Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS ONE MEMBER, QSOURCE, AN AFFILIATED SEC. 501(C)(3) ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | QSOURCE OF ARKANSAS' BOARD OF DIRECTORS MAY ELECT AT LEAST FIVE AND NOT MORE THAN NINE CONSUMER REPRESENTATIVES AS DIRECTORS. THE BOARD OF DIRECTORS OF THE SOLE MEMBER APPOINTS TWO MEMBERS OF THE ORGANIZATION'S BOARD. THE ORGANIZATION MAY HAVE UP TO, BUT NOT MORE THAN ELEVEN BOARD MEMBERS. UP TO, BUT NOT MORE THAN FOUR PHYSICIAN DIRECTORS ARE ELECTED BY QSOURCE OF ARKANSAS' BOARD OF DIRECTORS, WITH NOMINEES FOR THESE POSITIONS BEING SOUGHT FROM THE ARKANSAS MEDICAL FOUNDATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN IS GIVEN TO THE CFO, VP-CORPORATE COMPLIANCE AND DEVELOPMENT, AND CONTROLLER OF THE ORGANIZATION'S AFFILIATED, NONPROFIT, PUBLIC BENEFIT CORPORATION, WHICH IS THE SOLE MEMBER OF THE ORGANIZATION, FOR REVIEW. THE RETURN IS REVIEWED IN CONSULTATION WITH QSOURCE OF ARKANSAS' EXECUTIVE DIRECTOR. ANY ISSUES NOTED THAT WOULD WARRANT ADDITIONAL REVIEW WOULD BE PRESENTED TO THE BOARD. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS CONTAINED IN THE ORGANIZATION'S BYLAWS AND REQUIRES ANY AFFECTED PERSON TO DISCLOSE ANY FINANCIAL INTEREST, AS DEFINED IN THE BYLAWS, THAT MIGHT BE A CONFLICT OF INTEREST. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. | |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION IS REVIEWED BY INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION'S AFFILIATED, NONPROFIT, PUBLIC BENEFIT CORPORATION, WHICH IS THE SOLE MEMBER OF THE ORGANIZATION. SALARY SURVEYS OF COMPARABLE ENTITIIES ARE CONSIDERED. DOCUMENTATION REGARDING THE PROCESS IS RETAINED. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| TO RELATED ORGANIZATION: | FORM 990, PART VII, SECTION A, ESTIMATE OF AVERAGE HOURS PER WEEK DEVOTED | NANCY ARCHER, THE EXECUTIVE DIRECTOR, WAS COMPENSATED BY QSOURCE OF ARKANSAS FOR PART OF THE YEAR AND BY QSOURCE, THE RELATED ORGANIZATION, FOR PART OF THE YEAR. SHE DEVOTES APPROXIMATELY 2 HOURS PER WEEK TO THAT ORGANIZATION. PATRICK BROWN IS CFO OF RELATED ORGANIZATION, QSOURCE. HE DEVOTES APPROXIMATELY 35 HOURS PER WEEK TO THAT ORGANIZATION. DAWN FITZGERALD, THE CEO, IS ALSO THE CEO OF RELATED ORGANIZATION, QSOURCE. SHE DEVOTES APPROXIMATELY 42.6 HOURS A WEEK TO THAT ORGANIZATION. EACH ORGANIZATION BEARS ITS SHARE OF THE COSTS UNDER A CORPORATE SERVICE AGREEMENT. |
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