Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| RELATED PARTY INFORMATION AMONG OFFICERS | FORM 990, PAGE 6, PART VI, LINE 2 | JEANNE H. CARLSON, CPA SUSAN A. KLUGE CEO & PRES CFO & TREAS BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA JULIA C. SWANTEK CEO & PRES SECRETARY BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA MARC C. KESHISHIAN, MD CEO & PRES CMO BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA LAURIE WESTFALL CEO & PRES COO BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA JULIE A. ANGOTT CEO & PRES DIRECTOR BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA KEVIN L. SEITZ CEO & PRES DIRECTOR BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA WILLIAM H. BLACK CEO & PRES DIRECTOR BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA GREGORY A. SUDDERTH CEO & PRES DIRECTOR BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA CALVIN T. RAPSON CEO & PRES DIRECTOR BUSINESS RELATIONSHIP JEANNE H. CARLSON, CPA MARK R. BARTLETT CEO & PRES DIRECTOR BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA SUSAN A. KLUGE CEO & PRES CFO & TREAS BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA JULIA C. SWANTEK CEO & PRES SECRETARY BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA MARC C. KESHISHIAN, MD CEO & PRES CMO BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA LAURIE WESTFALL CEO & PRES COO BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA JULIE A. ANGOTT CEO & PRES DIRECTOR BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA KEVIN L. SEITZ CEO & PRES DIRECTOR BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA WILLIAM H. BLACK CEO & PRES DIRECTOR BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA GREGORY A. SUDDERTH CEO & PRES DIRECTOR BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA CALVIN T. RAPSON CEO & PRES DIRECTOR BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA MARK R. BARTLETT CEO & PRES DIRECTOR BUSINESS RELATIONSHIP SUSAN A. KLUGE JULIA C. SWANTEK CFO & TREAS SECRETARY BUSINESS RELATIONSHIP SUSAN A. KLUGE MARC KESHISHIAN, MD CFO & TREAS CMO BUSINESS RELATIONSHIP SUSAN A. KLUGE LAURIE WESTFALL CFO & TREAS COO BUSINESS RELATIONSHIP SUSAN A. KLUGE JULIE A. ANGOTT CFO & TREAS DIRECTOR BUSINESS RELATIONSHIP SUSAN A. KLUGE KEVIN L. SEITZ CFO & TREAS DIRECTOR BUSINESS RELATIONSHIP JULIA C. SWANTEK MARC KESHISHIAN, MD SECRETARY CMO BUSINESS RELATIONSHIP JULIA C. SWANTEK LAURIE WESTFALL SECRETARY COO BUSINESS RELATIONSHIP JULIA C. SWANTEK JULIE A. ANGOTT SECRETARY DIRECTOR BUSINESS RELATIONSHIP JULIA C. SWANTEK KEVIN L. SEITZ SECRETARY DIRECTOR BUSINESS RELATIONSHIP MARC KESHISHIAN, MD LAURIE WESTFALL CMO COO BUSINESS RELATIONSHIP MARC KESHISHIAN, MD JULIE A. ANGOTT CMO DIRECTOR BUSINESS RELATIONSHIP MARC KESHISHIAN, MD KEVIN L. SEITZ CMO DIRECTOR BUSINESS RELATIONSHIP LAURIE WESTFALL KEVIN L. SEITZ COO DIRECTOR BUSINESS RELATIONSHIP JULIE A. ANGOTT KEVIN L. SEITZ DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KEVIN L. SEITZ WILLIAM H. BLACK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KEVIN L. SEITZ GREGORY A. SUDDERTH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KEVIN L. SEITZ CALVIN T. RAPSON DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KEVIN L. SEITZ SHAUNA RYDER DIGGS, MD DIRECTOR DIRECTOR BUSINESS RELATIONSHIP WILLIAM H. BLACK GREGORY A. SUDDERTH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP WILLIAM H. BLACK CALVIN T. RAPSON DIRECTOR DIRECTOR BUSINESS RELATIONSHIP GREGORY A. SUDDERTH CALVIN T. RAPSON DIRECTOR DIRECTOR BUSINESS RELATIONSHIP GREGORY A. SUDDERTH MARK R. BARTLETT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP JEANNE H. CARLSON CPA MELVIN LARSEN CEO & PRES DIRECTOR BUSINESS RELATIONSHIP KEVIN JAMES KLOBUCAR, CPA MELVIN LARSEN CEO & PRES DIRECTOR BUSINESS RELATIONSHIP MELVIN LARSEN MARK R. BARTLETT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP MELVIN LARSEN CALVIN T. RAPSON DIRECTOR DIRECTOR BUSINESS RELATIONSHIP MELVIN LARSEN WILLIAM H. BLACK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP MELVIN LARSEN GREGORY A. SUDDERTH DIRECTOR DIRECTOR BUSINESS RELATIONSHIP MELVIN LARSEN KEVIN L. SEITZ DIRECTOR DIRECTOR BUSINESS RELATIONSHIP MARK R. BARTLETT CALVIN T. RAPSON DIRECTOR DIRECTOR BUSINESS RELATIONSHIP MARK R. BARTLETT WILLIAM H. BLACK DIRECTOR DIRECTOR BUSINESS RELATIONSHIP KEVIN L. SEITZ MARK R. BARTLETT DIRECTOR DIRECTOR BUSINESS RELATIONSHIP |
| CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PAGE 6, PART VI, LINE 6 | 100% STOCKHOLDER: BLUE CROSS BLUE SHIELD OF MICHIGAN |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | BLUE CROSS BLUE SHIELD OF MICHIGAN IS A 100% STOCKHOLDER AND HAS THE RIGHT TO APPOINT BOARD DIRECTORS. BCN'S MEMBERS ELECT THE REMAINING BOARD DIRECTORS. |
| 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 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 BLUE CARE NETWORK'S OFFICERS ARE REVIEWED AND APPROVED BY THE BLUE CROSS BLUE SHIELD OF MICHIGAN (BCBSM) PERSONNEL AND COMPENSATION SUBCOMMITTEE AND BY THE BLUE CARE NETWORK'S BOARD OF DIRECTORS. COMPENSATION RECOMMENDATIONS FOR BLUE CARE NETWORK'S KEY EMPLOYEE EXECUTIVES ARE REVIEWED AND APPROVED BY THE BCBSM PERSONNEL AND COMPENSATION SUBCOMMITTEE AND REQUIRES ACTION FROM THE BLUE CARE NETWORK OF MICHIGAN 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 GAINS ON INVESTMENTS OF 1,294,205, CONSOLIDATED SUBSIDIARIES BOOK NET INCOME OF 1,165,753, MALPRACTICE TRUST NET INCOME OF (5,063,397) AND STOP-LOSS TRUST NET INCOME OF (5,128,100). |
| 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. |
| Software ID: | |
| Software Version: |