2013-08-14T12:46:39-05:00 2012-09-30 382492570 DOEREN MAYHEW 305 WEST BIG BEAVER ROAD TROY MI 48084 990 2011-10-01 201452547 MACOMB HEALTH PLAN MACO 2486891340 18 MARKET STREET NO B MT CLEMENS MI 48043 PETER PROVENZANO 2486891340 2013-08-13 1 P00530005 2482443000 2011 2016-02-24 21:20:13Z JOSEPH BOEDEKER 18 MARKET STREET MT CLEMENS MI 48043 9078450 0 X WWW.MACOMBHEALTHPLAN.ORG X 2004 MI CREATE A SYSTEM FOR PROVIDING OR ARRANGING HEALTH CARE SERVICES IN A COST EFFECTIVE MANNER FOR INDIVIDUALS WHO ARE UNINSURED OR UNDER INSURED. 7 7 0 7 0 0 0 0 12304516 9055585 25535 22865 0 0 12330051 9078450 0 0 0 0 0 0 0 0 0 13561418 10661958 13561418 10661958 -1231367 -1583508 6674104 5864363 333824 1083218 6340280 4781145 X CREATE A SYSTEM FOR PROVIDING OR ARRANGING HEALTH CARE SERVICES IN A COST EFFECTIVE MANNER FOR INDIVIDUALS WHO ARE UNINSURED OR UNDER INSURED. 0 0 4995976 4000562 ADULT BENEFIT WAIVER PROGRAM 1884628 1885171 MACOMB COUNTY HEALTH PROGRAMS 1911780 1912331 "B" PROGRAM 1257158 1257521 ONE/THIRD SHARE PROGRAM AND OTHER PROGRAM SERVICES 1257158 1257521 10049542 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X DARLENE S VASI 2486891340 1942 HOPEDALE TROY MI 48085 X THE HONORABLE JOSEPH BOEDEKER 2.00 X 0 0 0 THOMAS KALKOFEN 2.00 X 0 0 0 DAVID DIEGEL 2.00 X 0 0 0 ANGELO NICHOLAS 2.00 X 0 0 0 PETER PROVENZANO 2.00 X 0 0 0 BARBARA ROSSMANN 2.00 X 0 0 0 DAMON SORENSON 2.00 X 0 0 0 0 0 0 0 0 0 0 MIDWEST HEALTH AKM INC 5050 SCHAEFFER ROAD DEARBORN MI 48126 HEALTH SERVICES 4965911 MYCARE HEALTH CENTER 18 MARKET STREET SUITE C MT CLEMENS MI 48043 HEALTH SERVICES 2246084 COUNTY OF MACOMB 10 NORTH MAIN MT CLEMENS MI 48043 HEALTH SERVICES 1910622 MEDLOGISTICS INC 33796 CAPITOL LIVONIA MI 48150 HEALTH MANAGEMENT SERVICES 611968 BLUE CARE NETWORK PO BOX 33608 DETROIT MI 482325608 HEALTH SERVICES 460154 5 ICA-BASED DSH PAYMENTS 624100 5055023 5055023 ADULT BENEFITS WAIVER 624100 4000562 4000562 9055585 22865 22865 9078450 9055585 0 22865 474000 474000 4862 4862 25351 25351 246 246 38557 1315 37242 41286 29482 11804 25995 25995 701 701 2988 2988 12796 12796 PHYSICIAN'S SERVICES 6774991 6774991 MACOMB COUNTY HEALTH PR 1884628 1884628 MEMBER INSURANCE PREMIU 460154 460154 BREAST AND CERVICAL CAN 365004 365004 550399 533968 16431 10661958 10049542 612416 0 1903038 1035381 11491 78186 71113 18081 81393 4136 86480 77257 4601982 4655458 6674104 5864363 33740 783134 300084 300084 333824 1083218 X 6340280 4781145 6340280 4781145 6674104 5864363 X -1583508 24373 X X 0 1 1 X 0 X 9841278 10227427 10673365 12304516 9055585 52102171 9841278 10227427 10673365 12304516 9055585 52102171 0 0 0 52102171 417408 64521 47845 25535 22865 578174 417408 64521 47845 25535 22865 578174 214 40 254 10258900 10291948 10721250 12330051 9078450 52680599 0.98900 0.98120 0.01100 0.01870 X 79957 2907 77050 1436 1229 207 77257 REQUIRED RESERVES 300084 300084 9078450 10661958 -1583508 24373 24373 -1559135 9078450 0 9078450 0 9078450 10661958 0 10661958 0 10661958 FORM 990, PART VI, SECTION A, LINE 3 MACOMB HEALTH PLAN ENGAGED MEDLOGISTICS TO PERFORM ADMINISTRATIVE AND MANAGEMENT SERVICES RELATING TO ALL SERVICES RENDERED BY MACOMB HEALTH PLAN. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE 990 IS PRESENTED TO THE BOARD OF DIRECTORS AT A BOARD MEETING AS AN ACTION ITEM. IT IS REVIEWED, OPEN FOR COMMENTS AND THEN FILED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY EACH BOARD MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT DISCLOSING ANY CONFLICT. DURING THE YEAR BOARD MEMBERS ARE ENCOURAGED TO DISCLOSE ANY NEW CONFLICT OF INTEREST THAT MAY ARISE. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: 24,373. FORM 990, PART XII, LINE 2C: WE HAVE A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. OUR PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.