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BlueCross BlueShield of Tennessee is a not-for-profit organization and the state's leader in health care solutions. Founded more than 60 years ago, the company and its subsidiaries provide a comprehensive range of group and individual health insurance plans, products and services to more than 5 million people. In 2007, BlueCross BlueShield of Tennessee paid $17.4 billion in health care benefits, while employing more than 4,500 people. BlueCross BlueShield of Tennessee is licensed by the BlueCross BlueShield Association to offer certain products and services under the BlueCross and BlueShield names. BlueCross BlueShield of Tennessee is an independent organization governed by its own board of directors, and it is responsible for its own obligations. In 2007, the company achieved a net gain of $173 million, with pre-tax investment earnings of $102 million. The company incurred more than $155 million in federal, state and local tax expenses, an increase of $39 million over 2007. In addition to its primary license, BlueCross BlueShield of Tennessee also owns and operates key subsidiaries, including Volunteer State Health Plan, Inc., a licensed HMO affiliate for BlueCross BlueShield of Tennessee; Group Insurance Services, Inc., an insurance agency for ancillary and flexible benefit programs; Southern Diversified Business Services, Inc.; Riverbend Government Benefits Administrator, a Part A Intermediary under the Medicare program; Shared Health, Inc., a health information technology firm; and Gordian Health Solutions, a population health management company. BlueCross BlueShield of Tennessee has established Southern Health Plan, Inc., a licensed, controlled affiliate 501c (4) organization doing business as the BlueCross BlueShield of Tennessee Community Trust, with the purpose of improving the quality of health in Tennessee, and the Tennessee Health Foundation, a licensed, controlled affiliate 501c (3) organization that promotes the philanthropic mission of BlueCross BlueShield of Tennessee. Group Insurance Services, Inc., doing business as Q2HR Workforce Solutions, off ers HR support services to employers. BlueCross BlueShield of Tennessee, doing business as RiverTrust Solutions, provides service as a Qualified Independent Contractor for the Centers for Medicare & Medicaid Services.