Supplier Diversity Form

Why is Blue Cross and Blue Shield of Kansas requesting this information? As Blue Cross and Blue Shield of Kansas (BCBSKS) is committed to the values of diversity, equity and inclusion, we are interested in creating opportunities for diverse businesses while maintaining a competitive environment.

We are developing strategies to support our company as well as our economy by encouraging the inclusion of businesses owned and controlled by diverse individuals in our contracting and procurement processes.

If you are interested in doing business with BCBSKS, please complete and submit this form to register your business. Also note that identifying your diverse classification is voluntary, yet would be very valuable in our efforts to make connections and build a great partnership with your business as we explore opportunities.

If an opportunity related to your business activity becomes available, you may be contacted for additional information.

Please note that by completing this form, you are not guaranteed bids or contracts with BCBSKS.

Company Data




Note: If your tax number is your Social Security Number (SSN), please leave this line blank. You will be contacted by an authorized representative of BCBSKS if we require your SSN.













Business Structure


Business Category

Check all that apply.

Primary Business Activity

Business Classification Type

Check all that apply. See classification definitions at right.below.

Business Certification


If yes, identify which entity certified your business. Check all that apply.

Provide details of your certification(s) below.


Classifications & Definition of Terms

Alaska Native Corporation (ANCs) means any Regional Corporation, Village Corporation, Urban Corporation, or Group Corporation organized under the laws of the State of Alaska in accordance with the Alaska Native Claims Settlement Act, as amended (43 U.S.C. 1601, et seq.) and which is considered a minority and economically concern under the criteria at 43 U.S.C. 1626 (e) (1). This definition also includes ANC direct and indirect subsidiary corporations, joint ventures, and partnerships that meet the requirements of 43.U.S.C. 1626 (e) 2. FAR 19.701.

Disability Owned Business Enterprise (DOBE) means a for-profit business that is at least 51% owned, managed, and controlled by a person (s) with a disability regardless of whether or not that business owner employs person(s) with a disability. Disability.org

Disadvantaged Business Enterprise (DBE) means a for-profit small business where socially and economically disadvantaged individuals own at least a 51% interest and also control and manage daily business operations and must be U.S. citizens or lawful permanent residents. Those presumed to be socially disadvantaged, are African Americans, Hispanics/Latine, Native Americans, Asian-Pacific Americans, Subcontinent Asian Americans, and Women. Other individuals can qualify if they show by a preponderance of the evidence that they are socially disadvantaged. To be regarded as economically disadvantaged, an individual’s personal net worth cannot exceed $1.32 million. This amount excludes the values of the applicant’s ownership interest in the business seeking certification and the owner’s primary residence. To be viewed as a small business, a firm must meet the U.S. Small Business Administration (SBA) size criteria (13 CFR, Part 121 & 124) and average annual gross receipts, over the previous 3 years must not exceed the DBE size limit. A DBE must receive certification from the relevant state. 49 CFR Part 26.

8(a) Small Business means a certification that is intended for small businesses that are at least 51% owned and controlled by U.S. citizens who are economically and socially disadvantaged. SBA considers African Americans, Hispanic/Latine Americans, Asian Pacific Americans, Native Americans, and Subcontinent Asian Americans to be socially and economically disadvantaged. Additionally, the owner (s) must manage day-to-day operations, make long-term decisions, and have a personal net worth that is less than $850,000 and adjusted gross income of $400,000 or less and assets totaling $6.5 million or less. 13 CFR Part 124.

HUBZone means a Historically Underutilized Business located in a zone, typically economically distressed areas, identified by the SBA. A HUBZone Small Business means a small business that meets the requirements that SBA has certified as eligible for federal contracting assistance under the HUBZone program. HUBZone businesses must meet the following criteria: must be a small business according SBA Size standards; be at least 51% owned and controlled by U.S. citizens or at least 51% owned by a Community Development Corporation, an agricultural cooperative, an Alaska Native corporation, a Native Hawaiian organization, or an Indian tribe. Its principal office must be located in a HUBZone and have at least 35% of its employees living in a HUBZone. To obtain HUBZone status the business must be certified as such by the (SBA). 13 CFR Part 126.

Indian Tribes means any Indian tribe, band, group, pueblo, or community, including native village and native groups (including corporations organized by Kenai, Juneau, Sitka, and Kodiak) as defined in the Alaska Native Claims Settlement act (43 U.S.C. 1601 et seq.), that is recognized by the Federal Government as eligible for services form the Bureau of Indian Affairs in accordance with 25 U.S.C. 1452 (c). This definition also includes Indian-owned economic enterprises that meet the requirements of 25 U.S.C. 1452 (e). FAR 19.701.

LGBTQIA+ Owned Business (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual. “+” stands for all the other identities not encompassed in the acronym) means a business that is at least 51% owned, operated, managed, and controlled by a person or persons who identify as part of the LGBTQIA + community. They are either a U.S. citizen or lawful permanent resident. The business must operate independently from any non-LGBTQIA+ business enterprise. The business is headquartered and has been formed as a legal for-profit entity in the United States. Third party certification is issued exclusively by the National Gay & Lesbian Chamber of Commerce (NGLCC).

Large Business Enterprise (LBE) means a business that exceeds the small business size code standards established by SBA as set forth in Code of Federal Regulations, Title 13, Part 121. The federal government looks at a company’s average annual receipts or the average number of employees over a three-to-five-year period.
Local Business means any business that is owned, operated, and located in the State of Kansas that provides goods or services to a local population in Kansas.

Small Business Enterprise (SBE) means a small business, including its affiliates, is independently owned and operated, is not dominant in the field of operation, and does not exceed the size standard for the product or service it is providing as measured by its employment and/or business receipts in accordance with the SBA small business size standards as prescribed by SBA 13 CFR Part 121 and 13 CFR Part 121.410.

Minority Business Enterprise (MBE) means a business that is at least 51% owned, managed, and controlled daily by one or more minority group members who are U.S. citizens or lawful permanent residents: Asian-Indian, Asian-Pacific, Black, Hispanic/Latine, or Native-American. (NMSDC.org). Additional requirements may be required dependent on who is issuing the certificate of certification. For example, some states or agencies may require a minority-owned business to be a small business.

Woman Business Enterprise (WBE) means a business that is at least 51% owned, operated, and controlled daily by one or more woman or women who are U.S. citizens or lawful permanent residents. FAR 52-219-8. Additional requirements may be required dependent on who is issuing the certificate of certification. For example, some states or agencies may require a woman-owned business to be a small business.

Service-Disabled Veteran Business Enterprise (SDVBE) means a small business concern that is at least 51% owned and controlled by a Service-Disabled Veteran (s), as defined in section 3(q) of the Small Business Act (15 U.S.C. 632(q)) and SBA’s implementing Service-Disabled Veteran Owned Small Business (SDVOSB) Program Regulations (13 CFR Part 128.200). A Service-Disabled Veteran is a person who served in the active military, naval, air or space service, and who was discharged or released under conditions other than dishonorable, and whose disability was incurred or aggravated in line of duty in the active military, naval, air or space service. (38 USC 101 (16). In the case of permanent or severe disability, the spouse or caregiver of such a service-disabled veteran may control the management and daily operations. 13 CFR Part 128.200.

Veteran-Owned Small Business (VOSB) means a business that is at least 51% owned by one or more veterans of the U.S. Armed Forces. Must be considered a small business as defined by the SBA size standard Title 13 Part 121. The veteran (s) must be in control and in charge of the company’s direction and daily management. The term “Veteran” means a person who served in the active military, naval or air service and who was discharged or released there from under conditions other than dishonorable. 38 USC 101 (2).

Supplier Diversity Form Submitted

Thank you for taking the time to register your business. We are glad that you have an interest in working with us, and we hope to have an opportunity to connect with you soon. If you have any questions, please email us at [email protected].