2012-08-15T09:24:02-05:00 2011-09-30 DOEREN MAYHEW 755 W BIG BEAVER SUITE 2300 TROY MI 48084 990 2010-10-01 201452547 MACOMB HEALTH PLAN MACO 2486891340 18 MARKET STREET MT CLEMENS MI 48043 DARLENE VASI 2486891340 2012-08-15 1 2482443000 2010 2016-02-24 21:20:13Z JOSEPH BOEDEKER 18 MARKET STREET MT CLEMENS MI 48043 12330051 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. 6 6 0 0 0 0 0 0 10673365 12304516 47845 25535 40 0 10721250 12330051 0 0 0 0 0 0 0 0 0 12815342 13561418 12815342 13561418 -2094092 -1231367 8841990 6674104 1270343 333824 7571647 6340280 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 6356362 7249493 ADULT BENEFIT WAIVER PROGRAM 2466883 1890062 MACOMB COUNTY HEALTH PROGRAMS 3036348 2326372 "B" PROGRAM 1094515 838589 ONE/THIRD SHARE PROGRAM AND OTHER PROGRAM SERVICES 1094515 838589 12954108 1 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 6 6 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 48098 X THE HONORABLE JOSEPH BOEDEKER 1.00 X 0 0 0 THOMAS KALKOFEN 1.00 X 0 0 0 DAVID DIEGEL 2.00 X 0 0 0 ANGELO NICHOLAS 1.00 X 0 0 0 PETER PROVENZANO 1.00 X 0 0 0 BARBARA ROSSMANN 1.00 X 0 0 0 DARLENE VASI 40.00 X 0 0 0 0 0 0 0 0 0 0 MIDWEST HEALTH AKM INC 5050 SCHAEFER ROAD DEARBORN MI 48126 HEALTH SERVICES 7784170 COUNTY OF MACOMB 10 NORTH MAIN MT CLEMENS MI 48043 HEALTH SERVICES 2466364 MYCARE HEALTH CENTER 18 MARKET STREET MT CLEMENS MI 48043 HEALTH SERVICES 952760 MEDLOGISTICS INC 33796 CAPITOL LIVONIA MI 48150 HEALTH MANAGEMENT SERVICES 940614 MACOMB BLUE 18 MARKET STREET SUITE B MT CLEMENS MI 48043 HEALTH SERVICES 721878 5 ADULT BENEFITS WAIVER 624100 7249493 7249493 ICH-BASED DSH PAYMENTS 624100 5055023 5055023 12304516 25535 25535 12330051 12304516 0 25535 474000 474000 807 807 33519 33519 10000 10000 5098 5098 21918 2251 19667 104046 99672 4374 31936 31936 2819 2819 287 287 13078 13078 PHYSICIAN'S SERVICES 9197810 9197810 MACOMB COUNTY HEALTH PR 2466883 2466883 MEMBER INSURANCE PREMIU 721878 721878 DHS SERVICE CONTRACT 360000 360000 DIRECT CARE EXPENSES 105614 105614 11725 11725 13561418 12954108 607310 0 5124291 1903038 11491 132571 71113 99915 13435 7385 86480 3577743 4601982 8841990 6674104 970278 33740 300065 300084 1270343 333824 X 7571647 6340280 7571647 6340280 8841990 6674104 -1231367 0 X 0 1 1 X 0 X 10098928 9841278 10227427 10673365 12304516 53145514 10098928 9841278 10227427 10673365 12304516 53145514 0 0 0 53145514 455374 417408 64521 47845 25535 1010683 455374 417408 64521 47845 25535 1010683 7674 214 40 7928 10561976 10258900 10291948 10721250 12330051 54164125 0.98120 0.97500 0.01870 0.02490 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: OTHER INCOME LOCATED ON SCHEDULE A, PART III, SECTION B, LINE 12 IS MISCELLANEOUS REVENUE. 79957 667 79290 18522 11332 7190 1436 1436 0 86480 REQUIRED RESERVES 300084 300084 12330051 13561418 -1231367 0 -1231367 12330051 0 12330051 0 12330051 13561418 0 13561418 0 13561418 FORM 990, PART VI, SECTION A, LINE 3 MACOMB HEALTH PLAN ENGAGED MEDLOGISTICS TO PERFORM ADMINISTRATIVE AND MANAGEMENT SERVICES RELATING TO THE ADULT BENEFITS WAIVER PROGRAM. 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.