Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | Renown Health is the sole corporate member of Hometown Health Plan. | |
| Form 990, Part VI, Section A, line 7a | Renown Health, acting through its Board of Directors, appoints the members of the Board of Governors of Hometown Health Plan. | |
| Form 990, Part VI, Section A, line 7b | Renown Health must approve any merger, consolidation or dissolution of Hometown Health Plan, any borrowing in excess of $1 million in any fiscal year, and encumbrances of assets and certain other actions not in the ordinary course of business. | |
| Form 990, Part VI, Section A, line 8b | There was no committee during the year that had the broad authority to act on behalf of the board. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared by the organization's tax department with support from a certified tax preparer. The form is reviewed by the organization's Chief Accounting Officer and the Chief Financial Officer prior to the final Form 990 being sent to the board. The IRS Form 990, as filed with the IRS, is sent to each voting member of the Renown Health Board prior to filing. Along with the forms, the Renown Health board is provided with a narrative that explains the various parts of the Form and their content. | |
| Form 990, Part VI, Section B, line 12c | On an annual basis at or prior to the first regular meeting following the election of new board members, the members of the Hometown Health Plan Board are given an Annual Disclosure Statement. They are expected to perform a reasonable investigation into their business, financial, family or significant personal relationships to disclose any actual or potential conflicts of interest. If, in connection with a proposed transaction or arrangement involving a Renown Health entity, a board member discovers that an actual or possible conflict of interest has arisen that was not disclosed on the Annual Statement, then the board member must disclose the existence and nature of his or her financial interests to the remaining directors that are considering the proposed transaction or arrangement in a timely manner. If a board member discloses an actual or possible conflict of interest, the board member shall leave the board or committee meeting while the remaining board members discuss the financial interest. The remaining board members shall vote upon and decide whether a conflict of interest actually exists. If the remaining board members determine that a conflict does exist, then appropriate mearsures are taken to ensure the issue is addressed. | |
| Form 990, Part VI, Section B, line 15 | Renown Health's executive compensation is set by the Renown Health Compensation Committee. Members of this committee review and approve various employee pay practices and parameters, as well as compensation for the CEO and certain executives. The Compensation Committee is comprised of independent members of the Renown Health Board of Directors unrelated to and not subject to the control or undue influence of executives, with no material financial interest in transactions of the Company or any other perceived or actual conflicts of interest. The Compensation Committee members are appointed by the Chairman of the Renown Health Board of Directors. The Compensation Committee meets approximately five times per year. Meeting minutes are kept documenting the deliberations and decisions regarding the compensation arrangements. Total cash compensation for the organization's executives are targeted at competitive compensation levels, relative to market surveys of comparable healthcare organizations, based upon the level of performance required to achieve the targeted compensation levels. Base compensation and total cash compensation is reviewed at a minimum of every two years in comparison to the surveys for comparable businesses and responsibilities and adjusted as to maintain equity with the survey information. The Compensation Committee undertook the process outlined above for the fiscal year 2011 executive compensation. | |
| Form 990, Part VI, Section C, line 19 | Hometown Health Plan does not make its governing documents, conflict of interest policy, or financial statements available to the general public. | |
| Average hours per week | Form 990, Part VII, Column B | Jim Miller, President & CEO, serves this entity and all related entities a total of 60 hours per week. See Part VII for hours devoted to this entity. Dawn Ahner, CFO, serves this entity and all related entities a total of 60 hours per week. See Part VII for hours devoted to this entity. Allan Hanssen, Vice President, serves this entity and all related entities a total of 60 hours per week. See Part VII for hours devoted to this entity. |
| Changes in Net Assets or Fund Balances: | Form 990, Part XI, line 5: | Net unrealized gains on investments: 120,645. Increase in value of Statutory reserve Rounding |
| Audit Committee | Form 990, Part XI, Line 2b | Renown Health, the sole member of this entity has an audit committee that assumes responsibility for the consolidated audit and selection of the independent accountant. |
| Number of employees on W-3 | Form 990, Part V, Line 2a | Hometown Health Plan has its own employees, however, Renown Health, the parent organization, pays all compensation and employee benefit amounts under a common paymaster arrangement. The actual compensation of each employee is directly charged to their assigned entity. Salaries are reported on line 7 of Part IX. |
| Software ID: | |
| Software Version: |