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, PATRICIA PARKER, AND MICHAEL RILEY 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 4,490,549. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,490,549. OTHER PROFESSIONAL SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,807,145. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,807,145. AGENTS COMMISSION : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,303,651. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,303,651. ADMIN FEE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 839,285. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 839,285. PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 47,327. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,327. DUES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 46,295. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 46,295. OTHER INSURANCE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 38,303. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,303. BAD DEBT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 35,179. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,179. TRAINING : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 33,304. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,304. REPAIRS AND MAINTENANCE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 23,857. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,857. OTHER ADMINISTRATIVE EXPENSES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 8,542. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,542. MISCELLANEOUS : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 7,143. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,143. POSTAGE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,087. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,087. TAX EXPENSE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,200. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,200. MEALS AND ENTERTAINMENT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 569. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 569. BANK FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 350. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 350. |
| 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. |
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