Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| RELATED PARTY INFORMATION AMONG OFFICERS | FORM 990, PAGE 6, PART VI, LINE 2 | KEVIN JAMES KLOBUCAR, CPA JEFFREY CONNOLLY CEO & PRES DIRECTOR BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA SUSAN A. KLUGE CEO & PRES CFO & TREAS BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA JULIE C. SWANTEK CEO & PRES SECRETARY BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA MARC KESHISHIAN, MD CEO & PRES CMO BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA LAURIE WESTFALL CEO & PRES COO BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA KEVIN SEITZ CEO & PRES DIRECTOR BUSINESS RELATIONSHIP SUSAN A. KLUGE JULIE C. SWANTEK CFO & TREAS SECRETARY BUSINESS RELATIONSHIP SUSAN A. KLUGE JEFFREY CONNOLLY CFO & TREAS DIRECTOR BUSINESS RELATIONSHIP SUSAN A. KLUGE MARC KESHISHIAN, MD CFO & TREAS CMO BUSINESS RELATIONSHIP SUSAN A. KLUGE JEANNE H. CARLSON, CPA CFO & TREAS CEO & PRES BUSINESS RELATIONSHIP SUSAN A. KLUGE LAURIE WESTFALL CFO & TREAS COO BUSINESS RELATIONSHIP SUSAN A. KLUGE KEVIN SEITZ CFO & TREAS DIRECTOR BUSINESS RELATIONSHIP JULIA C. SWANTEK JEFFREY CONNOLLY SECRETARY DIRECTOR BUSINESS RELATIONSHIP JULIA C. SWANTEK MARC KESHISHIAN, MD SECRETARY CMO BUSINESS RELATIONSHIP JULIA C. SWANTEK JEANNE H. CARLSON, CPA SECRETARY CEO & PRES BUSINESS RELATIONSHIP JULIA C. SWANTEK LAURIE WESTFALL SECRETARY COO BUSINESS RELATIONSHIP JULIA C. SWANTEK KEVIN SEITZ SECRETARY DIRECTOR BUSINESS RELATIONSHIP JEFFREY CONNOLLY MARC KESHISHIAN, MD DIRECTOR CMO BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA MARC KESHISHIAN, MD CEO & PRES CMO BUSINESS RELATIONSHIP LAURIE WESTFALL MARC KESHISHIAN, MD COO CMO BUSINESS RELATIONSHIP KEVIN SEITZ MARC KESHISHIAN, MD DIRECTOR CMO BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA LAURIE WESTFALL CEO & PRES COO BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA KEVIN SEITZ CEO & PRES DIRECTOR BUSINESS RELATIONSHIP KEVIN SEITZ LAURIE WESTFALL DIRECTOR CMO BUSINESS RELATIONSHIP |
| CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION IS FORMED AS A NON-PROFIT STOCK CORPORATION WHOLLY OWNED BY BLUE CARE NETWORK OF MICHIGAN (TAX ID 38-2359234), A HEALTH-MAINTENANCE ORGANIZATION WHICH IS ORGANIZED AND EXEMPT UNDER INTERNAL REVENUE CODE SECTION 501(C)4. |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | THE ORGANIZATION'S STOCKHOLDER, BLUE CARE NETWORK OF MICHIGAN, MAY APPOINT TWO OF THE THREE BOARD DIRECTORS. BLUECAID'S MEMBERS ELECT THE REMAINING BOARD DIRECTOR. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | NO REVIEW WAS CONDUCTED BY THE GOVERNING BODY. THE CFO & TREASURER, SUSAN A. KLUGE, REVIEWS THE FORM 990 BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | EACH BOARD MEMBER AND CORPORATE OFFICER ANNUALLY COMPLETES A CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE. THE QUESTIONNAIRES ARE REVIEWED TO IDENTIFY ANY POSSIBLE CONFLICTS AND DETERMINE HOW TO RESOLVE THEM. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE COMPENSATION STRATEGY IS DESIGNED TO ENSURE THAT AN APPROPRIATE BALANCE EXISTS BETWEEN INTERNAL EQUITY CONSIDERATIONS AND MARKET COMPENSATION FACTORS AND PRACTICES. MARKET DATA FROM THIRD PARTY EXECUTIVE COMPENSATION SURVEYS AND INDEPENDENT COMPENSATION CONSULTANTS ARE USED TO DETERMINE THE PRESIDENT/CEO'S COMPENSATION. THE COMPENSATION RECOMMENDATIONS ARE REVIEWED BY BLUE CROSS BLUE SHIELD OF MICHIGAN'S (BCBSM) PERSONNEL AND COMPENSATION SUBCOMMITTEE. THE ORGANIZATION'S PRESIDENT/CEO IS ALSO AN OFFICER OF THE INDIRECT PARENT, BCBSM, AND AS SUCH, THE COMPENSATION MUST BE PRESENTED TO THE BCBSM EXECUTIVE COMMITTEE AND BCBSM BOARD OF DIRECTORS. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | THE COMPENSATION RECOMMENDATIONS FOR BLUECAID'S OFFICERS ARE REVIEWED AND APPROVED BY THE BLUE CROSS BLUE SHIELD OF MICHIGAN (BCBSM) PERSONNEL AND COMPENSATION SUBCOMMITTEE, THE BCN FINANCE COMMITTEE AND THE BCN BOARD OF DIRECTORS. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS - NO DOCUMENTS AVAILABLE TO THE PUBLIC. CONFLICT OF INTEREST POLICY - NO DOCUMENTS AVAILABLE TO THE PUBLIC. AUDITED FINANCIALS - AUDITED STATUTORY-BASIS FINANCIALS ARE AVAILABLE FROM THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS AND THE OFFICE OF FINANCIAL AND INSURANCE REGULATION. |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | OTHER CHANGES IN NET ASSETS OR FUND BALANCE INCLUDE UNREALIZED LOSSES ON INVESTMENTS OF 1,477 AND GRANTOR TRUST ACTIVITY OF 119,083. |
| ADDITIONAL INFORMATION | FORM 990, PART XII | FORM 990 IS FILED BASED ON THE GAAP METHOD OF ACCOUNTING. NO SEPARATE BASIS 2010 GAAP AUDITED FINANCIAL STATEMENTS WERE ISSUED. HOWEVER, THE GAAP TRIAL BALANCE, WITH ADDITIONAL STATUTORY BASIS ADJUSTMENTS, WAS UTILIZED BY THE INDEPENDENT AUDITORS AS A BASIS FOR THE ISSUED AUDITED STATUTORY-BASIS FINANCIAL STATEMENTS. |
| CHANGE IN FINANCIAL REVIEW PROCESS | FORM 990, PAGE 12, PART XII, LINE 2C | CONSISTENT WITH MICHIGAN INSURANCE CODE CHAPTER 10, SECTION 1005.3, THE BLUE CARE NETWORK OF MICHIGAN AUDIT COMMITTEE WAS DESIGNATED TO SERVE AS THE BLUECAID OF MICHIGAN AUDIT COMMITTEE IN 2010. |
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