BLUECROSS01 11/14/2018920 AM ZZ/^ ^^V 2949132805105 8 A ^ Return of Private Foundation OMB No 1545-0052 9O or Section 4947 (a)(1) Form 7 F Trust Treated as Private Foundation 201 7 Do not enter social security numbers on this form it public . ^r^s^r ^^i Department of the Treasury ► as may be made Internal Revenue Service to www.irs.gov/Form99OPF for instructions and the latest information . pen to Public Inspection For calendar year 2017 or tax year beginning and ending Name of foundation A Employer identification number BLUE CROSS & BLUE SHIELD OF LOUISIANA FOUNDATION 72-1232379 Number and street (or P 0 box number if mail is not delivered to street address) Room/suite B Telephone number (see instructions) P.O. BOX 98022 225 - 295-3307 City or town, state or province , country, and ZIP or foreign postal code C If exemption application is pending , check here BATON ROUGE LA 7 0 8 9 8 - 9 0 2 2 ► G Check all that apply Initial return Initial return of a former public charity o 1 Foreign organizations , check here ► Final return Amended return 2 Foreign organizations meeting the Address change Name change 85% test , check here and attach computation P. H Check type of organization XX Section 501 (c)( 3) exempt private foundation If private foundation status was terminated under Section 4947 (a )( 1 ) nonexem pt charitable trust Other taxable p rivate foundation section 507 (b)(1((A), check here ► El Fair market value of all assets at J Accounting method [] Cash XX Accrual F If the foundation is in a 60-month termination end of year (from Part II , col (c), n Other (specify) under section 507(b )(1)(B), check here ► El line 16 ) ► $ 50 , 235 , 188 ( Part I column (d ) must be on cash basis INI P,,art I;, Analysis of Revenue and Expenses (The total of ( a) Revenue and (d ) Disbursements amounts in columns ( b), (c), and ( d) may not necessarily equal expenses per (b) Net investment ( c) Adjusted net for charitable income income purposes the amounts in column ( a) (see instructions )) books ( cash basis onl y) 1 Contributions , gifts, grants, etc , received (attach schedule) 10 , 13 3 , 911 '' F f 3!4,UTf "7a;t i¢ • JdI<'t t^'1 _7 ,. , 2 Check - n if the foundation is not required to attach Sch r## ;j q„{ ri {, ' f###;:x;"!#^r "'" 'e ` ' i • '" " 3 Interest on savings and temporary cash investments 2 , 03 9 2 , 03 9 4 Dividends and interest from securities 1,129,434 1,129,434 ; -A 5a Gross rents ail R41 1111 at b Net rental income or (loss ) C 6a Net gain or (loss) from sale of assets not on line 10 1 , 3 8 8 , 3 0 7 fY?r; , i-LIJ4 „< =i > b Gross sales price for all assets on line 6a 16,942,154 tlA)JJjJ# Tf " i7 't t;=>+'1:r r €: I;a'r•`___' l!g-:';•.paPJ," 7 Capital gain net income (from Part IV , line 2) 1, 0 9 2 , 875 LJAlY a , i, tlEar _ f r. rJi111 gv,* zTs^a' 1 8 Net short-term capital gain ^Efistl^3^1fE^: wi>',)m';I!0#! 0 9 Income modifications TRIM t i 197Vt.1 L_f l- 7714W144I ^J 10a Gross sales less returns and allowances f! _X31'3F)im.`.P. I;IE1_ frj ' s32€rii^' X11 i;. = ,^' - ` :_ _ :', ' = -'=' t b Less Cost of goods sold stt1^' 3^s Ifl1t 4B fA-fifflIFd^ .^W?Mlt+J c Gross profit or (loss ) (attach schedule ) `fl!!3f a^;<f f:fd ` it1J }1!JJ.. ^^ if _ I. P2 '! Q7 11 Other income ( attach schedule ) iUIMA^_ frirl ft. f_____ 12 Total . Add lines 1 throu g h 11 12,653 , 691 2,224,348 0 t;ti:{:^^tt EIE:I:I 4) 13 Compensation of officers , directors, trustees , etc 102, 267 102 , 2 67 14 Other employee salaries and wages 236, 118 2 3 6 , 118 Q It X 15 Pension plans, employee benefits 2 , 637 2 , 637 Li U ILL 16a Legal fees (attach schedule) . 4) b Accounting fees (attach schedule ) STMT 1 49,250 9,900 39,350 C LL ea c Other professional fees (attach schedule) STMT 2 192,457 107,350 85,107 y 17 Interest 2 18 Taxes (attach schedule ) (see instructions ) S TMT 3 155,209 41, 6 21 19 Depreciation (attach schedule) and depletion 'sr+=:^ -w fs ir` •^'^N H I'6 20 Occupancy u 21 Travel , conferences , and meetings 13, 097 13, 097 M 22 Printing and publications C 23 Other expenses (att sch ) STMT 4 35,656 35,656 ' 24 Total operating and administrative expenses. Add lines 13 through 23 786,691 158 , 871 0 514,232 0a 25 Contributions , gifts, grants paid 1, 010 ' 199 : ;.,-^^r €> t,ltt.. )ttrir. 1, 098, 532 26 Total ex penses and disbursements . Add lines 24 and 25 1,796,890 158,871 = 0 1, 612,764 27 Subtract line 26 from line 12 % ;, F;ai£_ ^ ^:5 ±F^'. ?fFf {^ : 'mf '",`:fit Sa' ffyf T`b;t 4^ti4}fir t ^'^ a Excess of revenue over expenses and disbursements 10 , 8 5 6 , 801 f[ P''r°'t^^'-"n^^^ 5^'^/+6^h 9^r^•iy 3^• lii^-i, t.,f,n'•^ b Net investment income ( If negative , enter -0-) •`i ?:^ ? {r^^ 2, 0 6 5 , 4 7 7 c Ad j usted net income ( if ne g ative , enter -0 0 c' 1ff*' For Paperwork Reduction Act Notice , see instructions . Form 990-PF (2017) DAA r^",U( , BLUECROSS01 11/14/2018920 AM Form 990-PF (20171 BLUE CROSS & BLUE SHIELD OF 72-12323 79 Paae 2 Attached schedules and amounts in the descr iption column Beginning of year End of year aP rt^,ijl Balance Sheets ^$L'.AI should be for end-of-year amounts onl y (See instructions (a) Book Value (b) Book Value (c) Fair Market Value 1 Cash - non -Interest-bearing 1,302 , 148 3,069,689 3,069,689 2 Savings and temporary cash investments 9t#iifilt ii 3 Accounts receivable ► a„RIA311" u,a, , ,e a M -3 "Ell . .0;s1 lulfig . a 11s0.11t ^ 3^0 1 Less allowance for doubtful accounts ► fitl l&^$1$ #f^14 4 Pledges receivable ► Less allowance for doubtful accounts ► 5 Grants receivable 6 Receivables due from officers , directors , trustees , and other disqualified persons ( attach schedule) (see Instructions) .cp.e a^ um& m mn ee nae d w s n' xau ^- mma a 7 Other notes and loans receivable ( an schedule ) ► ^ Less allowance for doubtful accounts ► 0 8 Inventories for sale or use a 9 Prepaid expenses and deferred charges 7 , 486 3,493 3, 4 9 3 Q 10a Investments - U S and state government obligations (attach schedule) b Investments - corporate stock ( attach schedule ) SEE STMT 5 34, 370, 395 47, 061, 589 47, 061, 589 c Investments - corporate bonds (attach schedule) 11 Investments - land, buildings , and equipment basis ► Less accumulated depreciation (attach sch) ► 12 Investments - mortgage loans 13 Investments - other (attach schedule ) SEE STATEMENT 6 161, 7 3 0 14 Land , buildings , and equipment basis ► ^gpLS^i^6 fl^lt^>^^1 [ I9^^^5^€i[^^L3 Less accumulated depreciation (attach sch) ► 21,770 15 Other assets (describe ► SEE STATEMENT 7 ) 100,417 100,417 16 Total assets (to be completed by all filers - see the instructions Also see p a g e 1 Item I 35, 863, 529 50 , 235, 188 50 , 235, 188 17 Accounts payable and accrued expenses 118 , 4 0 9 309,165 18 Grants payable 19 Deferred revenue ill = 20 Loans from officers , directors , trustees, and other disqualified persons _LQ 21 Mortgages and other notes payable (attach schedule ) Nis 3 fl am 13, 148 21 ,217 J 22 Other liabilities (describe ► SEE STATEMENT 8 ) 23 Total liabilities (add lines 17 throu g h 22) 131, 557 330,382 4 111 t'fl^r^tth3'.^. flit Foundations that follow SFAS 117, check here ► and complete lines 24 through 26 and lines 30 and 31. 24 Unrestricted 26, 166, 034 41, 295, 462 rj 6 a ^. 9 $I 5flie ca nit 9'$1 25 Temporarily restricted 9, 565,938 8,609 , 344 66 k g d ^fl ;t^p3^ 26 Permanently restricted . ' tt 3 r t Z Foundations that do not follow SFAS 117, check here ► ^, l o and complete lines 27 through 31. ^g,a^ fl € f ^ gt 27 Capital stock, trust principal , or current funds I fl to y 28 Paid- in or capital surplus , or land , bldg , and equipment fund .. t ; 29 Retained earnings , accumulated income , endowment , or other funds 1;6 30 Total net assets or fund balances ( see instructions ) 35, 731, 972 49,904,806 sfl tf€ f Z 31 Total liabilities and net assets/fund balances (see instructions ) 35, 863, 529 50 25, 188 a oPSart lll1, Analysis of Chan g es in Net Assets or Fund Balances 1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 ( must agree with end-of-year figure reported on prior year's return ) 1 35,731,972 2 Enter amount from Part I, line 27a 2 10,856, 801 3 Other increases not included in line 2 ( itemize) 'SEE STATEMENT 9 3 3,316,033 4 Add lines 1, 2 , and 3 4 49,904, 806 5 Decreases not included in line 2 ( itemize) ► 5 6 Total net assets or fund balances at end of year ( line 4 minus line 5) - Part II column ( b ), line 30 6 49,904, 806 Form 990-PF (2017) DAA BLUECROSS01 11/14/2018920 AM Form990-PF(2017) BLUE CROSS & BLUE SHIELD OF 72-1232379 Page3 IcIRV IV,! Ca p ital Gains and Losses for Tax on Investment Income (a) List and describe the kind( s) of property sold (for example , real estate .