Form990-PF
Click to see attachment
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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. 1545-0047
2021
Open to Public Inspection
For calendar year 2021, or tax year beginning 01-01-2021 , and ending 12-31-2021
Name of foundation
BLUE CROSS & BLUE SHIELD OF
MISSISSIPPI FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)3545 LAKELAND DRIVE
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
FLOWOOD, MS39232
A Employer identification number

20-0471034
B Telephone number (see instructions)

(601) 664-4473
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$119,611,651J 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) 84,538
2 Check bullet.............
3 Interest on savings and temporary cash investments 14,400 14,400  
4 Dividends and interest from securities... 2,878,874 2,878,874  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 2,796,452
b Gross sales price for all assets on line 6a 24,374,503
7 Capital gain net income (from Part IV, line 2)... 2,796,452
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)....... Click to see attachment 79,820 0 0
12 Total. Add lines 1 through 11........ 5,854,084 5,689,726 0
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 132,251 0 0 129,295
14 Other employee salaries and wages...... 139,198 0 0 132,947
15 Pension plans, employee benefits....... 32,747 0 0 34,757
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 25,000 0 0 19,000
c Other professional fees (attach schedule).... Click to see attachment 51,070 0 0 64,175
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 214,554 0 0 14,282
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings....... 3,689 0 0 5,487
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 387,089 282,859 0 99,068
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 985,598 282,859 0 499,011
25 Contributions, gifts, grants paid....... 9,864,794 9,864,794
26 Total expenses and disbursements. Add lines 24 and 25 10,850,392 282,859 0 10,363,805
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -4,996,308
b Net investment income (if negative, enter -0-) 5,406,867
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2021)
Form 990-PF (2021)
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......... 5,105,431 2,371,015 2,371,015
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) 4,821,524 Click to see attachment5,420,893 5,420,893
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule)....... 4,560,964 Click to see attachment7,132,342 7,132,342
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 100,954,829 Click to see attachment104,584,220 104,584,220
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment154,954 Click to see attachment103,181 Click to see attachment103,181
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 115,597,702 119,611,651 119,611,651
Liabilities 17 Accounts payable and accrued expenses.......... 41,268 48,087
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) Click to see attachment259,196 Click to see attachment380,650
23 Total liabilities (add lines 17 through 22)......... 300,464 428,737
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions........... 115,297,238 119,182,914
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 115,297,238 119,182,914
30 Total liabilities and net assets/fund balances (see instructions). 115,597,702 119,611,651
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 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
115,297,238
2
Enter amount from Part I, line 27a .....................
2
-4,996,308
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
8,881,984
4
Add lines 1, 2, and 3 ..........................
4
119,182,914
5
Decreases not included in line 2 (itemize) bullet
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
119,182,914
Form 990-PF (2021)
Form 990-PF (2021)
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 MUTUAL FUNDS / ETF'S - HARDY REED P   2021-12-31
b EXCHANGE TRADED FUNDS P   2021-12-31
c U.S. TREASURY NOTES / GOVERNMENT OBLIGATIONS P   2021-12-31
d CORPORATE BONDS P   2021-12-31
e LONG TERM CERTIFICATES OF DEPOSIT P   2021-12-31
(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 5,970,827   4,676,744 1,294,083
b 15,657,676   14,155,307 1,502,369
c 750,000   750,000 0
d 750,000   750,000 0
e 1,246,000   1,246,000 0
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       1,294,083
b       1,502,369
c       0
d       0
e       0
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 2,796,452
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  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
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 for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) 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 75,155
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 75,155
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 83,166
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 30,000
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 113,166
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment 8 0
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 38,011
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet38,011 RefundedBullet 11 0
Part VI-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 the instructions
for the 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 XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletMS
    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 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    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 (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-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.HEALTHIERMISSISSIPPI.ORG
    14
    The books are in care ofbulletJUSTIN L REULET Telephone no.bullet (601) 664-4503

    Located atbullet3545 LAKELAND DRIVEFLOWOODMS ZIP+4bullet39232
    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 2021, 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 VI-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? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
    Yes
     
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
    Yes
     
    (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)? ......................
    1a(5)
     
    No
    (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.) ...............
    1a(6)
     
    No
    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
     
    No
    c
    ........bullet
    d
    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 2021? .............
    1d
     
    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 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    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? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 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 2021.) .....................
    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 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-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))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    No
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals? .............
    5a(5)
     
    No
    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
     
     
    c
    .........bullet
    d
    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? .................
    5d
     
     
    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? .............................
    6a
     
    No
    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?
    7a
     
    No
    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? .........................
    8
     
    No
    Part VII
    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
    THOMAS C FENTER MD CHAIRMAN, DIRECTOR
    1.00     		0 0 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    HARRY M WALKER VICE CHAIRMAN, DIRECTOR
    1.00     		6,000 0 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    SCOTT T WILLIAMSON SECRETARY, DIRECTOR
    1.00     		0 0 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    DOUGLAS R GARRETT TREASURER, DIRECTOR
    1.00     		8,000 0 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    CASEY D BLAND RN DIRECTOR
    1.00     		0 0 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    CURTIS L GREER MD DIRECTOR
    1.00     		0 0 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    CHRISTINA C THOMAS DIRECTOR
    1.00     		0 0 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    JOYCE YATES DIRECTOR
    1.00     		8,000 0 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    SHEILA GROGAN PRESIDENT
    20.00     		93,871 16,380 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    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
    MELISA STEWART COMMUNITY & FOUNDATI
    28.00     		85,797 10,361 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    EUGENIA KING HEALTH & FITNESS COO
    27.00     		73,254 9,083 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    LAKEN JOHNSTON COMMUNITY & FOUNDATI
    7.00     		56,024 7,029 0
    3545 LAKELAND DRIVE
    FLOWOOD,MS39232
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    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
    TRUSTMARK NATIONAL BANK - WEALTH MANAGEMENT INVESTMENT MANAGEMENT & CONSULTING 169,934
    248 EAST CAPITOL STREET SUITE 1000
    JACKSON,MS39201
    HARDY REED LLC INVESTMENT MANAGEMENT & CONSULTING 112,925
    101 SOUTH FRONT STREET
    TUPELO,MS38804
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part VIII-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  
    2  
    3  
    4  
    Part VIII-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 (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    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
    119,083,434
    b
    Average of monthly cash balances.......................
    1b
    1,969,052
    c
    Fair market value of all other assets (see instructions)................
    1c
    81,504
    d
    Total (add lines 1a, b, and c).........................
    1d
    121,133,990
    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
    121,133,990
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    1,817,010
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    119,316,980
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    5,965,849
    Part X
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part IX, line 6..................
    1
    5,965,849
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    75,155
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    75,155
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    5,890,694
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    79,820
    5
    Add lines 3 and 4............................
    5
    5,970,514
    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 XII, line 1 ...
    7
    5,970,514
    Part XI
    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
     
    b
    Program-related investments—total from Part VIII-B..................
    1b
     
    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 XII, line 4.
    4
     
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 9
    Part XII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2020     		(c)
    2020     		(d)
    2021
    1 Distributable amount for 2021 from Part X, line 7 5,970,514
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 3,357,118
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016......  
    b From 2017......  
    c From 2018......  
    d From 2019......  
    e From 2020......  
    f Total of lines 3a through e ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 10,363,805
    a Applied to 2020, but not more than line 2a 3,357,118
    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 2021 distributable amount..... 5,970,514
    e Remaining amount distributed out of corpus 1,036,173
    5 Excess distributions carryover applied to 2021. 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 1,036,173
    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 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		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 2016 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		1,036,173
    10 Analysis of line 9:
    a Excess from 2017....  
    b Excess from 2018....  
    c Excess from 2019....  
    d Excess from 2020....  
    e Excess from 2021.... 1,036,173
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-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 2021, 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) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    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 IX, 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 XIV
    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:
    DR THOMAS C FENTER CHAIRMAN AND PRE
    3545 LAKELAND DRIVE
    JACKSON,MS39232
    (601) 664-4525
    bThe form in which applications should be submitted and information and materials they should include:
    THE BLUE CROSS & BLUE SHIELD OF MISSISSIPPI FOUNDATION ACCEPTS REQUESTS FROM POTENTIAL GRANTEES THROUGH ITS WEBSITE (WWW.HEALTHIERMISSISSIPPI.ORG) IN THE FORM OF A "LETTER OF INQUIRY," A BRIEF PRESENTATION OF A REQUEST FOR GRANT FUNDS. THE FOUNDATION ALSO DEVELOPS SIGNATURE GRANT FUNDING OPPORTUNITIES, INCLUDING THE HEALTHY HEROES PROGRAM FOR MUNICIPALITIES AND THE SCHOOL GARDEN PROGRAM FOR K-12 SCHOOLS. THE FOUNDATION'S HEALTHY HOMETOWN AWARDS PROGRAM ENCOURAGES AND REWARDS EXEMPLARY COMMUNITY HEALTH AND WELLNESS. SIMILAR TO THE HEALTHY HOMETOWN AWARDS PROGRAM IS THE HEALTHY SCHOOL AWARDS PROGRAM WHICH BUILDS ON THE GOALS OF SCHOOL HEALTH COUNCILS STATEWIDE. EACH GRANT APPLICATION RECEIVED BY THE FOUNDATION (INCLUDING AWARDS PROGRAM APPLICATIONS), IS PRESENTED TO THE BLUE CROSS & BLUE SHIELD OF MISSISSIPPI FOUNDATION BOARD OF DIRECTORS FOR FUNDING CONSIDERATION.
    cAny submission deadlines:
    N/A
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    TO BE ELIGILBE FOR FOUNDATION GRANT FUNDING CONSIDERATION, AN ORGANIZATION MUST BE A 501(C)3 CHARITABLE ORGANIZATION (BUT NOT A PRIVATE FOUNDATION) THAT BENEFITS MS, A MS MUNICIPALITY OR A MS SCHOOL. OTHER ELIGIBILITY REQUIREMENTS ARE:1)BE LOCATED IN MS OR IF NOT LOCATED IN MS, AGREE TO USE GRANT FUNDS ONLY FOR THE BENEFIT OF MS;2)BENEFIT THE COMMUNITIES IN MS;3)SERVE THE COMMUNITY WITH NO DISCRIMINATION BY AGE, RACE, GENDER, RELIGION, SEXUAL ORIENTATION, OR DISABILITY;4)NOT DUPLICATE OR SIGNIFICANTLY OVERLAP THE WORK OF PUBLIC AGENCIES;5)BE A 501(C)(3) CHARITABLE ORGANIZATION (BUT NOT A PRIVATE FOUNDATION) AND PROVIDE PROOF OF SUCH CURRENT DESIGNATION IN THE FORM OF AN IRS DETERMINATION LETTER; AND 6)CANNOT HAVE A CONTRACTUAL RELATIONSHIP WITH BLUE CROSS & BLUE SHIELD OF MS, ITS SUBSIDIARIES OR AFFILIATES. BLUE CROSS & BLUE SHIELD OF MS FOUNDATION DOES NOT PROVIDE FUNDING FOR: 1)INDIVIDUALS; 2)DENOMINATIONAL OR RELIGIOUS ORGANIZATIONS;3)POLITICAL CAUCUSES, CANDIDATES, OR CAMPAIGNS;
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    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
    ALCORN CAREER & TECHNOLOGY CENTER
    2101 NORMAN ROAD
    CORINTH,MS38834     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 36,754
    ALCORN STATE UNIVERSITY
    1000 ASU DRIVE 569
    LORMAN,MS39096     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 2 10,000
    BAPTIST MEMORIAL HEALTH CARE FOUNDATION
    350 N HUMPHREYS BOULEVARD
    MEMPHIS,TN38120     		  PC HEALTH & WELLNESS - COMMUNITY WALKING TRAIL 648,335
    BELL ACADEMY
    1016 TAYLOR ROAD
    BOYLE,MS38730     		  PC HEALTH & WELLNESS - HEALTHY SCHOOL AWARD 50,000
    CLINTON HIGH SCHOOL CAREER COMPLEX
    401 ARROW DRIVE
    CLINTON,MS39056     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 27,042
    COAHOMA COMMUNITY COLLEGE
    3240 FRIARS POINT ROAD
    CLARKSDALE,MS38614     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 2 10,000
    COPIAH-LINCOLN COMMUNITY COLLEGE
    PO BOX 649
    WESSON,MS39191     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 3 30,000
    DELTA STATE UNIVERSITY
    1003 WEST SUNFLOWER ROAD
    CLEVELAND,MS38733     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 3 30,000
    EAST MISSISSIPPI COMMUNITY COLLEGE
    PO BOX 158
    SCOOBA,MS39358     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 2 10,000
    EAST MISSISSIPPI COMMUNITY COLLEGE
    PO BOX 158
    SCOOBA,MS39358     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 3 30,000
    EAST SUNFLOWER ELEMENTARY SCHOOL
    212 EAST CLAIBORNE STREET
    SUNFLOWER,MS38778     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 15,800
    FAIRVIEW ATTENDANCE CENTER
    66 FAIRVIEW SCHOOL ROAD
    GOLDEN,MS38847     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 61,919
    FRANKLIN COUNTY UPPER ELEMENTARY SCHOOL
    409 US-98
    MEADVILLE,MS39653     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 20,987
    GEORGE COUNTY HIGH SCHOOL
    9284 OLD 63 SOUTH
    LUCEDALE,MS39452     		  PC HEALTH & WELLNESS - SCHOOL BICYCLE PROGRAM 28,169
    HATLEY HIGH SCHOOL
    60286 HATLEY ROAD
    AMORY,MS38821     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 28,371
    KIRKPATRICK HEALTH AND MEDICAL SCIENCE MAGNET SCHOOL
    1101 SMITH STREET
    CLARKSDALE,MS38614     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 56,993
    KOSCIUSKO LOWER ELEMENTARY SCHOOL
    229 W WASHINGTON STREET
    KOSCIUSKO,MS39090     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 29,013
    LIFE ENHANCEMENT AND ACHIEVEMENT PROGRAM
    4209 LAKELAND DRIVE 304
    FLOWOOD,MS39232     		  PC HEALTH & WELLNESS - SCHOOL GOLF PROGRAM 16,950
    MANNSDALE UPPER ELEMENTARY SCHOOL
    371 MANNSDALE ROAD
    MADISON,MS39110     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 21,953
    MANTACHIE ELEMENTARY SCHOOL
    311 MUSTANG DRIVE
    MANTACHIE,MS38855     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 16,436
    MISSISSIPPI DELTA COMMUNITY COLLEGE
    PO BOX 668
    MOORHEAD,MS38761     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 3 30,000
    MISSISSIPPI GULF COAST COMMUNITY COLLEGE
    51 MAIN STREET
    PERKINSTON,MS39573     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 2 10,000
    MISSISSIPPI STATE UNIVERSITY
    PO BOX DS
    MISSISSIPPI STATE,MS39762     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 1 10,000
    MISSISSIPPI VALLEY STATE UNIVERSITY
    14000 HWY 82 WEST
    ITTA BENA,MS38941     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 3 30,000
    MISSISSIPPI WILDLIFE FISHERIES & PARKS FOUNDATION
    PO BOX 14194
    JACKSON,MS39236     		  GOV HEALTH & WELLNESS - LEFLEUR'S BLUFF STATE PARK PLAYGROUND, OUTDOOR CLASSROOM AND PAVILION AND MUSEUM TRAIL 2,230,000
    MISSISSIPPI WILDLIFE FISHERIES & PARKS FOUNDATION
    PO BOX 14194
    JACKSON,MS39236     		  GOV HEALTH & WELLNESS - LEFLEUR'S BLUFF STATE PARK PLAYGROUND, OUTDOOR CLASSROOM AND PAVILION AND MUSEUM TRAIL - PROJECT SUSTAINABILITY 125,000
    MOSELLE ELEMENTARY SCHOOL
    168 RAYNER ROAD
    MOSELLE,MS39459     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM TRAIL PROJECT SUSTAINABILITY 31,690
    NETTLETON INTERMEDIATE SCHOOL
    170 MULLEN AVENUE
    NETTLETON,MS38858     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 68,916
    NORTHEAST LAUDERDALE ELEMENTARY SCHOOL
    6750 NEWELL ROAD
    MERIDIAN,MS39301     		  PC HEALTH & WELLNESS - HEALTHY SCHOOL AWARD 50,000
    NORTHEAST MISSISSIPPI COMMUNITY COLLEGE
    101 CUNNINGHAM BLVD
    BOONEVILLE,MS38829     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 3 30,000
    PEARL RIVER COMMUNITY COLLEGE
    101 HIGHWAY 11 NORTH
    POPLARVILLE,MS39470     		  PC HEALTH & WELLNESS - UNIVERSITY AND COLLEGE TOBACCO-FREE POLICY TIER 3 30,000
    PROJECT FIT AMERICA
    PO BOX 308
    BOYES HOT SPRINGS,CA95416     		  PC HEALTH & WELLNESS - PYSICAL EDUCATION EQUIPMENT FOR P.E. CONFERENCE TANGIBLE GRANTS 73,120
    SOUTH SUNFLOWER COUNTY HOSPITAL FOUNDATION
    121 E BAKER STREET
    INDIANOLA,MS38751     		  PC HEALTH & WELLNESS - INDIANOLA COMMUNITY WELLNESS CENTER - ARCHITECT FEES 144,000
    SOUTH SUNFLOWER COUNTY HOSPITAL FOUNDATION
    121 E BAKER STREET
    INDIANOLA,MS38751     		  PC HEALTH & WELLNESS - INDIANOLA COMMUNITY WELLNESS CENTER - CONSTRUCTION FEES 5,000,000
    SOUTH SUNFLOWER COUNTY HOSPITAL FOUNDATION
    121 E BAKER STREET
    INDIANOLA,MS38751     		  PC HEALTH & WELLNESS - INDIANOLA COMMUNITY WELLNESS CENTER - FURNITURE, FIXTURES AND EQUIPMENT 700,000
    ST RICHARD CATHOLIC SCHOOL
    100 HOLLY DRIVE
    JACKSON,MS39206     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 15,636
    THE NEW WILLIAM J BERRY ELEMENTARY SCHOOL
    P O DRAWER O
    HEIDELBERG,MS39439     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 33,937
    VICKSBURG HIGH SCHOOL
    3701 DRUMMOND STREET
    VICKSBURG,MS39066     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 20,000
    WEIR ELEMENTARY SCHOOL
    351 MARION KELLEY DRIVE
    WEIR,MS39772     		  PC HEALTH & WELLNESS - SCHOOL GARDEN PROGRAM 53,773
    Total .................................bullet 3a 9,864,794
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-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 ...........     		    14 14,400  
    4 Dividends and interest from securities ....          
    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 2,796,452  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aGRANT RECOVERIES     		        79,820
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 5,689,726 79,820
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    5,769,546
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-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 XV-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    11 RECOVERIES OF AMOUNTS TREATED AS QUALIFYING DISTRIBUTIONS. ALSO SEE PART XI, LINE 4.
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    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 instructions.
    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 (2021)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990)
    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
    2021
    Name of the organization
    BLUE CROSS & BLUE SHIELD OF
    MISSISSIPPI FOUNDATION
    Employer identification number

    20-0471034
    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) (2021)
    Schedule B (Form 990) (2021) Page 2
    Name of organization
    BLUE CROSS & BLUE SHIELD OF
    MISSISSIPPI FOUNDATION         		Employer identification number
    20-0471034
    Part I
    Contributors
    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 MISSISSIPPI
     
    3545 LAKELAND DRIVE
     
    FLOWOOD, MS39232

    		$ 84,538


    (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) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    BLUE CROSS & BLUE SHIELD OF
    MISSISSIPPI FOUNDATION         		Employer identification number

    20-0471034
    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) (2021)
    Schedule B (Form 990) (2021)
    Page 4
    Name of organization
    BLUE CROSS & BLUE SHIELD OF
    MISSISSIPPI FOUNDATION         		Employer identification number

    20-0471034
    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) (2021)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2021 AccountingFeesSchedule
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 25,000 0 0 19,000

    TY 2021 GeneralExplanationAttachment
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Identifier Return Reference Explanation
    RESTRICTIONS AND LIMITATIONS ON AWARDS FORM 990-PF PART XV, LINE 2D 4)SPECIAL OCCASION OR COMMEMORATIVE ADVERTISING, I.E., JOURNALS OR DINNER PROGRAMS, UNLESS PART OF AN OVERALL SPONSORSHIP EFFORT; 5)HOSPITALS OR HOSPITAL BUILDING FUNDS UNLESS TO A CHARITABLE BRANCH (501(C)(3)) OF A HOSPITAL; 6)COLLEGE ALUMNI ASSOCIATIONS; OR 7)HIGH SCHOOL OR COLLEGE SPORTS TEAMS OR EVENTS.
      FORM 990-PF PART VII-B, LINES 1A(3) AND 1A(4) THE FOUNDATION RECEIVED THE FOLLOWING ITEMS AT NO COST FROM BLUE CROSS & BLUE SHIELD OF MISSISSIPPI: 1) OFFICE AND OTHER INCIDENTAL SUPPLIES 2) NON-PROFESSIONAL SERVICES AND 3) THE USE OF BLUE CROSS & BLUE SHIELD OF MISSISSIPPI FACILITIES FOR OFFICE SPACE. AS ALLOWED UNDER REGULATIONS 53.4941(D)-3, THE FOUNDATION REIMBURSED BLUE CROSS & BLUE SHIELD OF MISSISSIPPI FOR COMPENSATION AND EXPENSES DIRECTLY RELATED TO THE PERFORMANCE OF PERSONAL SERVICES WHICH WERE REASONABLE AND NECESSARY TO CARRY OUT THE EXEMPT PURPOSE OF THE FOUNDATION.COMPENSATION PAID TO EMPLOYEES REFLECTED ON FORM 990-PF, PART VIII, LINES 1 AND 2 INCLUDES COMPENSATION PAID BY BLUE CROSS BLUE SHIELD OF MISSISSIPPI.

    TY 2021 InvestmentsCorpBondsSchedule
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Name of Bond End of Year Book Value End of Year Fair Market Value
    CORPORATE BONDS 7,132,342 7,132,342

    TY 2021 InvestmentsGovtObligationsSch
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    US Government Securities - End of Year Book Value:

    3,676,782
    US Government Securities - End of Year Fair Market Value:

    3,676,782
    State & Local Government Securities - End of Year Book Value:


    1,744,111
    State & Local Government Securities - End of Year Fair Market Value:


    1,744,111


    TY 2021 InvestmentsOtherSchedule2
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    MUTUAL FUNDS FMV 31,781,325 31,781,325
    CERTIFICATES OF DEPOSIT FMV 501,416 501,416
    EXCHANGE-TRADED FUNDS FMV 72,301,479 72,301,479

    TY 2021 OtherAssetsSchedule
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INTEREST 78,217 96,289 96,289
    PREPAID FEDERAL EXCISE TAX 8,166 6,892 6,892
    DEFERRED GRANT EXPENSE 68,571 0 0


    TY 2021 OtherExpensesSchedule
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    CUSTODY FEES 57,126 57,126 0 0
    INVESTMENT MANAGER FEES 225,733 225,733 0 0
    DUES & ASSESSMENTS 2,474 0 0 2,474
    SOFTWARE RENTALS & LEASES 4,686 0 0 4,686
    PRINTING & SUPPLIES 5,527 0 0 1,009
    BANKING FEES 1,123 0 0 1,123
    MISCELLANEOUS EXPENSES 1,228 0 0 661
    TELEPHONE EXPENSE 4,654 0 0 4,577
    CONTRIBUTED SERVICES 84,538 0 0 84,538


    TY 2021 OtherIncomeSchedule2
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    GRANT RECOVERIES 79,820   0


    TY 2021 OtherIncreasesSchedule
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Description Amount
    UNREALIZED GAINS & LOSSES 8,881,984


    TY 2021 OtherLiabilitiesSchedule
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Description Beginning of Year - Book Value End of Year - Book Value
    PAYABLE TO BLUE CROSS & BLUE SHIELD OF MISSISSIPPI 84,785 82,777
    DEFERRED FEDERAL EXCISE TAX LIABILITY 174,411 297,873


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    CONSULTING & PROFESSIONAL 51,070 0 0 64,175


    TY 2021 TaxesSchedule
    Name:
    BLUE CROSS & BLUE SHIELD OF
     
    MISSISSIPPI FOUNDATION
    EIN:
    20-0471034
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PAYROLL TAX 14,818 0 0 14,282
    EXCISE TAX - CURRENT 76,274 0 0 0
    EXCISE TAX - DEFERRED 123,462 0 0 0