2011-08-15T16:01:05-05:00 2010-09-30 DOEREN MAYHEW 755 W BIG BEAVER SUITE 2300 TROY MI 48084 990 2009-10-01 201452547 Macomb Health Plan MACO 5867839355 18 Market Street Mt Clemens MI 48043 Darlene S Vasi 5867839355 2011-08-15 1 2482443000 2009 2016-02-24 21:20:13Z darlene vasi 18 market street mt clemens MI 48043 10721250 0 X www.macombhealthplan.org X 2004 MI TO CREATE A SYSTEM FOR PROVIDING OR ARRANGING HEALTH CARE SERVICES IN A COST EFFECTIVE MANNER FOR PERSONS UNABLE TO PAY FOR SUCH HEALTH CARE SERVICES. 7 7 0 0 0 0 0 10227427 10673365 64521 47845 40 10291948 10721250 0 0 0 0 0 10526391 12815342 10526391 12815342 -234443 -2094092 10223366 8841990 557627 1270343 9665739 7571647 to provide quality health care to individuals who are uninsured or under insured. 0 0 4886376 2013852 ADULT BENEFIT WAIVER PROGRAM 2713495 1118329 macomb county health programs 2562946 1056283 "b" program 2102597 866556 one/third share program and other program services 2102597 866556 12265414 1 0 0 0 0 0 0 0 0 1 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 1 3 0 0 0 0 0 0 0 0 0 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 3139193527 1942 hopedale troy MI 48098 X THE HONORABLE JOSEPH BOEDEKER 1.50 X 0 0 0 THOMAS KALKOFEN 1.50 X 0 0 0 DAVID DIEGEL 2.00 X 0 0 0 DONNA KOPINSKI 1.50 X 0 0 0 ANGELO NICHOLAS 1.50 X 0 0 0 SUSAN DOHERTY 1.50 X 0 0 0 BARBARA ROSSMANN 1.50 X 0 0 0 0 0 0 0 0 0 0 MIDWEST HEALTH AKM INC 5050 SCHAEFER ROAD DEARBORN MI 48126 HEALTH SERVICES 7219918 COUNTY OF MACOMB 10 NORTH MAIN MT CLEMENS MI 48043 HEALTH SERVICES 2713495 CUSTOMER SERVICE SOLUTIONS 25600 KELLY ROAD ROSEVILLE MI 48066 HEALTH computer SERVICES 1426901 MEDLOGISTICS INC 32540 SCHOOLCRAFT ROAD STE 210 LIVONIA MI 48226 HEALTH management SERVICES 870776 mycare health center 18 market street mt clemens MI 48043 health serVICES 500000 5 ADULT BENEFITS WAIVER 624100 5618345 5618345 ICH-BASED DSH PAYMENTS 624100 5055020 5055020 10673365 47845 47845 miscellaneous income 624100 40 40 40 10721250 10673405 0 47845 7941 7941 11347 11347 283 283 18937 3324 15613 114859 113247 1612 14635 14635 1772 1772 874 874 12544 12544 PHYSICIAN'S SERVICES 7219918 7219918 MACOMB COUNTY HEALTH PR 2713495 2713495 MEMBER INSURANCE PREMIU 1313654 1313654 FQAC expense 505000 505000 MANAGEMENT FEE 474000 474000 406083 396776 9307 12815342 12265414 549928 0 6541432 5124291 109697 132571 19958 12573 862 7385 3571375 3577743 10223366 8841990 257627 970278 300000 300065 557627 1270343 X 9665739 7571647 9665739 7571647 10223366 8841990 X 0 1 1 X 0 X 9561280 10098928 9841278 10227427 10673365 50402278 9561280 10098928 9841278 10227427 10673365 50402278 0 0 0 50402278 300667 455374 417408 64521 47845 1285815 300667 455374 417408 64521 47845 1285815 7674 214 40 7928 9861947 10561976 10258900 10291948 10721250 51696021 0.97500 0.97350 0.02490 0.02630 X Schedule A, Part II, Line 12, Explanation of Other Income: Miscellaneous Revenue 18522 11711 6811 1436 862 574 7385 REQUIRED RESERVES 300065 300065 10721250 12815342 -2094092 0 -2094092 10721250 0 10721250 0 10721250 12815342 0 12815342 0 12815342 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 form 990 will be reviewed by the board of directors prior to filing. Form 990, Part VI, Section B, line 12c annual conflict of interest statements are reviewed, signed, and filed by each board member. should their status change, a new form is completed. 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.