Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MARK BURZYNSKI AND SEAN SLANGER - BUSINESS RELATIONSHIP MARK BURZYNSKI AND RAELYNN WILLIAMS - BUSINESS RELATIONSHIP | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WILL BE REVIEWED BY THE CONTROLLER OF BCBSMT AND THE MEMBERS OF THE TRUST BOARD BEFORE THE FORM 990 IS FILED. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS ARE RESPONSIBLE FOR COMPLETING THE CONFLICT OF INTEREST POLICY. ANY POTENTIAL CONFLICTS BROUGHT UP BY THE BOARD ARE REVIEWED BY THE COMPLIANCE STAFF MADE UP OF MEMBERS OF THE RELATED ORGANIZATION BLUE CROSS BLUE SHIELD'S LEGAL DEPARTMENT. ANY PERSONS WITH CONFLICTS ARE RESTRICTED FROM VOTING ON MATTERS INVOLVED IN THE CONFLICT OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15A AND 15B: NO COMPENSATION IS PAID BY THE TRUST. BOARD MEMBERS ARE EMPLOYEES OF BLUE CROSS BLUE SHIELD OF MONTANA AND COMPENSATION IS BASED UPON A VARIETY OF FACTORS INCLUDING COMPARABILITY DATA AND OTHER MARKET FACTORS. | ||
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. | |
| FORM 990, PART VII: | THE AMOUNTS SHOWN IN PART VII AS COMPENSATION FROM A RELATED ORGANIZATION ARE PAYMENTS FOR SERVICES THAT ARE PROVIDED TO BLUE CROSS BLUE SHIELD OF MONTANA, A RELATED ORGANIZATION. MARK BURZYNSKI DEDICATES AN AVERAGE OF 40 HOURS PER WEEK AS THE EXECUTIVE VP FOR EXTERNAL AFFAIRS OF BLUE CROSS BLUE SHIELD OF MONTANA, AND THE COMPENSATION SHOWN IN PART VII ARE FOR THOSE SERVICES. SEAN SLANGER DEDICATES AN AVERAGE OF 40 HOURS PER WEEK AS THE ASSOCIATE GENERAL COUNCIL OF BLUE CROSS BLUE SHIELD OF MONTANA, AND THE COMPENSATION SHOWN IN PART VII ARE FOR THOSE SERVICES. RAELYNN WILLIAMS DEDICATES AN AVERAGE OF 40 HOURS PER WEEK AS A MANAGER IN THE FINANCE DEPARTMENT OF BLUE CROSS BLUE SHIELD OF MONTANA, AND THE COMPENSATION SHOWN IN PART VII ARE FOR THOSE SERVICES. THE BOARD MEMBERS DO NOT RECEIVE ANY COMPENSATION FOR THE SERVICES THAT THEY PROVIDE TO BMT EMPLOYEE BENEFITS TRUST, INC AS BOARD MEMBERS. |
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