Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | MDWISE MEDICAID NETWORK, INC., A NOT-FOR-PROFIT ENTITY, WAS FORMED BY HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY WHO CONTRIBUTED 50%, AND INDIANA UNIVERSITY HEALTH WHO CONTRIBUTED 50% OF THE CAPITAL REQUIRED FOR MDWISE MEDICAID NETWORK TO MEET ALL OF ITS OBLIGATIONS. |
| FORM 990, PART VI, SECTION A, LINE 4 | EFFECTIVE 1/3/18, BOTH MDWISE AND THE MDWISE MEDICAID NETWORK ADOPTED NEW CORPORATE BY-LAWS TO REFLECT THE MHC ACQUISITION OF MDWISE EFFECTIVE 1/1/18. SUBSEQUENTLY, IN MARCH OF 2018, THE MCLAREN INTEGRATED HMO GROUP WAS FORMED AND BECAME THE SOLE LEGAL OWNER OF MDWISE AND MDWISE MEDICAID NETWORK. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS MCLAREN INTEGRATED HMO GROUP. |
| FORM 990, PART VI, SECTION A, LINE 7A | MCLAREN INTEGRATED HMO GROUP, MDWISE'S SOLE MEMBER HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS |
| FORM 990, PART VI, SECTION A, LINE 8B | THIS QUESTION IS MARKED "NO" AS THERE WERE NO MEETINGS OF THE EXECUTIVE COMMITTEE DURING THE YEAR. THEREFORE, NO MINUTES WERE NEEDED. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS REVIEWED BY MDWISE'S PRESIDENT & CEO AND ALSO BY THE CFO PRIOR TO FILING. AS PART OF AN INTEGRATED HEALTH SYSTEM, THE PARENT BOARD ALSO REVIEWS THE FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH MDWISE BOARD MEMBER, OFFICER AND SENIOR MANAGEMENT EXECUTIVE COMPLETES THE MDWISE CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. THE BOARD CHAIR AND PRESIDENT/CEO REVIEW ALL COMPLETED FORMS TO IDENTIFY ANY POTENTIAL CONFLICTS. ANY IDENTIFIED POTENTIAL CONFLICT IS INVESTIGATED AND RAISED WITH THE INDIVIDUAL, AS APPROPRIATE, TO RESOLVE THE CONFLICT OR DETERMINE IF ANY ACTION IS NEEDED, UP TO AND INCLUDING, POSSIBLE REMOVAL FROM THE BOARD, OR OFFICER/SENIOR MANAGEMENT POSITION. ANY IDENTIFIED CONFLICTS ARE REPORTED TO THE FULL BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 15 | NO HAS BEEN ANSWERED TO LINES 15A & 15B, AS THE FILING ORGANIZATION REIMBURSES MDWISE FOR OFFICERS' COMPENSATION PURSUANT TO A MANAGEMENT SERVICES AGREEMENT. ALL OFFICERS OF MDWISE MEDICAID NETWORK, INC. ARE EMPLOYEES OF AN AFFILIATED ENTITY MDWISE, INC. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE PROVIDED UPON REQUEST. |
| FORM 990, PART VI, SECTION B, LINES 13 & 14: | MDWISE MEDICAID NETWORK HAS ADOPTED AND COMPLIES WITH ALL POLICIES ESTABLISHED BY ITS AFFILIATED COMPANY, MDWISE INC. |
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