Interest In Controlled Entity0InterestInControlledEntity
Applicable Insurance Contract0ApplicableInsuranceContract
Comply With Public Inspection Rqr1ComplyWithPublicInspectionRqr
Website AddressBCBST.COM/ABOUT/COMMUNITY/TN-HEALTH-FOUNDATIONWebsiteAddress
Books In Care Of Person NameT RALPH WOODARD JRBooksInCareOfPersonName
Books In Care Of Phone Number4235355192BooksInCareOfPhoneNumber

Books In Care Of US Address BooksInCareOfUSAddress

FieldValueIRS element (for citing)
Address Line11 CAMERON HILL CIRCLEAddressLine1
CityCHATTANOOGACity
StateTNState
ZIP Code37402ZIPCode
FieldValueIRS element (for citing)
Foreign Bank1ForeignBank
Name Of Foreign CountryCANameOfForeignCountry
Name Of Foreign CountryCJNameOfForeignCountry

Statements Regarding Acty4720 StatementsRegardingActy4720

FieldValueIRS element (for citing)
Sale Or Exchange With Dsqfly Person0SaleOrExchangeWithDsqflyPerson
Borrow Or Lend With Dsqfly Person0BorrowOrLendWithDsqflyPerson
Furnished Goods With Dsqfly Person1FurnishedGoodsWithDsqflyPerson
Pay Compensation To Dsqfly Person0PayCompensationToDsqflyPerson
Transfer Assets To Dsqfly Person0TransferAssetsToDsqflyPerson
Payment To Government Offical0PaymentToGovernmentOffical
Acts Fail To Qualify As Exceptions0ActsFailToQualifyAsExceptions
Uncorrected Prior Acts0UncorrectedPriorActs
Undistributed Income Prior Years0UndistributedIncomePriorYears
Business Holdings0BusinessHoldings
Jeopardy Investments0JeopardyInvestments
Uncorrected Jeopardy Investments0UncorrectedJeopardyInvestments
Influence Legislation0InfluenceLegislation
Influence Election0InfluenceElection
Grants To Individuals0GrantsToIndividuals
Grants To Organizations0GrantsToOrganizations
Noncharitable Purpose0NoncharitablePurpose
Rcv Funds To Pay Prsnl Bnft Contract0RcvFundsToPayPrsnlBnftContract
Pay Premiums Prsnl Bnft Contract0PayPremiumsPrsnlBnftContract
Prohibited Tax Shelter Transactn0ProhibitedTaxShelterTransactn

Ofcr Dir Trustees Key Employee Info OfcrDirTrusteesKeyEmployeeInfo

Ofcr Dir Trustees Or Key Employee OfcrDirTrusteesOrKeyEmployee (20 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeTitleTitleAvg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPositionCompensationCompensationContri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtcExpense Account Other AllowancesExpenseAccountOtherAllowances
LAMAR J PARTRIDGE
1 CAMERON HILL CIRCLECHATTANOOGATN37402CHAIRPERSON1.00000
BETTY W DEVINNEY
1 CAMERON HILL CIRCLECHATTANOOGATN37402VICE CHAIRPERSON1.00000
VICKY B GREGG
1 CAMERON HILL CIRCLECHATTANOOGATN37402CEO/BOARD MEMBER1.00000
SHELIA D CLEMONS
1 CAMERON HILL CIRCLECHATTANOOGATN37402SECRETARY1.00000
JILL OAKS
1 CAMERON HILL CIRCLECHATTANOOGATN37402ASSISTANT SECRETARY1.00000
BRIAN STANA
1 CAMERON HILL CIRCLECHATTANOOGATN37402TREASURER1.00000
ALAINE ZACHARY
1 CAMERON HILL CIRCLECHATTANOOGATN37402ASSISTANT TREASURER1.00000
JOHN GIBLIN
1 CAMERON HILL CIRCLECHATTANOOGATN37402CFO1.00000
HULET M CHANEY
1 CAMERON HILL CIRCLECHATTANOOGATN37402BOARD MEMBER1.00000
MARTY G DICKENS
1 CAMERON HILL CIRCLECHATTANOOGATN37402BOARD MEMBER1.00000
HERBERT H HILLIARD
1 CAMERON HILL CIRCLECHATTANOOGATN37402BOARD MEMBER1.00000
T RALPH WOODARD JR
1 CAMERON HILL CIRCLECHATTANOOGATN37402CONTROLLER/CAO1.00000
PAUL E STANTON
1 CAMERON HILL CIRCLECHATTANOOGATN37402BOARD MEMBER1.00000
WILLIAM M GRACEY
1 CAMERON HILL CIRCLECHATTANOOGATN37402PRESIDENT/COO1.00000
EMILY J REYNOLDS
1 CAMERON HILL CIRCLECHATTANOOGATN37402BOARD MEMBER1.00000
JAMES M PHILLIPS
1 CAMERON HILL CIRCLECHATTANOOGATN37402BOARD MEMBER1.00000
CALVIN ANDERSON
1 CAMERON HILL CIRCLECHATTANOOGATN37402EXECUTIVE DIRECTOR1.00000
REGINALD W COOPWOOD
1 CAMERON HILL CIRCLECHATTANOOGATN37402BOARD MEMBER1.00000
JAMES B BAKER
1 CAMERON HILL CIRCLECHATTANOOGATN37402BOARD MEMBER1.00000
KATHY BINGHAM
1 CAMERON HILL CIRCLECHATTANOOGATN37402FOUNDATION MANAGER20.00000
FieldValueIRS element (for citing)
Comp Of Highest Paid Empl NONENONECompOfHighestPaidEmplNONE
Tot Number Of Oth Empl Paid Over50k0TotNumberOfOthEmplPaidOver50k
Comp Of Hghst Paid Cntrct NONENONECompOfHghstPaidCntrctNONE
Tot Number Of Cntrct Paid Over50k0TotNumberOfCntrctPaidOver50k

Summary Of Direct Charitable Acty SummaryOfDirectCharitableActy

FieldValueIRS element (for citing)
Description1SHAPE THE STATE PROGRAM FOCUSES ON COMBATING CHILDHOOD OBESITY THROUGH PHYSICAL ACTIVITY AND NUTRITION. MORE THAN 88,000 CHILDREN AT ALMOST 200 SCHOOL SITES HAVE PARTICIPATEDDescription1
Expenses1569584Expenses1

Sum Of Program Related Investments SumOfProgramRelatedInvestments

FieldValueIRS element (for citing)
Total0Total

Minimum Investment Return MinimumInvestmentReturn

FieldValueIRS element (for citing)
Avg Monthly FMV Of Securities128108570AvgMonthlyFMVOfSecurities
Avg Monthly Cash Balances6341217AvgMonthlyCashBalances
FMV All Other Noncharitable Assets0FMVAllOtherNoncharitableAssets
Total FMV Of Unused Assets134449787TotalFMVOfUnusedAssets
Reduction Claimed0ReductionClaimed
Acquisition Indebtedness0AcquisitionIndebtedness
Adj Total FMV Of Unused Assets134449787AdjTotalFMVOfUnusedAssets
Cash Deemed Charitable2016747CashDeemedCharitable
Net Noncharitable Assets132433040NetNoncharitableAssets
Minimum Investment Return6621652MinimumInvestmentReturn

Distributable DistributableAmount

FieldValueIRS element (for citing)
Minimum Investment Return6621652MinimumInvestmentReturn
Tax Based On Investment Income187249TaxBasedOnInvestmentIncome
Total Tax187249TotalTax
Distributable Amount Before Adj6434403DistributableAmountBeforeAdj
Recoveries Qlfy Distributions0RecoveriesQlfyDistributions
Distributable Amount Before Ded6434403DistributableAmountBeforeDed
Deduction Fr Distributable$0DeductionFrDistributableAmount
Distributable Amount As Adjusted6434403DistributableAmountAsAdjusted

Qualifying Distributions QualifyingDistributions

FieldValueIRS element (for citing)
Expenses And Contributions6294493ExpensesAndContributions
Program Related Investments Total0ProgramRelatedInvestmentsTotal
Qualifying Distributions6294493QualifyingDistributions
One Pct Sect4940e Org Net Invst Incm187249OnePctSect4940eOrgNetInvstIncm
Adj Qualifying Distributions6107244AdjQualifyingDistributions

Undistributed Income UndistributedIncome

FieldValueIRS element (for citing)
Distributable Amount As Adjusted6434403DistributableAmountAsAdjusted
Undistributed Income Prior Year5249016UndistributedIncomePriorYear
Total For Prior Years0TotalForPriorYears
Total Excess Distri Carryover0TotalExcessDistriCarryover
Qualifying Distributions6294493QualifyingDistributions
Applied To Year15249016AppliedToYear1
Applied To Prior Years0AppliedToPriorYears
Treated As Distri From Corpus0TreatedAsDistriFromCorpus
Applied To Current Year1045477AppliedToCurrentYear
Remaining Distri From Corpus0RemainingDistriFromCorpus
Excess Distri Cyov App CY Corpus0ExcessDistriCyovAppCYCorpus
Excess Distri Cyov Applied CY0ExcessDistriCyovAppliedCY
Total Corpus0TotalCorpus
Prior Year Undistributed Income0PriorYearUndistributedIncome
Prior Year Deficiency Or Tax0PriorYearDeficiencyOrTax
Taxable Amount10TaxableAmount1
Taxable Amount20TaxableAmount2
Undistributed Income CY5388926UndistributedIncomeCY
Distri From Corpus170b1 E Or4942g30DistriFromCorpus170b1EOr4942g3
Excess Distri Cyov From Year50ExcessDistriCyovFromYear5
Excess Distri Cyov To Next Year0ExcessDistriCyovToNextYear

Supplementary Information SupplementaryInformation

Appication Submission Info AppicationSubmissionInfo

FieldValueIRS element (for citing)
Recipient NameDAWN WEBER FOUNDATION MANAGERRecipientName

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line11 CAMERON HILL CIRCLEAddressLine1
CityCHATTANOOGACity
StateTNState
ZIP Code37402ZIPCode
FieldValueIRS element (for citing)
Recipient Phone Number4235357163RecipientPhoneNumber
Form And Info And MaterialsWWW.BCBST.COM/ABOUT/COMMUNITY/TN-HEALTH-FOUNDATION/FormAndInfoAndMaterials
Submission DeadlinesSUBMISSIONS MUST BE WITHIN 3 CYCLES: JAN,MAY,SEPSubmissionDeadlines
Restrictions On AwardsWWW.BCBST.COM/ABOUT/COMMUNITY/TN-HEALTH-FOUNDATION/RestrictionsOnAwards

Grant Or Contri Paid During Year GrantOrContriPaidDuringYear (58 entries)

Address Line1RecipientUSAddress/AddressLine1CityRecipientUSAddress/CityStateRecipientUSAddress/StateZIP CodeRecipientUSAddress/ZIPCodeRecipient RelationshipRecipientRelationshipRecipient Foundation StatusRecipientFoundationStatusPurpose Of Grant Or ContributionPurposeOfGrantOrContributionAmountAmount
AMERICAN RED CROSS GREATER CHATTANOOGA AREA CHAPTER
801 MCCALLIE AVECHATTANOOGATN37403NONE509(A)(1)CHATTANOOGA AREA TORNADO RELIEF EFFORTS$25,000
AMERICAN WAY MIDDLE
3805 AMERICAN WAYMEMPHISTN38118NONE509(A)(1)SHAPE THE STATE GRANT$1,000
BACHMAN MEMORIAL HOME INC
414 BRYMER CREEK ROADMCDONALDTN37353NONE509(A)(1)SHAPE THE STATE GRANT$1,477
BLEDSOE COUNTY BOARD OF EDUCATION
478 SPRING STPIKEVILLETN37367NONE509(A)(1)SHAPE THE STATE GRANT$1,792
CANNON COUNTY BOARD OF EDUCATION
301 W MAIN STSTE 100WOODBURYTN37190NONE509(A)(1)SHAPE THE STATE GRANT$1,930
CHESTER COUNTY JUNIOR HIGH SCHOOL
930E MAIN STHENDERSONTN38340NONE509(A)(1)SHAPE THE STATE GRANT$1,000
CHILD & FAMILY TENNESSEE
901 EAST SUMMIT HILL DRIVE 200KNOXVILLETN37915NONE509(A)(1)2012 TEAM BLUE BENEFICIARY - STATE WIDE INITIATIVE$10,000
CHILDREN'S HOME-CHAMBLISS SHELTER
315 GILLESPIE ROADCHATTANOOGATN37411NONE509(A)(1)2012 TEAM BLUE BENEFICIARY - STATE WIDE INITIATIVE$10,000
CLAIBORNE GOUNTY BOARD OF EDUCATION
1403 TAZEWELL ROADTAZEWELLTN37879NONE509(A)(1)SHAPE THE STATE GRANT$3,769
COMMUNITY HEALTH FOUNDATIONREGIONAL OBSTETRICAL CONSULTANTS
902 MCCALLIE AVECHATTANOOGATN37403NONE509(A)(1)STORC - SOLUTIONS TO OBSTETRICS IN RURAL COUNTIES PROGRAM$357,042
CREATIVE DISCOVERY MUSEUM
321 CHESTNUT STCHATTANOOGATN37402NONE509(A)(1)GOOD FOR YOU TRAVELING EXHIBIT$25,000
CUMMINGS SCHOOL
1037 CUMMINGS STREETMEMPHISTN38106NONE509(A)(1)SHAPE THE STATE GRANT$2,245
EXCHANGE CLUB-CARL PERKINS CENTER
341 REDDEN STREETHUNTINGDONTN38344NONE509(A)(1)2012 TEAM BLUE BENEFICIARY STATE WIDE INITIATIVE$10,000
FAITH FAMILY MEDICAL CLINIC
326 21ST AVENUE NORTHNASHVILLETN37205NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$8,000
FIRST ASSEMBLY OF GOD - HOUSTON COUNTY CHRISTIAN ACADEMY
270 ARLINGTON STREETERINTN37061NONE509(A)(1)SHAPE THE STATE GRANT$1,575
FRIENDS IN NEED HEALTH CENTER INC
1105 W STONE DRKINGSPORTTN37660NONE509(A)(1)MATCHING GRANT PROJECT$100,000
GIRLS INC OF MEMPHIS
2670 UNION AVE EXT STE 606MEMPHISTN38112NONE509(A)(1)NO BABY TEEN PREGNANCY PREVENTION CAMPAIGN$25,000
GRACE MEDICAL CLINIC
100 COVEY DRIVEFRANKLINTN37067NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$5,000
GREENEVILLE CITY SCHOOLS
PO BOX 1420GREENEVILLETN37744NONE509(A)(1)SHAPE THE STATE GRANT$1,560
HAMILTON COUNTY GOVERNMENT
117 E 7TH ST 500CHATTANOOGATN37402NONE509(A)(1)RIVERWALK PROJECT$250,000
HEALING HANDS HEALTH CENTER
210 MEMORIAL DRIVEBRISTOLTN37620NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$4,000
HEAVENLY HOST LUTHERAN SCHOOL
777 S WILLOW AVENUECOOKEVILLETN38501NONE509(A)(1)SHAPE THE STATE GRANT$1,341
HOPE FAMILY HEALTH SERVICES
12124 TENNESSEE 52WESTMORELANDTN37186NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$6,000
INTERFAITH HEALTH CLINIC
315 GILL AVENUEKNOXVILLETN37917NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$8,000
KNOXVILLE AREA PROJECT ACCESS
115 SUBURBAN ROAD SOUTHWESTKNOXVILLETN37923NONE509(A)(1)EMERGENCY ROOM UTILIZATION INITIATIVE EXPANSION$100,000
KNOXVILLE NEWS SENTINEL CHARITIES INC
2332 NEWS SENTINEL DRIVEKNOXVILLETN37921NONE509(A)(1)FREE FLU SHOT SATURDAY PROGRAM$60,000
LAMPLIGHTER MONTESSORI
8563 FAY ROADCORDOVATN38018NONE509(A)(1)SHAPE THE STATE GRANT$1,000
LENIOR CITY INTERMEDIATE MIDDLE SCHOOL
2141 HARRISON AVENUELENOIR CITYTN37771NONE509(A)(1)SHAPE THE STATE GRANT$1,742
MEDICAL FOUNDATION OF CHATTANOOGA
1917 EAST THIRD STREETCHATTANOOGATN37404NONE509(A)(1)HEALTH KIDS HEALTH COMMUNITIES$30,000
MERCY HEALTH PARTNERS FOUNDATION
900 E OAK HILL AVEKNOXVILLETN379174505NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$8,000
METHODIST HEALTHCARE FOUNDATION
PO BOX 42048MEMPHISTN381742048NONE509(A)(1)SICKLE CELL CENTER OF MEMPHIS$50,000
MILAN SPECIAL SCHOOL DISTRICT
1165 S MAIN STREETMILANTN38358NONE509(A)(1)SHAPE THE STATE GRANT$2,005
MONROE HARDING
1120 GLENDALE LANENASHVILLETN37204NONE509(A)(1)2012 TEAM BLUE BENEFICIARY - STATE WIDE INITIATIVE$10,000
MT JULIET CHRISTIAN ACADEMY
735 N MT JULIET ROADMT JULIETTN37122NONE509(A)(1)SHAPE THE STATE GRANT$1,313
MTN HOPE GOOD SHEPHERD CLINIC
312 PRINCE STREETSEVIERVILLETN37862NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$8,000
NATIONAL CIVIL RIGHTS MUSEUM
450 MULBERRYMEMPHISTN38103NONE509(A)(1)RENOVATION PROJECT$100,000
ONEIDA SPECIAL SCHOOL DISTRICT
PO BOX 4819ONEIDATN37841NONE509(A)(1)SHAPE THE STATE GRANT$1,617
PARTNERS FOR HEALING
109 W BLACKWELL STTULLAHOMATN37388NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$5,000
PORTER LEATH CHILDREN'S HOME
868 NORTH MANASSAS STREETMEMPHISTN38107NONE509(A)(1)2012 TEAM BLUE BENEFICIARY - STATE WIDE INITIATIVE$10,000
PRIMARY CARE & HOPE CLINIC
1453 A HOPE WAYMURFREESBOROTN37129NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$6,000
PUTNAM COUNTY BOARD OF EDUCATION
1400 EAST SPRING STREETCOOKEVILLETN38506NONE509(A)(1)SHAPE THE STATE GRANT$1,444
ROCK SPRINGS MIDDLE
3301 ROCK SPRINGS ROADSMYRNATN37167NONE509(A)(1)SHAPE THE STATE GRANT$1,253
SE SUCCESS SCHOOL
5396 MEDENHALL SQUARE MALLMEMPHISTN38115NONE509(A)(1)SHAPE THE STATE GRANT$1,000
SALVUS CENTER INC
556 HARTSVILLE PIKEGALLATINTN37066NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$5,000
SILOAM FAMILY HEALTH CENTER
820 GALE LANENASHVILLETN37204NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$10,000
THE CHURCH HEALTH CENTER
1210 PEABODY AVEMEMPHISTN38104NONE509(A)(1)2ND OF 3 DIABETIC OBESITY WEIGHT LOSS$84,000
TN HOSPITAL EDUCATION & RESEARCH FDN
500 INTERSTATE BLVD SOUTHNASHVILLETN37210NONE509(A)(2)TN PATIENT SAFETY PROGRAM$507,885
TN HOSPITAL EDUCATION & RESEARCH FDN
500 INTERSTATE BLVD SOUTHNASHVILLETN37210NONE509(A)(2)TN SURGICAL QUALITY IMPROVEMENT PROJECT$935,050
TN PHARMACISTS RESEARCH & EDUCATION FDN
500 CHURCH STREET SUITE 650NASHVILLETN37219NONE509(A)(1)PHARMACISTS PROVIDED DIABETES CARE PROGRAM$195,969
TN SCORE
1207 18TH AVE SOUTH 326NASHVILLETN37212NONE509(A)(1)STATE COLLABORATIVE ON REFORMING EDUCATION$100,000
TUSCULUM UNIVERSITY
PO BOX 5048GREENEVILLETN37743NONE509(A)(1)SIMULATION CENTER - NURSING$263,996
UNIVERSITY OF TN
62 SOUTH DUNLAPMEMPHISTN38163NONE509(A)(1)TEAMWORK - FOCUSED INTERDISCIPLINARY SIMULATIONS PROGRAM$944,993
UNIVERSITY OF TN
910 MADISON AVE STE 827MEMPHISTN38163NONE509(A)(1)BLUES PROJECT, PHASE III$1,392,261
VAN BUREN COUNTY BOARD OF EDUCATION
293 SPARTA STREETSPENCERTN38585NONE509(A)(1)SHAPE THE STATE GRANT$2,012
VOLUNTEERS IN MEDICINE
5705 MARLIN RDCHATTANOOGATN37411NONE509(A)(1)2012 VOLUNTEER CLINIC SUPPORT$5,000
WEAKLEY COUNTY BOARD OF EDUCATION
8319 HIGHWAY 22 SUITE ADRESDENTN38225NONE509(A)(1)SHAPE THE STATE GRANT$1,200
WEST MIDDLE SCHOOL
317 DENMARK-JACKSON ROADDENMARKTN38391NONE509(A)(1)SHAPE THE STATE GRANT$1,000
YOUTH VILLAGES
3915 BRISTOL HIGHWAYJOHNSON CITYTN37601NONE509(A)(1)2012 TEAM BLUE BENEFICIARTY - STATE WIDE INITIATIVE$10,000
FieldValueIRS element (for citing)
Tot Grant Or Contri Paid During Year5717471TotGrantOrContriPaidDuringYear
Tot Grant Or Contri Approved Future0TotGrantOrContriApprovedFuture

Analysis Income Producing Acty AnalysisIncomeProducingActy

Int On Savings And Temp Cash Invst IntOnSavingsAndTempCashInvst

FieldValueIRS element (for citing)
Exclusion Code14ExclusionCode
Exclusion$4,457ExclusionAmount

Dividends And Int From Sec Part VII DividendsAndIntFromSecPartVII

FieldValueIRS element (for citing)
Exclusion Code14ExclusionCode
Exclusion$2,110,553ExclusionAmount

Gain Sales Assets Oth Than Invntry GainSalesAssetsOthThanInvntry

FieldValueIRS element (for citing)
Exclusion Code14ExclusionCode
Exclusion$1,259,520ExclusionAmount

Subtotals Part XVIA SubtotalsPartXVIA

FieldValueIRS element (for citing)
Unrelated Business Income$0UnrelatedBusinessIncomeAmount
Exclusion$3,374,530ExclusionAmount
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Part XVIA3374530TotalPartXVIA

Trnsfr Tr Rln With Noncharitable EO TrnsfrTrRlnWithNoncharitableEO

FieldValueIRS element (for citing)
Trnsfr Of Cash To Noncharitable EO0TrnsfrOfCashToNoncharitableEO
Trnsfr Oth Assets Noncharitable EO0TrnsfrOthAssetsNoncharitableEO
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssets
Purchase Assets Noncharitable EO0PurchaseAssetsNoncharitableEO
Rental Of Facilities Etc0RentalOfFacilitiesEtc
Reimbursement Arrangements0ReimbursementArrangements
Loans Or Loan Guarantees0LoansOrLoanGuarantees
Performance Of Services Etc0PerformanceOfServicesEtc
Sharing Of Facilities Etc0SharingOfFacilitiesEtc
Relationships Noncharitable E Os0RelationshipsNoncharitableEOs

Schedule B IRS990ScheduleB

FieldValueIRS element (for citing)
Organization501c3 Exempt PFXOrganization501c3ExemptPF
General RuleXGeneralRule

Contributor Info ContributorInfo (2 entries)

Contributor NumberContributorNumberAddress Line1ContributorAddressUS/AddressLine1CityContributorAddressUS/CityStateContributorAddressUS/StateZIP CodeContributorAddressUS/ZIPCodeAggregate ContributionsAggregateContributionsPerson Contribution TypePersonContributionTypeNoncash Contribution TypeNoncashContributionType
BLUECROSS BLUESHIELD OF TENNESSEE INC
11 CAMERON HILL CIRCLECHATTANOOGATN37402252021349X
BLUECROSS BLUESHIELD OF TENNESSEE INC
21 CAMERON HILL CIRCLECHATTANOOGATN37402252027978651X

Noncash Property NoncashProperty

FieldValueIRS element (for citing)
Contributor Number From Part I2ContributorNumberFromPartI
Noncash Property DescriptionPUBLICLY TRADED SECURITIESNoncashPropertyDescription
Fair Market Value27978651FairMarketValue
Date Received2012-12-31DateReceived

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees AccountingFees

FieldValueIRS element (for citing)
CategoryAUDIT & TAX SERVICE EXPCategory
Amount$8,750Amount
Net Investment Income1313NetInvestmentIncome
Disbursements Charitable Prps7438DisbursementsCharitablePrps

General Explanation Attachment GeneralExplanationAttachment

General Explanation GeneralExplanation (2 entries)

ExplanationExplanation
FORM 990PF, PART XVINFORMATION REGARDING FOUNDATION MANAGERS============================================================THE DIRECTORS AND OFFICERS OF THE FOUNDATION ARE DIRECTORSOR OFFICERS OR EMPLOYEES OF BLUECROSS BLUESHIELD OFTENNESSEE, INC., WHICH IS THEIR PRIMARY SUPPORTER ANDSUBSTANTIAL CONTRIBUTOR TO THE FOUNDATION. A LISTING OFTHESE INDIVIDUALS IS CONTAINED IN STATEMENT 12 FORFORM 990-PF
PART XV 3B - FUTURE CONTRIBUTIONS============================================================NO FUTURE COMMITMENTS CONSIDERED UNCONDITIONAL

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corp Stock InvestmentsCorpStock (10 entries)

Name Of StockNameOfStockEOY Book ValueEOYBookValueEOYFMVEOYFMV
PIMCO TOTAL RETURN FD-INST4531130845311308
ISHARES S&P 500 INDEX FUNDS1840365318403653
ISHARES S&P SMALLCAP 60083706028370602
AURORA OFFSHORE FD LTD II CL A1354148013541480
SELECTINVEST MULTISTRATEGY LTD993662993662
ABS OFFSHORE SPC GLOBAL PORT1102131511021315
SILCHESTER INT'L EQUITY TRUST2446744024467440
EATON VANCE PARAMETRIC TAX-MGD EMERGING MARKETS FUND1345288413452884
ISHARES BARCLAYS 0-5 YEAR TIPS1126551011265510
GAMMA CONVERTIBLE FUND68981416898141

Other Assets Schedule OtherAssetsSchedule

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBOY Book ValueBOYBookValueEOY Book ValueEOYBookValueEOYFMVEOYFMV
ACCRUED BOND INTEREST RECEIVABLE128447834783
INVESTMENT RECEIVABLE9100000

Other Expenses Schedule OtherExpensesSchedule

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionRevenue And Expenses Per BooksRevenueAndExpensesPerBooksNet Investment IncomeNetInvestmentIncomeDisbursements Charitable PrpsDisbursementsCharitablePrps
PUBLIC RELATIONS5695840569584
DUES50000
MISC INVESTMENT EXP110468470

Other Increases Schedule OtherIncreasesSchedule

Other Increases OtherIncreases

FieldValueIRS element (for citing)
DescriptionUNREALIZED GAINDescription
Amount$10,504,869Amount

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionFRANCHISE & EXCISE TAX PAYABLEDescription
BOY Book Value44342BOYBookValue
EOY Book Value-267EOYBookValue

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees OtherProfessionalFees

FieldValueIRS element (for citing)
CategoryMANAGEMENT FEESCategory
Amount$221,720Amount
Net Investment Income221720NetInvestmentIncome
Disbursements Charitable Prps0DisbursementsCharitablePrps

Taxes Schedule TaxesSchedule

Taxes Taxes (2 entries)

CategoryCategoryAmountAmountNet Investment IncomeNetInvestmentIncomeDisbursements Charitable PrpsDisbursementsCharitablePrps
TAX AND LICENSE$320668790
EXCISE TAX$195,39100

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.