Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| BUSINESS RELATIONSHIPS | FORM 990, PART VI, SECTION A, LINE 2 | CURT KRETZINGER, JOHN WILSON, AND DOUGLAS BRANDT HAVE A BUSINESS RELATIONSHIP. THEY ARE OFFICERS OR DIRECTORS OF MIDWESTERN HEALTH MANAGEMENT, INC., HHS PROPERTIES, INC., COMMUNITY HEALTH PLAN, OR COMMUNITY HEALTH PLAN INSURANCE COMPANY. CURT KRETZINGER, JOHN WILSON, MICHAEL PULIDO, DOUGLAS BRANDT, AND PHILIP FRACICA, MD, HAVE A BUSINESS RELATIONSHIP. THEY ARE ALL OFFICERS AND EMPLOYEES OF HEARTLAND REGIONAL MEDICAL CENTER. |
| REVIEW PROCESS OF FORM 990 | FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES THE RETURN. IT IS THEN REVIEWED BY THE TRUSTEES. AFTER REVISIONS, IF NECESSARY, THE TRUSTEES AGAIN REVIEW THE FINAL RETURN. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | ALL TRUSTEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY AND THE APPLICABLE CONFLICT OF INTEREST DISCLOSURE FORM AND QUESTIONNAIRE, WHICH IS COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES WITH RESPECT TO WHICH IT IS BELIEVED A CONFLICT MAY ARISE. EACH TRUSTEE IS ASKED TO DISCLOSE FULLY AND FRANKLY ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS OR DUALITY OF INTEREST OR RESPONSIBILITY, WHETHER PERSONAL, INDIVIDUAL OR BUSINESS, WHICH MAY EXIST OR APPEAR TO EXIST. A DUALITY OF INTEREST BECOMES A CONFLICT OF INTEREST ONLY IF THE DISINTERESTED TRUSTEES DECIDE THAT A CONFLICT OF INTEREST EXISTS BECAUSE THE DUALITY OF INTEREST IS SO SUBSTANTIAL THAT IT COULD COMPROMISE OBJECTIVE DECISION-MAKING OR COULD OTHERWISE BE DETRIMENTAL TO THE EXEMPT STATUS OR FINANCIAL WELL-BEING OF THE PLAN. |
| GOVERNING DOCUMENTS | 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. PLAN DOCUMENTS ARE PROVIDED TO ALL EMPLOYEE PARTICIPANTS. |
| NET ASSET RECONCILIATION | FORM 990, PART XI, LINE 5 | NET UNREALIZED LOSS ON INVESTMENT $(926) |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:CURT KRETZINGER TITLE:TRUSTEE HOURS:59 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:JOHN P WILSON TITLE:TRUSTEE HOURS:59 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MICHAEL PULIDO TITLE:TRUSTEE HOURS:59 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:DOUGLAS BRANDT TITLE:TRUSTEE HOURS:59 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:PHILIP FRACICA, MD TITLE:TRUSTEE HOURS:59 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MOHAN HINDUPUR, MD TITLE:TRUSTEE HOURS:59 |
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