Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0052
2018
Open to Public Inspection
For calendar year 2018, or tax year beginning 01-01-2018 , and ending 12-31-2018
Name of foundation
Blue Cross Blue Shield of North Dakota C
 
Number and street (or P.O. box number if mail is not delivered to street address)4510 13th Ave South
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Fargo, ND58121
A Employer identification number

36-3606394
B Telephone number (see instructions)

(701) 282-1100
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$9,643,169J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I 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)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 5,275,553
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 197,071 197,071  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 77,997
b Gross sales price for all assets on line 6a 450,000
7 Capital gain net income (from Part IV, line 2)... 77,997
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........ 5,550,621 275,068  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0   0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 2,572 2,572   0
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 5,737 0   0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 321,438 0   52,622
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 329,747 2,572   52,622
25 Contributions, gifts, grants paid....... 441,008 441,008
26 Total expenses and disbursements. Add lines 24 and 25 770,755 2,572   493,630
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 4,779,866
b Net investment income (if negative, enter -0-) 272,496
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2018)
Form 990-PF (2018)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing.............      
2 Savings and temporary cash investments......... 59,502 14,180 14,180
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
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) bullet  
Less: allowance for doubtful accounts bullet        
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).......      
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 5,487,451 Click to see attachment9,628,982 9,628,982
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment5,577 Click to see attachment7 Click to see attachment7
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 5,552,530 9,643,169 9,643,169
Liabilities 17 Accounts payable and accrued expenses.......... 3,382 2,823
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 bullet)    
23 Total liabilities (add lines 17 through 22)......... 3,382 2,823
Net Assets or Fund Balances Foundations that follow SFAS 117, check here bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................. 5,549,148 9,640,346
25 Temporarily restricted...............    
26 Permanently restricted...............    
Foundations that do not follow SFAS 117, check here bullet
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)..... 5,549,148 9,640,346
31 Total liabilities and net assets/fund balances (see instructions). 5,552,530 9,643,169
Part III
Analysis of Changes 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
5,549,148
2
Enter amount from Part I, line 27a .....................
2
4,779,866
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
10,329,014
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
688,668
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
9,640,346
Form 990-PF (2018)
Form 990-PF (2018)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(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 Publicly Traded Securities P    
b
c
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a 450,000   372,003 77,997
b
c
d
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       77,997
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 77,997
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 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2017 272,283 5,267,275 0.051693
2016      
2015      
2014      
2013      
2
Total of line 1, column (d) .....................
2
0.051693
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5.0, or by the number of years the foundation has been in existence if less than 5 years ......
3
0.051693
4
Enter the net value of noncharitable-use assets for 2018 from Part X, line 5......
4
8,863,884
5
Multiply line 4 by line 3......................
5
458,201
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
2,725
7
Add lines 5 and 6........................
7
460,926
8
Enter qualifying distributions from Part XII, line 4,.............
8
493,630
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.
Form 990-PF (2018)
Form 990-PF (2018)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket includes lines 1a and 1b
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 2,725
hereBulletand 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 0
3 Add lines 1 and 2........................... 3 2,725
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 2,725
6 Credits/Payments:
a 2018 estimated tax payments and 2017 overpayment credited to 2018 6a 2,823
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 2,823
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 16
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 82
11 Enter the amount of line 10 to be: Credited to 2019 estimated taxBullet82 RefundedBullet 11 0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition).................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletND
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2018 or the taxable year beginning in 2018? See the instructions for Part XIV.
    If "Yes," complete Part XIV .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletwww.bcbsnd.com/caring-foundation/about-us
    14
    The books are in care ofbulletBlue Cross Blue Shield of North Dak Telephone no.bullet (701) 282-1100

    Located atbullet4510 13th Ave SouthFargoND ZIP+4bullet58121
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2018, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet  
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ........
    1b
     
     
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2018?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2018, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2018?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2018 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2018.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2018?
    4b
     
    No
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ......
    5b
     
    No
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .................
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    Timothy J Huckle Chair
    0.50     		0 0 0
    4510 13th Ave South
    Fargo,ND58121
    Dave J Breuer Treasurer
    0.50     		0 0 0
    4510 13th Ave South
    Fargo,ND58121
    Daniel R Conrad Director
    0.50     		0 0 0
    4510 13th Ave South
    Fargo,ND58121
    Elizabeth A Faust Director
    0.50     		0 0 0
    4510 13th Ave South
    Fargo,ND58121
    Jodi L Atkinson Director
    0.50     		0 0 0
    4510 13th Ave South
    Fargo,ND58121
    Dave A Sprynczynatyk Director
    0.50     		0 0 0
    4510 13th Ave South
    Fargo,ND58121
    Greg C Glasner MD Director
    0.50     		0 0 0
    4510 13th Ave South
    Fargo,ND58121
    Pam Gulleson Executive Director
    15.00     		0 0 0
    4510 13th Ave South
    Fargo,ND58121
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (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
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    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
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    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 CaringForKidsSupport evidenced based initiatives aimed at preventing childhood obesity and supporting healthy minds and bodies at an early age. 37,447
    2 Colorectal Cancer AwarenessColorectal cancer can be detected and detected at an early stage when it is most treatable. BCBSND Caring Foundation produced two videos featuring North Dakota colorectal cancer survivors through a collaboration with the KAT Marketing, the American Cancer Society North Dakota chapter and the North Dakota Colorectal Cancer Roundtable. The videos were created with a few goals in mind:- To educate North Dakotans about colorectal cancer prevention, detection and treatment- To encourage them to discuss colorectal cancer screening with their providers- To reduce fear and instill hope for recoveryIn the videos Elliott Rhodes of Fort Yates, N.D., and Amanda Houston of Fargo share their personal colorectal cancer stories in the videos and urge you to talk to your doctor about your screening options. 9,900
    3 Opioid EventsMisuse and overdose of opioids have become a serious public health problem in North Dakota and throughout the United States. Blue Cross Blue Shield of North Dakota Caring Foundation has partnered with Prairie Public Broadcast, Bell Banks and Dakota Medical Foundation to produce a 30-minute North Dakota state-based documentary. The documentary spotlights some of the most important things North Dakota opioid users, affected families, health care professionals, educators, businesses and community members need to know upfront about the opioid epidemic but most importantly how they can drive action in helping to solve the problem. Our vision of hope identifies solutions from multiple facets with focuses on promotion and prevention, early intervention, and treatment and recovery. We all have a role. Together we will make a difference. 4,184
    4 Suicide PreventionIn an effort to prevent suicide and help those struggling with depression and other mental illnesses, the BCBSND Caring Foundation supports various initiatives across the state to reduce the stigma and provide important resources and assistance. 977
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    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  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    8,941,406
    b
    Average of monthly cash balances.......................
    1b
    57,461
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    8,998,867
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    8,998,867
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    134,983
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    8,863,884
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    443,194
    Part XI
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    443,194
    2a
    Tax on investment income for 2018 from Part VI, line 5......
    2a
    2,725
    b
    Income tax for 2018. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    2,725
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    440,469
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    440,469
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    440,469
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    493,630
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    493,630
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b. See instructions.................
    5
    2,725
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    490,905
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2017     		(c)
    2017     		(d)
    2018
    1 Distributable amount for 2018 from Part XI, line 7 440,469
    2 Undistributed income, if any, as of the end of 2018:
    a Enter amount for 2017 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2018:
    a From 2013......  
    b From 2014......  
    c From 2015......  
    d From 2016......  
    e From 2017...... 11,746
    fTotal of lines 3a through e........ 11,746
    4Qualifying distributions for 2018 from Part
    XII, line 4: bullet$ 493,630
    a Applied to 2017, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2018 distributable amount..... 440,469
    e Remaining amount distributed out of corpus 53,161
    5 Excess distributions carryover applied to 2018. 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 64,907
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    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......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2017. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2018. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2019 ..........     		0
    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) .......     		0
    8 Excess distributions carryover from 2013 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2019.
    Subtract lines 7 and 8 from line 6a ......     		64,907
    10 Analysis of line 9:
    a Excess from 2014....  
    b Excess from 2015....  
    c Excess from 2016....  
    d Excess from 2017.... 11,746
    e Excess from 2018.... 53,161
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2018, enter the date of the ruling....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    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) 2018 (b) 2017 (c) 2016 (d) 2015
             
    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          
    Part XV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    Caring Foundation
    4510 13th Ave S
    Fargo,ND58121
    (701) 282-1100
    caringfoundation@bcbsnd.com
    bThe form in which applications should be submitted and information and materials they should include:
    Caring Foundation applications located on our website
    cAny submission deadlines:
    Varies based on grant type
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    In general must impact North Dakotans and tie back to our mission of bettering health and well-being.
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 11
    Part XV
    Supplementary Information (continued)
    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)
    aPaid during the year
    Altru Health Foundation
    2501 Demers Avenue
    Grand Forks,ND58201     		None PC Support disease prevention screenings 4,000
    Altru Health Foundation-TEARS Program
    PO Box 6002
    Grand Forks,ND58201     		None PC mental health first aid for adults trainer certification 10,000
    Anne Carlson Center
    PO Box 8000
    Jamestown,ND58402     		None PC Bike camp sponsor 2,700
    Anne Carlson Center
    PO Box 168
    Bottineau,ND58318     		None PC Annie's House Adaptive Recreation program scholarships 6,000
    Ashley Swimming Pool
    PO Box 382
    Ashley,ND58413     		None GOV Funds for community to put on a 5k/ pool night event for families in partnership with their Park District 1,500
    Alzheimer's Association of MN-ND
    7900 West 78th Street
    Minneapolis,MN55439     		None PC Casual Day Dollars Donation 480
    Fraser
    2902 S University Drive
    Fargo,ND58103     		None PC Purchased baby blankets for low income families & decorations for festival of trees to benefit Fraser, Ltd. 417
    American Diabetes Association
    8000 W 78th Street Suite 175
    Edina,MN55439     		None PC Camp Sioux fundraiser 1,200
    American Foundation of Suicide Prevention ND Chapter
    PO Box 11295
    Fargo,ND58106     		None PC Casual Day Dollars donation 417
    American Gold Gymnastics
    2001 17th Ave S
    Fargo,ND58103     		None PC scholarship program 2,500
    American Red Cross ND Chapter
    2602 12th Street N
    Fargo,ND58102     		None PC Casual Day Dollars Donation 740
    Bakken BBQ Charities
    PO Box 122
    Dickinson,ND58602     		None PC Listed as Unincorporated Association; Proceeds from this charitable event benefitted North Dakota Make-A-Wish 500
    Barnes County North School District
    2192 101 Ave SE
    Wimbledon,ND58492     		None GOV fitness equipment 2,500
    Ben Franklin Middle School
    1420 8th Street N
    Fargo,ND58102     		None GOV pedometers for students 560
    Bethany Auxiliary
    4255 30th Ave S
    Fargo,ND58104     		None PC Dollars for Doers/Charitable Giving 400
    Big 987 Christmas Wish
    2720 7th Ave S
    Fargo,ND58103     		None PC Dollars for Doers/Charitable Giving 200
    Bismarck Cancer Center
    500 N 8th Street
    Bismarck,ND58501     		None PC matching BCBSND employee funds 180
    Boys and Girls Club of the Red River Valley
    2500 18th St S
    Fargo,ND58103     		None PC Triple Play project 10,000
    Brave the Shave
    1950 Far West Drive
    Bismarck,ND58504     		None PC Fundraiser and Casual Day Dollars Donation 6,487
    Camp Courage
    5001 Amber Valley Pkwy
    Fargo,ND58104     		None PC Dollars for Doers/Charitable Giving 200
    Cats Cradle Shelter
    9 9th St S
    Fargo,ND58103     		None PC Dollars for Doers/Charitable Giving 600
    Central Cass Public School District
    802 5th Street N
    Casselton,ND58102     		None GOV STEM 10,000
    Century High School Sources of Strength
    1000 East Century Avenue
    Bismarck,ND58103     		None GOV Sources of Strength Program 350
    Children's Miracle Network
    PO Box 2010
    Fargo,ND58122     		None PC Fundraiser and Dollars for Doers/Charitable Giving 1,444
    Christian Adoption Services
    PO Box 850
    West Fargo,ND58078     		None PC Dollars for Doers/Charitable Giving 200
    Circle of Friends Humane Society
    4375 N Washington St
    Grand Forks,ND58203     		None PC Dollars for Doers/Charitable Giving 200
    Clara Barton Hawthorne
    1417 6th Street S
    Fargo,ND58103     		None GOV walkathon support 500
    Crohns and Colitis Foundation of America
    22865 Hunters Ridge Rd
    Lakeville,MN55044     		None PC Dollars for Doers/Charitable Giving 200
    Cullen Childrens Foundation
    PO Box 594
    West Fargo,ND58078     		None PC Dollars for Doers/Charitable Giving 400
    Dreams in Motion Inc
    PO Box 625
    Mandan ND,ND58554     		None PC Dollars for Doers/Charitable Giving 200
    Elgin New Leipzig Public Schools
    PO Box 70
    Elgin,ND58533     		None GOV Sources of Strength Program 5,000
    Elks Camp Grassick
    833 Grassick Ln
    Dawson,ND58428     		None PC Dollars for Doers/Charitable Giving 200
    Emergency Food Pantry
    PO Box 2821
    Fargo,ND58108     		None PC Dollars for Doers/Charitable Giving 800
    Essentia Health Regional Foundation
    3000 32nd Avenue South
    Fargo,ND58103     		None PC NICU family resource support 2,500
    Eventide Foundation
    801 Main Avenue
    Moorhead,MN58560     		None PC Dollars for Doers/Charitable Giving 200
    Family HealthCare
    301 NP Avenue
    Fargo,ND58102     		None PC FHCs preventive in school dental services, yr 2 of 3, and Dollars for Doers 8,533
    Fargo Park District Foundation
    701 Main Avenue
    Fargo,ND58103     		None PC fitness equipment 22,750
    FirstLink
    4357 13th Ave S
    Fargo,ND58103     		None PC Text 211 program, and Dollars for Doers 6,485
    Fraser
    2902 S University Drive
    Fargo,ND58103     		None PC festival of trees sponsorship, help fund services, and Casual Day Dollars 953
    Furry Friends Rockin Rescue
    2500 14th Ave SE
    Mandan,ND58554     		None PC Dollars for Doers/Charitable Giving 600
    Gateway to Science Center Inc
    1810 Schafer St
    Bismarck,ND58501     		None PC support Stem programs 4,000
    Gigi's Playhouse
    3224 20th Street S
    Fargo,ND58104     		None PC support programming 500
    Grand Forks Senior Center
    620 4th Ave S
    Grand Forks,ND58201     		None PC Dollars for Doers/Charitable Giving 200
    Great North Pole
    675 13th Avenue E
    West Fargo,ND58078     		None PC Dollars for Doers/Charitable Giving 800
    Lincoln Elementary
    2120 9th St S
    Fargo,ND58103     		None GOV Bikes for kids in need Lincoln Elementary 3,220
    Great Plains Food Bank
    1720 3rd Avenue N
    Fargo,ND58102     		None PC Casual Day Dollars 997
    Greater FM Economic Development Center (STEM Alliance)
    51 Broadway N
    Fargo,ND58102     		None PC Dollars for Doers/Charitable Giving 200
    HERO
    5012 53rd St S
    Fargo,ND58104     		None PC Medical equipment cleaning 5,000
    Higher Power Automotive Ministries Inc
    5302 River Dr
    Fargo,ND58102     		None PC Dollars for Doers/Charitable Giving 200
    Hillsboro Backpack Program
    PO Box 44
    Hillsboro,ND58045     		None GOV backpack program 5,000
    HIPP Kids Therapy
    2497 Mustang Drive South
    Mandan,ND58554     		None PC Occupational Services for children 300
    Homeward Animal Shelter
    1201 28th Ave N
    Fargo,ND58102     		None PC Dollars for Doers/Charitable Giving 800
    Hope Center
    313 3rd Street NE
    Devils Lake,ND58301     		None PC Dollars for Doers/Charitable Giving 400
    Hopes Landing WEM
    Box 3645
    Dickinson,ND58601     		None PC support sober living 2,500
    Hospice of the Red River Valley
    1701 38th Street S
    Fargo,ND58103     		None PC Dollars for Doers/Charitable Giving 200
    Humane Society of Richland Wilkin County
    1809 79 1/2 St SE
    Wahpeton,ND58075     		None PC Dollars for Doers/Charitable Giving 200
    Independence Inc
    2000 E Burdick Expressway
    Minot,ND58701     		None PC chili bowl sponsorship 750
    Jamestown United Way
    PO Box 85
    Jamestown,ND58402     		None PC Fundraiser Donations 73
    JDRF Dakotas
    1305 W 18th St Route 5192
    Sioux Falls,SD57117     		None PC support type 1 diabetes research 2,500
    Jeremiah Project
    3104 Fiechtner Dr S
    Fargo,ND58103     		None PC Dollars for Doers/Charitable Giving 200
    Kamp Kace
    PO Box 6462
    Fargo,ND58109     		None PC Dollars for Doers/Charitable Giving 200
    Lake Agassiz Habitat for Humanity
    PO Box 1022
    Moorhead,MN56561     		None PC Dollars for Doers/Charitable Giving 200
    Langdon Area High School
    715 14th Avenue
    Langdon,ND58249     		None GOV Sources of Strength Program 5,000
    Lend a Hand Dakota Medical Foundation
    4141 28th Ave S
    Fargo,ND58104     		None PC Dollars for Doers/Charitable Giving 400
    Little Missouri Arc
    403 2nd Ave SE
    Bowman,ND58623     		None PC Casual Day Dollars 179
    Lutheran Social Services
    3911 20th Avenue S
    Fargo,ND58103     		None PC support companion program 10,000
    Make-A-Wish ND Chapter
    4143 26th Ave S
    Fargo,ND58104     		None PC Casual Day Dollars 301
    March of Dimes Foundation
    PO Box 673667
    Marietta,GA30006     		None PC Dollars for Doers/Charitable Giving 2,973
    Memory Cafe of the RRV
    PO Box 883
    Fargo,ND58107     		None PC Dollars for Doers/Charitable Giving 200
    Mental Health America of ND
    PO Box 4106
    Bismarck,ND58502     		None PC Support mental illness 750
    Midkota Public School
    PO Box 98
    Glenfield,ND58421     		None GOV Sources of Strength Program 5,000
    Minot Family YMCA
    PO Box 69
    Minot,ND58702     		None PC Family Fun night sponsor 2,000
    Minot Head Start
    2815 Burdick Expy E
    Minot,ND58701     		None PC Dollars for Doers/Charitable Giving 200
    Missouri Slope Areawide United Way
    PO Box 2111
    Bismarck,ND58502     		None PC Emergency homeless shelter 8,500
    Missouri Valley Family YMCA
    1608 North Washington Street
    Bismarck,ND58501     		None PC Safety around water program funding 9,500
    National Kidney Foundation
    2601 S Minnesota Ave St 105-196
    Sioux Falls,SD57105     		None PC Dollars for Doers/Charitable Giving 200
    Native American Development Center
    205 North 24th Street
    Bismarck,ND58501     		None PC transportation services and peer support program 7,500
    ND Autism Center
    647 13th Ave E
    West Fargo,ND58078     		None PC support for walk for autism event 700
    ND Center for Nursing
    3523 45th Street South
    Fargo,ND58103     		None PC Workplace culture 5,000
    ND Child Care Providers Inc
    2731 10th Ave SE
    Mandan,ND58554     		None PC support for first aid, CPR, and SIDS trainers 500
    ND Dental Foundation Mission of Mercy
    4141 28th Ave S
    Fargo,ND58104     		None PC free dental care 8,000
    ND Federation of Families for Children's Mental Health
    PO Box 3061
    Bismarck,ND58502     		None PC youth mental health 1,000
    NDANO
    PO Box 1091
    Bismarck,ND58502     		None PC Nonprofit Leadership conference sponsor 500
    NDSU School of Pharmacy
    1401 Albrecht Blvd
    Fargo,ND58102     		None GOV Funding used to develop an Opioid Misuse Risk Prevention Toolkit for community pharmacists 9,500
    New American Consortium for Wellness & Empowerment
    15 21st Street S
    Fargo,ND58103     		None PC Dollars for Doers/Charitable Giving 200
    Gladys Ray Shelter
    1519 1st Ave S
    Fargo,ND58103     		None GOV Purchased backpacks for homeless female veterans at the Gladys Ray Shelter 183
    Northern Lights Youth Services Inc
    502 West Caledonia Ave
    Hillsboro,ND58045     		None PC Dollars for Doers/Charitable Giving 200
    Northern Prairie Performing Arts - FMCT
    333 4th St S
    Fargo,ND58103     		None PC Dollars for Doers/Charitable Giving 200
    Parkside Lutheran Home
    501 3rd Avenue W
    Lisbon,ND58054     		None PC recumbent bike 1,000
    Rape and Abuse Crisis Center
    PO Box 2984
    Fargo,ND58108     		None PC Dollars for Doers/Charitable Giving 200
    Red River Valley FOP Lodge #1
    21 18th Street S
    Fargo,ND58103     		None PC support local children with new shoes, clothing, and backpacks 1,000
    Richland Wilkin Emergency Food Pantry Inc
    699 8th Ave S
    Wahpeton,ND58075     		None PC Dollars for Doers/Charitable Giving 200
    Robert Asp Elementary
    910 11th Street N
    Moorhead,MN56560     		None GOV walkathon support 500
    Ronald McDonald House of RRV
    1330 18th Avenue S
    Fargo,ND58103     		None PC Casual Day Dollars 1,016
    Ronald McDonald House Charities of Bismarck
    PO Box 7323
    Bismarck,ND58103     		None PC Casual Day Dollars 216
    Safe Kids Grand Forks
    PO Box 6002
    Grand Forks,ND58206     		None PC Safe Kids Day 100
    Salvation Army
    PO Box 2124
    Fargo,ND58107     		None PC Dollars for Doers/Charitable Giving 200
    Souris Valley United Way
    1941 4th Street SW
    Minot,ND58701     		None PC backpack buddies program to fight childhood hunger 7,000
    Southern Valley Figure Skating Club
    PO Box 1412
    Wahpeton,ND58074     		None PC promote and encourage skaters of all ages 200
    Southwestern District Health Unit
    227 16th Street West
    Dickinson,ND58601     		None PC Kids Health and Safety Fair 100
    Special Olympics North Dakota
    2616 S 26th St
    Grand Forks,ND58201     		None PC Dollars for Doers/Charitable Giving 200
    Star Legacy Foundation
    7820 Terrey Pine Ct 80
    Eden Prairie,MN55347     		None PC Dollars for Doers/Charitable Giving 200
    The Arc Cass County
    215 North University Drive
    Fargo,ND58102     		None PC Casual Day Dollars 178
    The Arc of Barnes County
    141 2nd Street NE
    Valley City,ND58072     		None PC Casual Day Dollars 178
    The Arc of Bismarck
    1500 E Capitol
    Bismarck,ND58501     		None PC Casual Day Dollars 178
    The Arc of Dickinson
    653 19th Street W
    Dickinson,ND58601     		None PC Casual Day Dollars 178
    The Arc Upper Valley Inc
    2500 Demers Ave
    Grand Forks,ND58201     		None PC Casual Day Dollars 178
    The Village Family Service Center
    PO Box 9859
    Fargo,ND58106     		None PC Support for addiction, awareness and destigmatization 2,900
    Theatre B
    215 10th Street N
    Moorhead,MN58560     		None PC Dollars for Doers/Charitable Giving 200
    Theodore Roosevelt Medora Foundation
    PO Box 198
    Medora,ND58645     		None PC Dollars for Doers/Charitable Giving 400
    Tobacco Free ND
    PO Box 3237
    Bismarck,ND58502     		None PC educational material to educate tobacco dangers, reduce youth initiation 5,000
    Turtle Lake Community Hospital Association
    PO Box 280
    Turtle Lake,ND58575     		None PC support 'crash-cart' equip upgrade 1,000
    UND Dakota Conference
    1301 N Columbia Road Stop 9037
    Grand Forks,ND58202     		None GOV Opioid Work 2,000
    Underwood Public Schools District #8
    123 Summit Street
    Underwood,ND58576     		None GOV Sources of Strength Program 5,000
    United Way of Cass Clay
    219 7th Street S
    Fargo,ND58103     		None PC Annual Corporate Donation, and Casual Day Dollars 50,959
    United Way of Barnes County
    PO Box 29
    Valley City,ND58072     		None PC Fundraiser Donations 73
    United Way of Dickinson
    PO Box 501
    Dickinson,ND58602     		None PC Fundraiser Donations 73
    United Way of Grand Forks East Grand Forks & Area
    1407 24th Avenue South
    Grand Forks,ND58201     		None PC Fundraiser Donations 73
    United Way of Richland-Wilkin
    PO Box 746
    Wahpeton,ND58074     		None PC Fundraiser Donations 73
    Basin United Way of Williston
    PO Box 176
    Williston,ND58802     		None PC Fundraiser Donations 73
    Valley Community Health Center
    212 4th Street 200
    Grand Forks,ND58201     		None PC School Dental Sealant Program 18,000
    Valley Memorial Foundation
    2900 14th Avenue S
    Grand Forks,ND58201     		None PC Headstart 100
    Wish Fast
    8037 116th Avenue S
    Crete,ND58040     		None PC Benefit for Make a Wish ND 500
    Wishek Public School
    PO Box 247
    Wishek,ND58495     		None GOV Sources of Strength Program 5,000
    YWCA of Cass and Clay Counties
    3100 12th Avenue N
    Fargo,ND58102     		None PC Dollars for Doers/Charitable Giving 1,200
    University of North Dakota
    264 Centennial Dr Mail Stop 7306
    Grand Forks,ND58202     		None GOV Rural Health Providers Partnership Grants 50,140
    Bismarck State College
    1500 Edwards Ave PO Box 5587
    Bismarck,ND58506     		None GOV Health Profession Scholarships 2,500
    Cankdeska Cikana Community College
    PO Box 269
    Fort Totten,ND58335     		None GOV Health Profession Scholarships 2,500
    Dakota College at Bottineau
    105 Simrall Blvd
    Bottineau,ND58318     		None GOV Health Profession Scholarships 2,500
    Mayville State University
    330 3rd Street NE
    Mayville,ND58257     		None GOV Health Profession Scholarships 2,500
    Minot State University
    500 University Ave W
    Minot,ND58707     		None GOV Health Profession Scholarships 2,500
    NDSCS Financial Aid
    800 6th Street N
    Wahpeton,ND58076     		None GOV Health Profession Scholarships 2,500
    NDSU One Stop
    PO Box 6050 Dept 2836
    Fargo ND,ND58108     		None GOV Health Profession Scholarships 17,500
    School of Medicine & Health Sciences
    1301 N Columbia Road Stop 9037
    Grand Forks,ND58202     		None GOV Health Profession Scholarships 17,500
    United Tribes Technical College
    3315 University Drive
    Bismarck,ND58504     		None GOV Health Profession Scholarships 2,500
    University of Mary Financial Aid
    7500 University Drive
    Bismarck,ND58504     		None GOV Health Profession Scholarships 2,500
    University of North Dakota
    264 Centennial Drive Stop 8371
    Grand Forks,ND58202     		None GOV Health Profession Scholarships 5,000
    Williston State College
    1410 University Avenue
    Williston,ND58801     		None GOV Health Profession Scholarships 5,000
    Total .................................bullet 3a 441,008
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    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
    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....     14 197,071  
    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.....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		    18 77,997  
    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).. 0 275,068 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    275,068
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2018)
    Form 990-PF (2018)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2018)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors

    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
    OMB No. 1545-0047
    2018
    Name of the organization
    Blue Cross Blue Shield of North Dakota C
     
    Employer identification number

    36-3606394
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ






    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
    Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2
    Name of organization
    Blue Cross Blue Shield of North Dakota C
          		Employer identification number
    36-3606394
    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
    Noridian Mutual Insurance Company
     
    4510 13th Ave S
     
    Fargo, ND58121

    		$ 5,268,816


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
    Page 3
    Name of organization
    Blue Cross Blue Shield of North Dakota C
          		Employer identification number

    36-3606394
    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) (2018)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
    Page 4
    Name of organization
    Blue Cross Blue Shield of North Dakota C
          		Employer identification number

    36-3606394
    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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2018 InvestmentsOtherSchedule2
    Name:
    Blue Cross Blue Shield of North Dakota C
    EIN:
    36-3606394
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    Baird Aggregate Bond Fund FMV 3,813,994 3,813,994
    Transamerica International Equty Fund FMV 876,470 876,470
    Vanguard Total Stock Market FMV 4,938,518 4,938,518

    TY 2018 OtherAssetsSchedule
    Name:
    Blue Cross Blue Shield of North Dakota C
    EIN:
    36-3606394
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    Investment Income Receivable 5,577 7 7


    TY 2018 OtherDecreasesSchedule
    Name:
    Blue Cross Blue Shield of North Dakota C
    EIN:
    36-3606394
    Description Amount
    Unrealized Loss 688,668


    TY 2018 OtherExpensesSchedule
    Name:
    Blue Cross Blue Shield of North Dakota C
    EIN:
    36-3606394
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Miscellaneous Expenses 114 0   114
    Administrative Expenses 268,816 0   0
    CaringForKids 37,447 0   37,447
    Opioid Events 4,184 0   4,184
    Suicide Prevention 977 0   977
    Colorectal Cancer Awareness 9,900 0   9,900


    TY 2018 OtherProfessionalFeesSchedule
    Name:
    Blue Cross Blue Shield of North Dakota C
    EIN:
    36-3606394
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Investment Management Fees 2,572 2,572   0


    TY 2018 TaxesSchedule
    Name:
    Blue Cross Blue Shield of North Dakota C
    EIN:
    36-3606394
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Excise Taxes 5,737 0   0