Please complete the accrual form monthly and submit to Budgets & Analysis (B&A):

I. This form should be submitted to your Budget Analyst on the 1st workday of the month following the closing month. Closing Month Due Date Jan-11 2/1/2011 Feb-11 3/1/2011 Mar-11 4/1/2011 Apr-11 5/2/2011 May-11 6/1/2011 Jun-11 7/1/2011 Jul-11 8/1/2011 Aug-11 9/1/2011 Sep-11 10/3/2011 Oct-11 11/1/2011 Nov-11 12/1/2011 Dec-11 1/3/2012 This form should be completed if your cost center has incurred expenses (over $10,000): - for goods received or services performed during or prior to the month for which an invoice has been submitted late in the month and may not get paid before the month end; or - for services for which you have not yet received an invoice. III. Definition of each of the column in the form. Col A B C D E F G H I J Column Heading Account No. Department No. Amount Vendor Name Purchase Order Number Invoice Number or Other Sources Date of Invoice Type of Merchandise or Service Period Service Covered Project Code Definition Always a 6-digit number beginnng with "6". For example, 625600 for professional services. Also, refer to the Operating Account Listing available in the Budgets & Analysis in fyiblue. Always a 6-digit number beginnng with "0" for IL dept; "5" for TX; "2" for NM & "4" for OK. For example, 000551. Actual amount of invoice, if available. Use estimate, if no invoice is available. Name of vendor that rendered the service or which we received goods from. Complete this if PO # is available. If available, then provide the invoice #. If no invoice is available and estimate is used, then state that this is an estimate and provide basis of the estimates; such as, last month's invoice. Indicate type of service - eg. consulting, maintenance, license; or type of merchandise. Indicate the period the service is for. For example, the maintenance period is 3/09 - 12/09. Complete only if this is applicable. The Projects tab in this file provides a complete list of active project numbers and names. Refer to this tab for the correct project name before selecting the project code from the drop down listing available in this column.

II.

IV. Once the form is completed, send (via email or fax) it to the Budget Analyst responsible for your division. Appropriate accruals will be made to your cost center so that a more accurate accounting for the month would be made. A listing of the Budget Analysts is available in the B&A website in fyiblue. The fax # for your Budget Analyst is 312-819-9459.

Accrual Form Report of Unpaid Charges for Merchandise and or Services Received As of June, 2011
Due to Budgets & Analysis Dept: Budget Analyst Name: July 1, 2011 Angela Fuller Prepared By: Lucy Mendoza Date: 7/1/2011 Phone: 312 653 4607 Manager or Authorized Designee Signature: * Maurice Smith

Subject: Month-end Accruals

Purpose:

* If accrual form is sent via email, then cc head should be copied.

Please select a project code using the drop down menu starting in Cell J16. You can refer to the "Project Code Reference" tab to obtain a valid project code. Any questions contact: Cori Pierre-Auguste at 8-653-5359

List below those expenses (over $10,000 per item) that were incurred (goods received or services performed) prior to June 30, 2011, but due to timing, a check is not anticipated to be issued by the end of the month. Documentation, such as invoice or Statement of Work or basis of estimates, must accompany each entry on this sheet and be returned by July 1, 2011.

Instructions: Complete the form below with appropriate information. Email the completed form to your respective Budget Analyst. Mail or fax the necessary backup (copy of invoices, etc) to your respective Budget Analyst. See Instructions tab for further assistance. A B C D E F G H

Account No. 625900

Department No. 000663

Amount

Vendor Name

Purchase Order Number

Invoice Number or Other Source of Document Date of Invoice

$305,459.00 Ernst & Young

Type of Merchandise or Service Progress billing 2010 Audit HCSC FS

Period Service Covered thru June 2011

Project Code (Complete only if applicable)

Project ID
F060029 F060030 F060031 F060800 F070001 F070002 F070003 F070004 F070005 F080001 F080002 F080011 F080012 F080013 F100001 F100002 F100003 F100004 IE10200 IE10201 IE10202 IE10204 IE10206 IE10207 IE10209 IE10211 IE10212 IE10215 IE10219 IE10220 IE10234 IE10235 IE10236 IE10237 IE10501 IE10509 IE10511 IE10512 IE10513 IE10519 IE10528 IE10533 IE10900 IE10910 IE10920 IE10930 IE11201 IE11204 IE11205 IE11206 IE11212 IE11213 IE11216 IE11219 IT09016 IT10003 IT10015 IT10016 IT10025 IT10033 IT10038 IT10040 IT10042 IT10045 IT10047 IT10048 IT10050 IT10052 IT10054 IT10200 IT10204 IT10208 IT10212 IT10213 IT10216

Project Name
Richardson - Campbell Road Quincy Expansion Texas Headquarters Vertical Expansion Amarillo Temp Training 111 E. Wacker additional space Downers Grove Additional Space Texas OSC Shiloh Road Tulsa FSU Chicago OSC Expansion CDC2 - Corporate Data Center2 UPS Replacement Springfield V Expansion Hallmark Relocation Technical Infras Dev & Exp (TIDE) Team Fitness Center Build Out Behavioral Health Build Out DNoA Relocation Wintel Server Growth & Obs Open Systems Growth & Obs Distributed SW Utility Labor Fund Growth & Obsolescence Distributed Storage - Replaces Tape Media Websphere Tool Growth & Obs WEB Verisign Lic & Soman Renewals 2010 RSA Tokens NIDS/NIPS Desktop Software Sales Force Automation License ECM Infrastructure-Content Management PC/LAPTOP Infoprint Solutions Upgrade BlueCoat EMC Emailxtender & Diskxtender Hardware File and Print Obs Mainframe VSM Growth Waukegan SAN Storage Growth Waukegan TSM Growth LDAP Server Growth WAS Pivot Environment (SAN) Waukegan SAN Storage Replac FDL Hallmark DNoA MEDecision IS Risk Assessment/Threat Management Tool NetQos Additional Licenses Work From Home Routers Desktop Refresh Hardware File and Print Enterasys Switches RSA Token Replacement Distributed Storage - Replaces PowerBuilder/Magna X Modernization Change AMU/SRE Implement ECM for Client Ops Image Area Front-end 2010 BA Reporting Needs Pre Screen Process Large Group Pricing Adjustments - November Release MEDecision - Legacy Medical Village Production Dashboard for API Comm Goal #11 Blue Access for Producers Redesign Automating Test Scripts on HP Quality Center BAE Auto Registration BIS THRU-PUT MEDICARE Southwest Region Quick Quotes Requirements Phase Alternative Provider Payment Models BCC Market Segmentation Strategy Assessment GO Lan Telecomm Refresh GO LMS GO Help Desk Toolset GO Data Stage Upgrade GO Cognos v8.4 Upgrade Database Monitoring Tool - Distributed

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Project ID
IT10219 IT10225 IT10226 IT10233 IT10236 IT10242 IT10243 IT10245 IT10505 IT11212 IT11213 IT11214 IT11501 IT11502 IT11701 IT11702 IT11703 IT11704 L000001 Z030005 Z050014 Z050046 Z050048 Z050049 Z060030 Z070007 Z080011 Z080027 Z080032 Z080033 Z090001 Z090004 Z090008 Z090009 Z090010 Z090011 Z090017 Z090018 Z090020 Z090022 Z090023 Z090025 Z090039 Z090040 Z090047 Z090049 Z090055 Z090057 Z090061 Z090062 Z100001 Z100002 Z100003 Z100005 Z100006 Z100007 Z100010 Z100011 Z100012 Z100013 Z100016 Z100017 Z100020 Z100021 Z100023 Z100024 Z100025

Project Name
GO IRIS Decommissioning GO Premier Provider Simplification DB2 Upgrade v9.1 LUW Databases Physical Topology Creation Tool GOI YE 2010 ESB/BPM GO ACR & Insight GOI - 2010 YE Future State Skillset Agent Monitor for Lotus Domino Ariba Release 9r1 Wireless LAN Site Survey GOI - Rad to Eclipse Migration GOI - People Tools Upgrade Host Transition Claims Processing Analytics Association BlueSquared 4.4 IL Performing Provider Billing Bahavioral Health Enhancements Identification of Alternate Provider Networks Federal Lobbying Activity Amarillo FSU Texas Commissions CCSP Program Execution OSC East Loop Build Out Reengineer Labor CCSP DB2 Conversion Blue Access Employers Redesign Behavioral Health Shared Accum EFT ERA Phys Separating Test from Prod EPP Implementation Phase I CCSP-BRM CCSP-Contract and Benefit Dete ANSI 5010 BCC Commercialization ASO Bill Presentment ITG DCII Application Remediation ITG DCII Infrastructure ITG DCII Strategic & Operation Gov ITG DCII DR Security ITG DCII Operations Hallmark Modernization Assessment COBRA Mental Health Parity McKesson ClaimsXten Enterprise Appeals Specialty Pharmacy BAM Strategy Assessment Web Strategy IT Foundation Web Strategy Retail and Reform CCSP IT Foundation CCSP Patient Select CCSP Retire DDE Mainline CCSP Pre Eligibility - PRAP Alineo Implementation EPP 2010 Ent Benefit Simplification TMG Waukegan Data Center Dental Call Center Expansion IL Facility Discount Systems Electronic Records Management Secure Provider Portal Mobile & Cross Channel Assessment HCRIT - Program Governance Distributed Source Control Methodology Web Fundamentals ITG DCII - Testing ICD - 10 Requirements Case

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Project ID
Z100026 Z100027 Z100028 Z100029 Z100030 Z100032 Z100033 Z100034 Z100035 Z100036 Z100037 Z100039 Z100040 Z100041 Z100042 Z100044 Z100045 Z100046 Z100047 Z100048 Z100049 Z100050 Z100051 Z100052 Z100054 Z100055 Z100056 Z110002 Z110003 Z110004 Z110005 Z110006 Z110007 Z110008 Z110009 Z110012 Z110013 Z110014 Z110015 Z110017 Z110018 Z110019 Z110020 Z110021 Z110022 Z110025 Z110029 Z110030 Z110032 Z110033 Z110038 Z110039 Z110041 Z110042 Z110043 Z110044 Z110045 Z110046 Z110047 Z110048 Z110049 Z110050 Z110051 Z110052 Z110053 Z110054 Z110055 Z110056 Z110057 Z110058 Z110059 Z110060 Z110061 Z110062 Z110063 Z110064 Z110065 Z110066 Z110067

Project Name
HCRIT - Government HCRIT - Patient Protections HCRIT - Financial HCRIT - Commercialization HCRIT - SSD Operations Web Strategy Special Beginnings Enterprise Print Assessment HCRIT - Financial Phone Bill Member IVR Teradata Optimization Enterprise Gateway Program Financial Automation-IL Small Group Mobile Implementation Cash Receipts Optimization Retail Notepad & Application Redesign Consumer Markets Future State Call Center Platform Enterprise Provider Finder Portal & Secure Site Content Management Web Service Exchange Retail Kiosk Pilot Integrated Channel
CCSP Duplicate Check CCSP Initial Mouse Replacement & PWBS GUI CCSP Inquiry

Desktop and Virtualization Medication Therapy Management BCC Integrated Service Delivery Model Inquiry Reporting Assessment Large GroupPricing Adj Part 1 Health Care Disparities Assessment BA-MQ WF to Websphere Process Server IPPA Plan Codes / Zip Codes Administrative Simplification 270/271 SCP Labor Benefits CDHP Process & Technical Improvements Labor Web Site Security Advocate Health Care 80-10-10 PA 096-0857 IL Small Group App SFA 3.9 Release Workflow Change for BIT 95 Ent Credentialing Nested Facil TriWest Healthcare Alliances Adjustments to Non-Pursue RFCR Blue Distinction Additional RTB Provision field Accommodate BCA Never Events BIS Thruput Member Eligibility Benefit Contract Notification Lotus Notes to Right Fax FEP Streamlining Assessment Websphere - DB2 Client Patch NetWare to Linux Migration Enterprise Authentication CICS Transaction Server V4.1.0 Exec Dashboard Key Perf Metric Southwest Region Reporting Packaging Employer Communication Enhancing the Member Experience (Member Profile III) Competitive Position of BCC HCRIT-Risk Adjustment HCRIT-Rating System Consolidation HCRIT-Data Collection HCRIT-Exchange Readiness HB 1342 FEP Streamline Availity Clinical Exchnage EMS Reliability Center of Excellence Texas Medicaid RFP Service Portfolio Management Enterprise Pharmacy for the Bridge Period HIT - Village Health, Health Information Exchange Opportunity PAD - Nuance SOW Enterprise Print Strategy Cash Forecasting Web Fundamentals Phase 2 CM Sales Call Center Blue Access for Members - Redesign Phase I Optim IL Facility Discount System Technology Refresh

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