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Gap Evaluation

The purpose of this form is for board members and management to rate the existing and optimal levels of board involvement for each strategic business activity on a scale of one to five. (One represents areas that are chiefly management’s responsibility, and five represents areas that are exclusively the board’s responsibility.) This exercise may surface gaps between where the board needs to be focused and where it is actually spending its time and resources.

1 – No Board Involvement
2 – Low Board Involvement
3 – Moderate Board Involvement
4 – High Board Involvement
5 – Exclusive Board Involvement
? – Not Applicable/Don’t Know

Strategy

Strategic direction

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Strategic plans

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Strategy implementation

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Comments

Operations

Product development

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Claims administration

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Marketing and sales

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Information technology

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Comments

Human resources & Organization

Leadership development

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Non-CEO executive compensation

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Human capital

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Organization

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Corporate culture

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Comments

Financial management

Financial strategy

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Capital structure

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Actual management of investments

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Major investments

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Financial reporting

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Comments

Risk Management

Enterprise risk management

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Ethical performance and compliance

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Audit

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Comments

External relations

Brand positioning and integrity

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Policyholder relations

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Legal and regulatory

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Other constituencies

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Comments

CEO effectiveness

CEO performance appraisal

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

CEO compensation

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

CEO succession

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Comments

Corporate governance

Board effectiveness

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Director selection

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Director assessment

Current level of Board involvement(Required)

1

2

3

4

5

?

Optimal level of Board involvement(Required)

1

2

3

4

5

?

Gap

Comments

Other

Other 1

Current level of Board involvement

1

2

3

4

5

?

Optimal level of Board involvement

1

2

3

4

5

?

Other 2

Current level of Board involvement

1

2

3

4

5

?

Optimal level of Board involvement

1

2

3

4

5

?

Other 3

Current level of Board involvement

1

2

3

4

5

?

Optimal level of Board involvement

1

2

3

4

5

?

General comments

Please provide any desired comments, especially on items with a gap of 3 or 4.

Name(Required)

Comments

This field is for validation purposes and should be left unchanged.

Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.