TY 2015 Form 990PF

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............	42,226	23,437	23,437
	2	Savings and temporary cash investments.........
	3	Accounts receivable
		Less: allowance for doubtful accounts
	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).....
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........
	10a	Investments—U.S. and state government obligations (attach schedule)
	b	Investments—corporate stock (attach schedule).......	1,753,555	1,723,975	1,723,975
	c	Investments—corporate bonds (attach schedule).......
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........
	14	Land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	15	Other assets (describe )
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	1,795,781	1,747,412	1,747,412
	17	Accounts payable and accrued expenses..........		12,541
	18	Grants payable..................
	19	Deferred revenue.................
	20	Loans from officers, directors, trustees, and other disqualified persons
	21	Mortgages and other notes payable (attach schedule)......
	22	Other liabilities (describe )
	23	Total liabilities (add lines 17 through 22).........		12,541
		Foundations that follow SFAS 117, check here
		and complete lines 24 through 26 and lines 30 and 31.
	24	Unrestricted..................	1,795,781	1,734,871
	25	Temporarily restricted...............
	26	Permanently restricted...............
		Foundations that do not follow SFAS 117, check here
		and complete lines 27 through 31.
	27	Capital stock, trust principal, or current funds........
	28	Paid-in or capital surplus, or land, bldg., and equipment fund
	29	Retained earnings, accumulated income, endowment, or other funds
	30	Total net assets or fund balances (see instructions).....	1,795,781	1,734,871
	31	Total liabilities and net assets/fund balances (see instructions).	1,795,781	1,747,412

Part III

Analysis of Changes in Net Assets or Fund Balances

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) ...............

1,795,781

Enter amount from Part I, line 27a .....................

43,678

Other increases not included in line 2 (itemize) bullet

Add lines 1, 2, and 3 ..........................

1,839,459

Decreases not included in line 2 (itemize) bullet

104,588

Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .

1,734,871

(a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.)		(b) How acquired P—Purchase D—Donation	(c) Date acquired (mo., day, yr.)	(d) Date sold (mo., day, yr.)
1 a	TOTAL STOCK MKT IDX ADM	P	2008-03-31	2015-11-19
b	TOTAL BOND MKT INDEX ADM	P	2008-03-31	2015-04-01
c	HIGH-YIELD CORP FUND ADM	P	2007-12-13	2015-04-01
d	TOT INTL STOCK IX ADMIRAL	P		2015-04-01
e

(e) Gross sales price		(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a	25,000	13,437	11,563
b	44,225	23,534	20,691
c	5,765	3,068	2,697
d	20,360	10,835	9,525
e

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69			(l) Gains (Col. (h) gain minus col. (k), but not less than -0-) or Losses (from col.(h))
(i) F.M.V. as of 12/31/69	(j) Adjusted basis as of 12/31/69	(k) Excess of col. (i) over col. (j), if any
a			11,563
b			20,691
c			2,697
d			9,525
e

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2	45,862
3	Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
	If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0- in Part I, line 8 ...................		3

Total of line 1, column (d) .....................

20.0455

Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years . . .

0.0455

Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....

1,782,276

Multiply line 4 by line 3......................

81,094

Enter 1% of net investment income (1% of Part I, line 27b)...........

849

Add lines 5 and 6........................

81,943

Enter qualifying distributions from Part XII, line 4.............

79,389

If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.

1a	Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line 1.
	Date of ruling or determination letter: (attach copy of letter if necessary–see instructions)
b	Domestic foundations that meet the section 4940(e) requirements in Part V, check	1	1,699
	hereand enter 1% of Part I, line 27b...................
c	All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2	Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	2
3	Add lines 1 and 2...........................	3	1,699
4	Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	4
5	Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- .....	5	1,699
6	Credits/Payments:

a	2015 estimated tax payments and 2014 overpayment credited to 2015	6a
b	Exempt foreign organizations—tax withheld at source......	6b
c	Tax paid with application for extension of time to file (Form 8868)...	6c	5,400
d	Backup withholding erroneously withheld ...........	6d

7	Total credits and payments. Add lines 6a through 6d..............		7	5,400
8	Enter any penalty for underpayment of estimated tax. Check hereif Form 2220 is attached.		8	22
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10	3,679
11	Enter the amount of line 10 to be: Credited to 2015 estimated tax3,679	Refunded	11

(a) Name and address	(b) Title, and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-)
DON GEORGE	PRESIDENT & DIRECTOR 1.0	0
445 INDUSTRIAL LANE BERLIN,VT05602
ANDREW GARLAND	VICE PRESIDENT & DIRECTOR 1.0	0
445 INDUSTRIAL LANE BERLIN,VT05602
RUTH GREENE	TREASURER 1.0	0
445 INDUSTRIAL LANE BERLIN,VT05602
CHRISTOPHER GANNON	SECRETARY & DIRECTOR 1.0	0
445 INDUSTRIAL LANE BERLIN,VT05602
ALEXA MCGRATH	ASSISTANT SECRETARY 1.0	0
445 INDUSTRIAL LANE BERLIN,VT05602

List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.	Expenses
1


2


3


4

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.	Amount
1


2


All other program-related investments. See instructions.
3

		(a) Corpus	(c) 2014	(d) 2015
1 Distributable amount for 2015 from Part XI, line 7				87,415
2 Undistributed income, if any, as of the end of 2015:
a Enter amount for 2014 only.......			0
b Total for prior years:2013, 2012, 2011
3 Excess distributions carryover, if any, to 2015:
a From 2010......
b From 2011......
c From 2012......
d From 2013......
e From 2014......	0
fTotal of lines 3a through e........		0
4Qualifying distributions for 2015 from Part
XII, line 4: $ 79,389
a Applied to 2014, but not more than line 2a			0
b Applied to undistributed income of prior years (Election required—see instructions).....
c Treated as distributions out of corpus (Election required—see instructions)........
d Applied to 2015 distributable amount.....				79,389
e Remaining amount distributed out of corpus		0
5 Excess distributions carryover applied to 2015.		0		0
(If an amount appears in column (d), the same amount must be shown in column (a).)
6Enter the net total of each column as indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5		0
b Prior years’ undistributed income. Subtract line 4b from line 2b ..........
c Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed......
d Subtract line 6c from line 6b. Taxable amount —see instructions ...........
e Undistributed income for 2014. Subtract line 4a from line 2a. Taxable amount—see instructions .............			0
f Undistributed income for 2016. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2015 ..........				8,026
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (Election may be required - see instructions) .......
8Excess distributions carryover from 2010 not applied on line 5 or line 7 (see instructions) ...
9Excess distributions carryover to 2016. Subtract lines 7 and 8 from line 6a ......		0
10 Analysis of line 9:
a Excess from 2011....
b Excess from 2012....
c Excess from 2013....
d Excess from 2014....
e Excess from 2015....	0

2a Enter the lesser of the adjusted net income from Part I or the minimum investment return from Part X for each year listed ..........	Tax year	Prior 3 years			(e) Total
	(a) 2015	(b) 2014	(c) 2013	(d) 2012	(e) Total

b 85% of line 2a .........
c Qualifying distributions from Part XII, line 4 for each year listed .....
d Amounts included in line 2c not used directly for active conduct of exempt activities ..........
e Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c ....
3 Complete 3a, b, or c for the alternative test relied upon:
a “Assets" alternative test—enter:
(1) Value of all assets ......
(2) Value of assets qualifying under section 4942(j)(3)(B)(i)
b “Endowment" alternative test— enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed...
c “Support" alternative test—enter:
(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) ....
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii)....
(3) Largest amount of support from an exempt organization
(4) Gross investment income

aThe name, address, and telephone number or email address of the person to whom applications should be addressed:

bThe form in which applications should be submitted and information and materials they should include:

cAny submission deadlines:

dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:

3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient	If recipient is an individual, show any relationship to any foundation manager or substantial contributor	Foundation status of recipient	Purpose of grant or contribution	Amount
Name and address (home or business)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year
Vermont FEED 1611 Harbor Road Shelburne,VT05482	NONE	Exempt Organization	Youth Health	25,000
Capstone Community Action 20 Gable Place Barre,VT05641	NONE	EOF	ECONOMIC OPPORTUNITY	4,253
BROC - COMMUNITY ACTION IN SOUTHWESTERN VT 60 CENTER STREET RUTLAND,VT05701	NONE	EOF	ECONOMIC OPPORTUNITY	3,456
NORTHEAST KINGDOM COMMUNITY ACTION 70 MAIN STREET NEWPORT,VT05855	NONE	EOF	ECONOMIC OPPORTUNITY	2,392
SOUTHEASTERN VERMONT COMMUNITY ACTION 91 BUCK DRIVE WESTMINSTER,VT05158	NONE	EOF	ECONOMIC OPPORTUNITY	3,456
GOOD NEIGHBOR SHELTER 81 ELM STREET BARRE,VT05641	NONE	EOF	ECONOMIC OPPORTUNITY	532
BENNINGTON COUNTY COALITION FOR THE HOMELESS 250 NORTH STREET BENNINGTON,VT05201	NONE	EOF	ECONOMIC OPPORTUNITY	266
MORNINGSIDE SHELTER 81 ROYAL ROAD BRATTLEBORO,VT05302	NONE	EOF	ECONOMIC OPPORTUNITY	266
JOHN GRAHAM SHELTER 69 MAIN STREET VERGENNES,VT05491	NONE	EOF	ECONOMIC OPPORTUNITY	266
UPPER VALLEY HAVEN 713 HARTFORD AVENUE WHITE RIVER JUNCTION,VT05001	NONE	EOF	ECONOMIC OPPORTUNITY	266
BRATTLEBORO AREA DROP IN CENTER 60 SOUTH MAIN STREET BRATTLEBORO,VT05301	NONE	EOF	ECONOMIC OPPORTUNITY	532
LUNEBURGGILMAN SCHOOL 2720 RIVER ROAD GILMAN,VT05904	NONE	EOF	ECONOMIC OPPORTUNITY	266
VERMONT AGENCY OF EDUCATION 219 NORTH MAIN STREET SUITE 402 BARRE,VT05641	NONE	EOF	ECONOMIC OPPORTUNITY	5,049
Total ................................. 3a				46,000

	Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)	(a) Revenue and expenses per books		(b) Net investment income	(c) Adjusted net income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)	70,800
2	Check Sch. B .............
3	Interest on savings and temporary cash investments	121		121
4	Dividends and interest from securities...	44,595		44,595
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		45,862
b	Gross sales price for all assets on line 6a 96,736
7	Capital gain net income (from Part IV, line 2)...			45,862
8	Net short-term capital gain.........
9	Income modifications...........
10a	Gross sales less returns and allowances
b	Less: Cost of goods sold....
c	Gross profit or (loss) (attach schedule).....
11	Other income (attach schedule).......
12	Total. Add lines 1 through 11........	161,378		90,578
13	Compensation of officers, directors, trustees, etc.
14	Other employee salaries and wages......
15	Pension plans, employee benefits.......
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......		13,000	1,073	0	6,245
c	Other professional fees (attach schedule)....		10,812	891		5,195
17	Interest...............
18	Taxes (attach schedule) (see instructions)...		2,732
19	Depreciation (attach schedule) and depletion...
20	Occupancy..............
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......		45,156	3,683		21,949
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	71,700		5,647	0	33,389
25	Contributions, gifts, grants paid.......	46,000				46,000
26	Total expenses and disbursements. Add lines 24 and 25	117,700		5,647	0	79,389
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	43,678
b	Net investment income (if negative, enter -0-)			84,931
c	Adjusted net income (if negative, enter -0-)...

3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000	(b) Type of service	(c) Compensation

Enter gross amounts unless otherwise indicated.	Unrelated business income		Excluded by section 512, 513, or 514		(e) Related or exempt function income (See instructions.)
1Program service revenue:	(a) Business code	(b) Amount	(c) Exclusion code	(d) Amount	(e) Related or exempt function income (See instructions.)
a
b
c
d
e
f
gFees and contracts from government agencies
2 Membership dues and assessments....
3 Interest on savings and temporary cash investments ...........
4 Dividends and interest from securities....			14	44,716
5 Net rental income or (loss) from real estate:
aDebt-financed property......
bNot debt-financed property.....
6 Net rental income or (loss) from personal property
7 Other investment income.....			18	45,862
8 Gain or (loss) from sales of assets other than inventory ............
9 Net income or (loss) from special events:
10 Gross profit or (loss) from sales of inventory..
11 Other revenue: a
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e)..				90,578

(a) Line No.	(b) Amount involved	(c) Name of noncharitable exempt organization	(d) Description of transfers, transactions, and sharing arrangements

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name				Firm's EIN
	Firm's address				Phone no.


(a) Name and address of each employee paid more than $50,000	(b) Title, and average hours per week devoted to position	(c) Compensation	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances










Total number of other employees paid over $50,000...................

bApproved for future payment

Total ................................. 3b

Name of organization BLUE CROSS AND BLUE SHIELD OF VERMONT CARING FOR CHILDREN FOUNDATION INC

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
1	BLUE CROSS BLUE SHIELD OF VERMONT 445 INDUSTRIAL LANE BERLIN, VT05602	$ 67,708	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Name of organization BLUE CROSS AND BLUE SHIELD OF VERMONT CARING FOR CHILDREN FOUNDATION INC		Employer identification number 65-1249139

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)


Name of organization BLUE CROSS AND BLUE SHIELD OF VERMONT CARING FOR CHILDREN FOUNDATION INC			Employer identification number 65-1249139
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

Identifier	Return Reference	Explanation
TAX	Part XIII Line 2(a)	BLUE CROSS AND BLUE SHIELD OF VERMONT CARING FOR CHILDREN FOUNDATION, INC. FILED TAX FORM 990PF FOR THE FIRST TIME IN 2014. BLUE CROSS AND BLUE SHIELD OF VERMONT CARING FOR CHILDREN FOUNDATION, INC. WAS ONLY SUBJECT TO THE 4940 TAX AND NOT SUBJECT TO OTHER CHAPTER 42 TAXES OR REQUIREMENTS IN 2014. THEREFORE, BLUE CROSS AND BLUE SHIELD OF VERMONT CARING FOR CHILDREN FOUNDATION, INC. WAS NOT SUBJECT TO THE DISTRIBUTION REQUIREMENTS SHOWN ON 2014 PART XIII COLUMN (D) ROW 6F DUE BY 12/31/2015.
2014 Tax	PART V QUESTION 1	BLUE CROSS AND BLUE SHIELD OF VERMONT CARING FOR CHILDREN FOUNDATION, INC. INCLUDED EXPENSES PAID FOR CHARITABLE PURPOSES IN THE TOTAL QUALIFYING DISTIBUTIONS AMOUNT IN 2015. BLUE CROSS AND BLUE SHIELD OF VERMONT CARING FOR CHILDREN FOUNDATION INC. DID NOT INCLUDE EXPENSES PAID FOR CHARITABLE PURPOSES IN THE TOTAL QUALIFYING DISTIBUTIONS OF $46,000 REPORTED ON THE 2014 TAX RETURN. THE 2014 QUALIFYING DISTRIBUTIONS REPORTED IN PART V HAVE BEEN ADJUSTED TO $80,044 TO CAPTURE EXPENSES PAID FOR CHARITABLE PURPOSES IN ORDER TO NOT DISTORT THE TEST FOR THE REDUCED TAX RATE ON NET INVESTMENT INCOME.

Name of Stock	End of Year Book Value	End of Year Fair Market Value
INVESTMENTS - VANGUARD	1,246,433	1,723,975
UNREALIZED G/L ON INVESTMENTS	477,542

Description	Amount
NET UNREALIZED LOSS ON INVESTMENTS	95,037
TAX ON UNREALIZED GAINS	9,551

Description	Revenue and Expenses per Books	Net Investment Income	Disbursements for Charitable Purposes
BCBSVT ALLOCATED EXPENSES	44,583	3,676	21,419
POSTAGE, FREIGHT, & DELIVERY	491		491
OFFICE SUPPLIES	82	7	39

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