Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | JEFFREY PAWLOWSKI, BOARD MEMBER, AND MICHAEL RILEY, BOARD MEMBER, HAVE A BUSINESS RELATIONSHIP. BOARD MEMBERS CARL ERICKSON, RICHARD BARSOTTI, JOE HROMCO, KAREN CARNAHAN, AND PATRICIA PARKER OWN OR CONTROL ENTITIES THAT DO BUSINESS WITH FAMILYCARE, INC A RELATED ORGANIZATION TO FAMILYCARE HEALTH PLANS, INC. |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF FORM 990 IS PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING THE OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. |
| FORM 990, PART VI, SECTION C, LINE 19 | FAMILYCARE HEALTH PLANS, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 24E | OTHER MEDICAL AND HOSPITAL EXPENSES : PROGRAM SERVICE EXPENSES 2,576,541. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,576,541. OTHER PROFESSIONAL SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,840,479. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,840,479. ADMIN FEE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 571,135. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571,135. AGENTS COMMISSION : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 427,299. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 427,299. BAD DEBT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 74,137. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 74,137. REPAIRS AND MAINTENANCE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 67,482. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,482. POSTAGE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 45,158. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,158. PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 17,505. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,505. OTHER ADMINISTRATIVE EXPENSES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 10,306. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,306. DUES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 9,721. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,721. TRAINING : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 8,884. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,884. MEALS AND ENTERTAINMENT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,296. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,296. OTHER INSURANCE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,655. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,655. MISCELLANEOUS : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,031. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,031. BANK FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,272. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,272. TAX EXPENSE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 742. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 742. |
| FORM 990, PART XI, LINE 9: | INVESTMENT FROM FAMILYCARE, INC. 20,000,000. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS FOR OVERSEEING THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |